Circulation, Vol 76, 1422-1436, Copyright © 1987 by American Heart Association
DA Kass, WL Maughan, ZM Guo, A Kono, K Sunagawa and K Sagawa
We examined the quantitative influence of carefully controlled alterations
in end-diastolic volume and afterload resistance on multiple simultaneously
determined ejection and isovolumetric phase indexes of left ventricular
contractile function in 23 isolated supported canine ventricles. The
influence of load change on each index was compared with its sensitivity to
inotropic stimulation, and this sensitivity was in turn contrasted to the
response of the end-systolic pressure-volume relationship (ESPVR).
Experimental data demonstrated various degrees of load sensitivity among
the indexes, with a generally curvilinear relationship between load and
index response for both preload and afterload alterations. The curvilinear
nature of these relationships meant that over a select range of loading,
many indexes demonstrated relative load independence. They also often
displayed greater sensitivity to inotropic change than the ESPVR, and both
factors help explain their enduring clinical utility. To further explore
the influence of load and contractile state on several of the indexes, we
developed a theoretical analysis, using variables common to pressure-volume
relationships, in which these dependencies could be derived. The
theoretical models fit very well with the experimental data, and reaffirmed
the frequently curvilinear nature of the relationships. We conclude that
while many clinical indexes of ventricular contractile function show
significant load dependence, the information they provide can be reasonably
interpreted within defined ranges of load and inotropic alteration. Any
advantage of the ESPVR will derive not from the magnitude of its response
to inotropic change, which is smaller than most other indexes, but from its
relative insensitivity to load alteration over a wider range of load.
ARTICLES
Comparative influence of load versus inotropic states on indexes of ventricular contractility: experimental and theoretical analysis based on pressure-volume relationships [published erratum appears in Circulation 1988 Mar;77(3):559]
Johns Hopkins Medical Institutions, Department of Medicine, Baltimore, MD.
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