Circulation, Vol 87, 59-69, Copyright © 1993 by American Heart Association
H Takaoka, M Takeuchi, M Odake, Y Hayashi, K Hata, M Mori and M Yokoyama
BACKGROUND. Recently, several indexes such as tension-time index (TTI),
tension-time or force-time integral (FTI), rate-pressure product (RPP),
pressure-work index (PWI), and systolic pressure-volume area (PVA) have
been developed as predictors of myocardial oxygen consumption in
experimental and clinical studies. However, it is still unclear whether
these indexes are reliable predictors of myocardial oxygen consumption
under various contractile states in human hearts. METHODS AND RESULTS. We
assessed the relation between TTI, FTI, RPP, PWI, and PVA and myocardial
oxygen consumption per beat (VO2) in 13 patients with heart disease during
volume loading. Left ventricular (LV) volume and pressure were measured
simultaneously by the conductance catheter with the tipped micromanometer
technique. VO2 was calculated from arterial coronary sinus oxygen content
difference, and coronary sinus blood flow was measured by the
thermodilution method. After z transformation of the correlation
coefficients, mean z value for the VO2-PVA relation (1.83 +/- 0.60) was
greater than those for the VO2-TTI relation (1.22 +/- 0.66; p < 0.005),
VO2-FTI relation (1.18 +/- 0.61; p < 0.05), VO2- RPP relation (0.95 +/-
0.65; p < 0.05), and VO2-PWI relation (1.24 +/- 0.58; p < 0.05).
During dobutamine infusion (5 micrograms.kg-1.min-1) in five of the 13
patients, VO2 also correlated best with PVA (z = 1.70 +/- 0.89) compared
with TTI (z = 1.43 +/- 0.86), FTI (z = 1.48 +/- 0.95), RPP (z = 1.00 +/-
0.53), and PWI (z = 0.88 +/- 0.80). The contractile efficiency (38 +/- 14%
to 38 +/- 20%), the reciprocal of the slope of the VO2-PVA relation,
remained unchanged, whereas the VO2,PVA 0.8 (VO2 at PVA = 0.8 J per
beat/100 g LV) increased from 1.48 +/- 1.16 to 2.06 +/- 1.13 J per beat/100
g LV (p < 0.05). These results show the parallel upward shift of the
VO2-PVA relation during dobutamine infusion. Because increases in the
VO2-intercept represent the VO2 for the increased excitation-contraction
(E-C) coupling associated with the augmented contractile state, the
parallelism of the VO2-PVA relation could discriminate between VO2 for
mechanical work (PVA-dependent VO2) and VO2 for E-C coupling
(PVA-independent VO2). CONCLUSIONS. The results of the present study
indicate that PVA is a reliable and valuable predictor of myocardial oxygen
consumption under different contractile states in human hearts. The VO2-PVA
relation could provide useful information about mechanoenergetics in
diseased human hearts.
ARTICLES
Comparison of hemodynamic determinants for myocardial oxygen consumption under different contractile states in human ventricle
First Department of Medicine, Kobe University School of Medicine, Japan.
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