This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Brown, K. A. Articles by Ditchey, R. V. Search for Related Content PubMed PubMed Citation Articles by Brown, K. A. Articles by Ditchey, R. V.

Circulation, Vol 78, 81-91, Copyright © 1988 by American Heart Association

ARTICLES

Human right ventricular end-systolic pressure-volume relation defined by maximal elastance

KA Brown and RV Ditchey
Cardiology Unit, University of Vermont College of Medicine, Burlington.

This study was undertaken to determine 1) whether a combined radionuclide-hemodynamic technique could define the right ventricular end-systolic pressure-volume relation (RV ESPVR) in the clinical setting, 2) whether the human RV ESPVR defined by maximal elastance is linear and responsive to inotropic interventions, and 3) whether more easily measured modifications of the ESPVR are reliable substitutes as an index of RV function. Eight patients with normal RV function were studied with simultaneous micromanometer RV pressure measurements and radionuclide ventriculography to construct RV pressure-volume loops. Data were collected at baseline and after at least two alterations in loading conditions with nitroglycerin, phenylephrine, or saline. End systole was defined by maximal elastance (E(t) = P(t)/[V(t) - V0]). Data were also obtained during administration of dobutamine in four patients and after atrial pacing tachycardia in one patient. The RV ESPVR defined by maximal elastance was highly linear (r = 0.988-0.999) throughout the range of pressures and volumes tested. Furthermore, the linear correlations were significantly higher (p less than 0.005), and the linear regression standard error of the estimate (SEE) was significantly lower (p less than 0.005) for the RV ESPVR defined by maximal elastance compared with modifications of the ESPVR with the ratio of pulmonary artery-dicrotic notch pressure or RV peak pressure to end-ejection volume. Dobutamine or atrial pacing tachycardia produced a leftward shift of the entire RV pressure-volume loop, and in each patient (five of five), the point of maximal elastance fell outside the 95% confidence interval defined by the baseline ESPVR. However, because of the larger SEE, the leftward shift with modifications of the ESPVR was not statistically significant in any patient by the pulmonary artery-dicrotic notch pressure: end-ejection volume ratio and was significant in only one of five patients by the RV peak pressure: end-ejection volume ratio (p less than 0.03). Therefore, it appears that the steady-state RV ESPVR defined by maximal elastance in patients with normal RV function is responsive to alterations in inotropic state and is more sensitive to alterations in RV function than the frequently used, more easily measured modifications of the RV ESPVR.

This article has been cited by other articles:

				F. Haddad, P. Couture, C. Tousignant, and A. Y. Denault The Right Ventricle in Cardiac Surgery, a Perioperative Perspective: I. Anatomy, Physiology, and Assessment Anesth. Analg., February 1, 2009; 108(2): 407 - 421. [Abstract] [Full Text] [PDF]

				F. Haddad, S. A. Hunt, D. N. Rosenthal, and D. J. Murphy Right Ventricular Function in Cardiovascular Disease, Part I: Anatomy, Physiology, Aging, and Functional Assessment of the Right Ventricle Circulation, March 18, 2008; 117(11): 1436 - 1448. [Full Text] [PDF]

				K. van Heusden, J. Gisolf, W. J. Stok, S. Dijkstra, and J. M. Karemaker Mathematical modeling of gravitational effects on the circulation: importance of the time course of venous pooling and blood volume changes in the lungs Am J Physiol Heart Circ Physiol, November 1, 2006; 291(5): H2152 - H2165. [Abstract] [Full Text] [PDF]

				Y. Ochiai, S. Morita, Y. Tanoue, Y. Kawachi, R. Tominaga, and H. Yasui Use of transesophageal echocardiography for postoperative evaluation of right ventricular function Ann. Thorac. Surg., January 1, 1999; 67(1): 146 - 152. [Abstract] [Full Text] [PDF]

				C. I. Brookes, P. A. White, A. J. Bishop, P. J. Oldershaw, A. N. Redington, and N. E. Moat Validation of a new intraoperative technique to evaluateload-independent indices of right ventricular performance in patients undergoingcardiac operations J. Thorac. Cardiovasc. Surg., September 1, 1998; 116(3): 468 - 472. [Abstract] [Full Text]

				Y. Ochiai, S. Morita, Y. Tanoue, Y. Kawachi, R. Tominaga, and H. Yasui Effects of amrinone, a phosphodiesterase inhibitor, on right ventricular/arterial coupling immediately after cardiac operations J. Thorac. Cardiovasc. Surg., July 1, 1998; 116(1): 139 - 147. [Abstract] [Full Text]

				P. M. Heerdt and M. L. Dickstein Assessment of Right Ventricular Function Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 1997; 1(3): 215 - 224. [Abstract] [PDF]

				W. A. Mandarino, S. Winowich, J. Gorcsan III, T. A. Gasior, S. M. Pham, B. P. Griffith, and R. L. Kormos Right Ventricular Performance and Left Ventricular Assist Device Filling Ann. Thorac. Surg., April 1, 1997; 63(4): 1044 - 1049. [Abstract] [Full Text]

				J. Gorcsan III, S. Murali, P. J. Counihan, W. A. Mandarino, and R. L. Kormos Right Ventricular Performance and Contractile Reserve in Patients With Severe Heart Failure: Assessment by Pressure-Area Relations and Association With Outcome Circulation, December 15, 1996; 94(12): 3190 - 3197. [Abstract] [Full Text]

				M. Vogel, M. R. Schmidt, S. B. Kristiansen, M. Cheung, P. A. White, K. Sorensen, and A. N. Redington Validation of Myocardial Acceleration During Isovolumic Contraction as a Novel Noninvasive Index of Right Ventricular Contractility: Comparison With Ventricular Pressure-Volume Relations in an Animal Model Circulation, April 9, 2002; 105(14): 1693 - 1699. [Abstract] [Full Text] [PDF]