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(Circulation. 2002;105:2701.)
© 2002 American Heart Association, Inc.

Editorial

Evolution of the Study of Left Ventricular Function

Everything Old Is New Again

Blase A. Carabello, MD

From the Department of Medicine, Baylor College of Medicine, and Houston Veterans Affairs Medical Center, Houston, Tex.

Correspondence to Blase A. Carabello, MD, 2002 Holcombe Blvd (111 MCL), Houston, Texas 77030. E-mail BlaseAnthony.Carabello@med.va.gov

Key Words: Editorials • ventricles • imaging • myocardial contraction

The science of cardiology has evolved parallel to most medical sciences, first emphasizing anatomy, then physiology, and now molecular biology. In the 1960s, when it had become obvious that effective medical and surgical therapies were available for cardiac diseases, there developed a heightened interest in measuring cardiac function as a way of evaluating the heart’s response to those therapies. Because the heart is a muscle, it was logical that measurements of muscle function would be prognostic indicators of the success or failure of a given therapy.

See Circulation. 2002;105:1602–1608

The cardiac muscle translates force into motion, generating cardiac output that is the product of heart rate and stroke volume. Stroke volume is dependent upon contractility (the innate ability of the muscle to generate force), preload, and afterload. Because contractility is the fundamental ability of the heart muscle to do its job, this property generated the greatest focus for measurement. The ideal measure of contractility would have the characteristics listed in Table 1. Unfortunately, despite literally hundreds of investigations, this ideal measure was never developed. Each index of function went through a typical evolution of discovery, enthusiasm, concern for imperfections, and eventual abandonment. The strengths and weaknesses of many of the indexes are listed in Table 2.^1–20 The result has been that ejection fraction was chosen by the cardiology community at large and remains the index overwhelmingly used to assess cardiac function in both clinical and experimental studies. The success and persistence of ejection fraction as the premiere . . . [Full Text of this Article]

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