Circulation, Vol 86, 513-521, Copyright © 1992 by American Heart Association
RP Kelly, CT Ting, TM Yang, CP Liu, WL Maughan, MS Chang and DA Kass
BACKGROUND. This study tested whether the simple ratio of ventricular
end-systolic pressure to stroke volume, known as the effective arterial
elastance (Ea), provides a valid measure of arterial load in humans with
normal and aged hypertensive vasculatures. METHODS AND RESULTS. Ventricular
pressure-volume and invasive aortic pressure and flow were simultaneously
determined in 10 subjects (four young normotensive and six older
hypertensive). Measurements were obtained at rest, during mechanically
reduced preload, and after pharmacological interventions. Two measures of
arterial load were compared: One was derived from aortic input impedance
and arterial compliance data using an algebraic expression based on a
three-element Windkessel model of the arterial system [Ea(Z)], and the
other was more simply measured as the ratio of ventricular end-systolic
pressure to stroke volume [Ea(PV)]. Although derived from completely
different data sources and despite the simplifying assumptions of Ea(PV),
both Ea(Z) and Ea(PV) were virtually identical over a broad range of
altered conditions: Ea(PV) = 0.97.Ea(Z) + 0.17; n = 33, r2 = 0.98, SEE =
0.09, p less than 0.0001. Whereas Ea(PV) also correlated with mean arterial
resistance, it exceeded resistance by as much as 25% in older hypertensive
subjects (because of reduced compliance and wave reflections), which better
indexed the arterial load effects on the ventricle. Simple methods to
estimate Ea (PV) from routine arterial pressures were tested and validated.
CONCLUSIONS. Ea(PV) provides a convenient, useful method to assess arterial
load and its impact on the human ventricle. These results highlight effects
of increased pulsatile load caused by aging or hypertension on the
pressure-volume loop and indicate that this load and its effects on cardiac
performance are often underestimated by mean arterial resistance but are
better accounted for by Ea.
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Effective arterial elastance as index of arterial vascular load in humans
Department of Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, MD 21205.
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T. P. Cappola, D. A. Kass, G. S. Nelson, R. D. Berger, G. O. Rosas, Z. A. Kobeissi, E. Marban, and J. M. Hare Allopurinol Improves Myocardial Efficiency in Patients With Idiopathic Dilated Cardiomyopathy Circulation, November 13, 2001; 104(20): 2407 - 2411. [Abstract] [Full Text] [PDF]
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I. S. Wittstein, D. A. Kass, P. H. Pak, W. L. Maughan, B. Fetics, and J. M. Hare Cardiac nitric oxide production due to angiotensin-converting enzyme inhibition decreases beta-adrenergic myocardial contractility in patients with dilated cardiomyopathy J. Am. Coll. Cardiol., August 1, 2001; 38(2): 429 - 435. [Abstract] [Full Text] [PDF]
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C. S Hayward, W. V Kalnins, and R. P Kelly Gender-related differences in left ventricular chamber function Cardiovasc Res, February 1, 2001; 49(2): 340 - 350. [Abstract] [Full Text] [PDF]
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P. V. Vaitkevicius, M. Lane, H. Spurgeon, D. K. Ingram, G. S. Roth, J. J. Egan, S. Vasan, D. R. Wagle, P. Ulrich, M. Brines, et al. A cross-link breaker has sustained effects on arterial and ventricular properties in older rhesus monkeys PNAS, January 30, 2001; 98(3): 1171 - 1175. [Abstract] [Full Text] [PDF]
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R. J. Spina, S. Rashid, V. G. Davila-Roman, and A. A. Ehsani Adaptations in beta -adrenergic cardiovascular responses to training in older women J Appl Physiol, December 1, 2000; 89(6): 2300 - 2305. [Abstract] [Full Text] [PDF]
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P. Segers, N. Stergiopulos, and N. Westerhof Quantification of the Contribution of Cardiac and Arterial Remodeling to Hypertension Hypertension, November 1, 2000; 36(5): 760 - 765. [Abstract] [Full Text] [PDF]
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A J BISHOP Improving ventricular systolic function: simple messages from complex models Heart, June 1, 2000; 83(6): 614 - 614. [Full Text]
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O. E. Suman, D. Hasten, M. J. Turner, M. R. Rinder, R. J. Spina, and A. A. Ehsani Enhanced inotropic response to dobutamine in strength-trained subjects with left ventricular hypertrophy J Appl Physiol, February 1, 2000; 88(2): 534 - 539. [Abstract] [Full Text] [PDF]
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A. Nussbacher, G. Gerstenblith, F. C. O'connor, L. C. Becker, D. A. Kass, S. P. Schulman, J. L. Fleg, and E. G. Lakatta Hemodynamic effects of unloading the old heart Am J Physiol Heart Circ Physiol, November 1, 1999; 277(5): H1863 - H1871. [Abstract] [Full Text] [PDF]
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U. E. G. Ekelund, R. W. Harrison, O. Shokek, R. N. Thakkar, R. S. Tunin, H. Senzaki, D. A. Kass, E. Marban, and J. M. Hare Intravenous Allopurinol Decreases Myocardial Oxygen Consumption and Increases Mechanical Efficiency in Dogs With Pacing-Induced Heart Failure Circ. Res., September 3, 1999; 85(5): 437 - 445. [Abstract] [Full Text] [PDF]
