Circulation, Vol 84, 1698-1708, Copyright © 1991 by American Heart Association
DA Kass and R Beyar
BACKGROUND. Maximal ventricular power (PWRmax) reflects contractile state
and has the potential to be noninvasively determined. However, its
sensitivities to preload, afterload resistance, and inotropic state are
incompletely defined. The present study determines these dependencies and
proposes a novel power-based contractile index that is little altered by
load. METHODS AND RESULTS. Seven open-chest, autonomically blocked dogs
were instrumented with a proximal aortic flow probe, central aortic and
ventricular micromanometers, and a conductance catheter for ventricular
chamber volume. Preload was transiently reduced by left atrial hemorrhage,
and afterload was increased by intra-aortic balloon inflation. Inotropic
state was pharmacologically altered by lidocaine, dobutamine, propranolol,
or verapamil. PWRmax was highly preload sensitive, altering 1.7 +/- 0.1-
fold a given percent change in end-diastolic volume (EDV). This preload
dependence was reduced by dividing PWRmax by EDV but was virtually
eliminated when PWRmax was divided by EDV2. This latter index also
displayed little change in response to as much as 60% increases in
afterload resistance. PWRmax/EDV2 varied directly with inotropic state,
correlating to both the slope (Ees) of the end-systolic pressure-volume
relation (PWRmax x 1,000/EDV2 = 0.31 x Ees - 0.04, r = 0.82, p less than
0.001) and the slope (A) of the dP/dtmax-EDV relation (PWRmax x 1,000/EDV2
= 0.025 x A + 0.02, r = 0.86, p less than 0.001). PWRmax values determined
from the product of ventricular pressure and flow versus central aortic
pressure and flow were nearly identical over a broad loading range,
indicating that PWRmax may be noninvasively assessed (i.e., without
requiring left ventricular chamber pressure). CONCLUSIONS. PWRmax divided
by EDV2 provides a measure of contractile function that is little
influenced by loading conditions and has potential for noninvasive clinical
use.
ARTICLES
Evaluation of contractile state by maximal ventricular power divided by the square of end-diastolic volume
Department of Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, MD 21205.
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