Circulation, Vol 82, 1352-1361, Copyright © 1990 by American Heart Association
K Nakano, M Sugawara, K Ishihara, S Kanazawa, WJ Corin, S Denslow, RW Biederman and BA Carabello
The slope of the end-systolic pressure-volume relation (ESPVR) is useful in
assessing acute changes in contractile state. However, a limitation of
ESPVR is that its slope decreases progressively as ventricular size
increases without this change necessarily indicating a change in
contractile state. In this respect, an index of contractile function that
is independent of ventricular size would have an obvious advantage. The
exponential constant (k) of the end-systolic relation between wall stress
(sigma) and the natural logarithm of the reciprocal of wall thickness
[ln(1/H)], sigma = Cekln(1/H), corresponds to the stiffness constant of the
myocardium (kSM), a contractile index that should be independent of
ventricular size and geometry. To examine the size independence of kSM, we
studied left ventricular kSM during beta- blockade (to stabilize inotropic
state) in 25 normal dogs with greatly differing ventricular sizes whose
end-diastolic volumes ranged from 14 to 82 ml. The kSM was nearly constant
(3.6 +/- 0.4) over this wide range of end-diastolic volumes and thus was
independent of end- diastolic volume. Conversely, ESPVR, also obtained
during beta- blockade, was closely and negatively correlated to
end-diastolic volume (r = 0.92). To test the ability of kSM to measure
changes in contractile state, we altered contractile state
pharmacologically. The kSM increased from 3.7 +/- 0.5 to 4.8 +/- 0.8 (p
less than 0.01) with infusion of dobutamine (after reversal of
beta-blockade) and decreased to 3.1 +/- 0.3 (p less than 0.05) with
inhalation of isoflurane, a negative inotrope, during beta-blockade (p less
than 0.05). We conclude that kSM is independent of ventricular size and is
sensitive to changes in inotropic state. As such, it should be useful as an
index of contractile function.
ARTICLES
Myocardial stiffness derived from end-systolic wall stress and logarithm of reciprocal of wall thickness. Contractility index independent of ventricular size
Division of Cardiology, Medical University of South Carolina, Charleston 29425.
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