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S. Soderstrom, J. Sellgren, and J. Ponten Aortic and Radial Pulse Contour: Different Effects of Nitroglycerin and Prostacyclin Anesth. Analg., September 1, 1999; 89(3): 566 - 566. [Abstract] [Full Text] [PDF]
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C.-H. Chen, M. Nakayama, M. Talbot, E. Nevo, B. Fetics, G. Gerstenblith, L. C. Becker, and D. A. Kass Verapamil acutely reduces ventricular-vascular stiffening and improves aerobic exercise performance in elderly individuals J. Am. Coll. Cardiol., May 1, 1999; 33(6): 1602 - 1609. [Abstract] [Full Text] [PDF]
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W. H. Devlin, J. Petrusha, K. Briesmiester, D. Montgomery, and M. R. Starling Impact of Vascular Adaptation to Chronic Aortic Regurgitation on Left Ventricular Performance Circulation, March 2, 1999; 99(8): 1027 - 1033. [Abstract] [Full Text] [PDF]
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C.-H. Chen, M. Nakayama, E. Nevo, B. J. Fetics, W. L. Maughan, and D. A. Kass Coupled systolic-ventricular and vascular stiffening with age: Implications for pressure regulation and cardiac reserve in the elderly J. Am. Coll. Cardiol., November 1, 1998; 32(5): 1221 - 1227. [Abstract] [Full Text] [PDF]
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A. DeAnda Jr., M. Komeda, M. R. Moon, G. R. Green, A. F. Bolger, S. D. Nikolic, G. T. Daughters II, and D. C. Miller Estimation of regional left ventricular wall stresses in intact canine hearts Am J Physiol Heart Circ Physiol, November 1, 1998; 275(5): H1879 - H1885. [Abstract] [Full Text] [PDF]
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C.-H. Chen, C.-T. Ting, S.-J. Lin, T.-L. Hsu, S.-J. Ho, P. Chou, M.-S. Chang, F. O'Connor, H. Spurgeon, E. Lakatta, et al. Which Arterial and Cardiac Parameters Best Predict Left Ventricular Mass? Circulation, August 4, 1998; 98(5): 422 - 428. [Abstract] [Full Text] [PDF]
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D. Georgakopoulos, W. A. Mitzner, C.-H. Chen, B. J. Byrne, H. D. Millar, J. M. Hare, and D. A. Kass In vivo murine left ventricular pressure-volume relations by miniaturized conductance micromanometry Am J Physiol Heart Circ Physiol, April 1, 1998; 274(4): H1416 - H1422. [Abstract] [Full Text] [PDF]
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P. Colin, M. Slama, A. Vahanian, Y. Lecarpentier, G. Motte, and D. Chemla Hemodynamic correlates of effective arterial elastance in mitral stenosis before and after balloon valvotomy J Appl Physiol, October 1, 1997; 83(4): 1083 - 1089. [Abstract] [Full Text] [PDF]
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C.-H. Chen, E. Nevo, B. Fetics, P. H. Pak, F. C.P. Yin, W. L. Maughan, and D. A. Kass Estimation of Central Aortic Pressure Waveform by Mathematical Transformation of Radial Tonometry Pressure : Validation of Generalized Transfer Function Circulation, April 1, 1997; 95(7): 1827 - 1836. [Abstract] [Full Text]
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M. R. Moon, A. F. Bolger, A. DeAnda, M. Komeda, G. T. Daughters II, S. D. Nikolic, D. C. Miller, and N. B. Ingels Septal Function During Left Ventricular Unloading Circulation, March 4, 1997; 95(5): 1320 - 1327. [Abstract] [Full Text]
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L. C. Becker, C. J. Pepine, R. Bonsall, J. D. Cohen, A. D. Goldberg, C. Coghlan, P. H. Stone, S. Forman, G. Knatterud, D. S. Sheps, et al. Left Ventricular, Peripheral Vascular, and Neurohumoral Responses to Mental Stress in Normal Middle-Aged Men and Women: Reference Group for the Psychophysiological Investigations of Myocardial Ischemia (PIMI) Study Circulation, December 1, 1996; 94(11): 2768 - 2777. [Abstract] [Full Text]
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H. Senzaki, C.-H. Chen, and D. A. Kass Single-Beat Estimation of End-Systolic Pressure-Volume Relation in Humans: A New Method With the Potential for Noninvasive Application Circulation, November 15, 1996; 94(10): 2497 - 2506. [Abstract] [Full Text]
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M. D. Feldman, P. H. Pak, C. C. Wu, H. L. Haber, C. M. Heesch, J. D. Bergin, E. R. Powers, T. D. Cowart, W. Johnson, A. M. Feldman, et al. Acute Cardiovascular Effects of OPC-18790 in Patients With Congestive Heart Failure : Time- and Dose-Dependence Analysis Based on Pressure-Volume Relations Circulation, February 1, 1996; 93(3): 474 - 483. [Abstract] [Full Text]
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A. Nussbacher, S. Arie, R. Kalil, P. Horta, M. D. Feldman, G. Bellotti, F. Pileggi, M. Ellis, W. H. Johnson, G. B. Camarano, et al. Mechanism of Adenosine-Induced Elevation of Pulmonary Capillary Wedge Pressure in Humans Circulation, August 1, 1995; 92(3): 371 - 379. [Abstract] [Full Text]
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P. Segers, N. Stergiopulos, and N. Westerhof Relation of effective arterial elastance to arterial system properties Am J Physiol Heart Circ Physiol, March 1, 2002; 282(3): H1041 - H1046. [Abstract] [Full Text] [PDF]
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