Circulation, Vol 79, 167-178, Copyright © 1989 by American Heart Association
DA Kass, R Beyar, E Lankford, M Heard, WL Maughan and K Sagawa
Although in situ end-systolic pressure-volume relations (ESPVRs) are
approximately linear throughout a limited load range, they often yield
seemingly "negative" volume axis intercepts (V0) and V0 shifts with
inotropic interventions. We tested whether or not these findings could stem
from in situ ESPVR nonlinearity, and we examined the physiologic meaning
and limitations of linearized ESPVR variables frequently used for assessing
contractile state. Continuous left ventricular pressures and volumes were
obtained by micromanometer and conductance (volume) catheters in six
open-chest dogs. Left ventricular loading was varied throughout a wide
range by rapid left atrial hemorrhage into a reservoir. Propranolol and
verapamil were administered to reduce inotropic state, with heart rate
maintained by atrioventricular sequential pacing. ESPVRs were fit to
nonlinear [Pes = a(Ves-V'0)2 + b(Ves-V'0)] and linear (Pes = Ees (Ves-V0)]
models. Contractile state was assessed by the slope of the ESPVR at V'0 (b,
of nonlinear model) and by two other ESPVR model-independent measures: the
slope of the dP/dtmax and end-diastolic volume relation, and the slope of
the stroke work and end-diastolic volume relation. ESPVR was frequently
curvilinear, and a significant correlation existed between the extent of
nonlinearity (a) and contractile state. Volume intercepts derived from
linear fits to the high load ESPVR range were mostly negative and were
dependent on changes in Ees. V0 estimates derived from the low load portion
were positive and relatively insensitive to Ees. Thus, in situ ESPVR
displays contractility-dependent curvilinearity. The contractility range
throughout which ESPVRs are essentially linear is typical for isolated
hearts, but the range represents low values for in situ ventricles. Despite
curvilinearity, Ees determined in situ throughout limited load ranges can
accurately assess inotropic state; however, comparisons between ESPVRs
should consider potential nonlinearity, and if possible, they should be
made within similar end- systolic pressure ranges.
ARTICLES
Influence of contractile state on curvilinearity of in situ end- systolic pressure-volume relations
Department of Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland.
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