Circulation, Vol 90, 2481-2491, Copyright © 1994 by American Heart Association
AF Leite-Moreira and TC Gillebert
BACKGROUND--Effects of systolic left ventricular pressure (LVP) on rates of
pressure fall remain incompletely understood. This study analyzed
phase-plane dP/dt versus LVP plots to differentiate between accelerating
and decelerating effects and to investigate the variability in reported
load effects on rates of LVP fall. METHODS AND RESULTS--Abrupt aortic
occlusions were performed by inflating a balloon positioned in the
ascending aorta of anesthetized open-chest dogs (n = 17). The occlusions
resulted in clamp elevations of systolic LVP. In protocol A, the elevations
of systolic LVP induced by total aortic occlusions were timed at early,
mid, and late ejection. The magnitude of the elevations was 36.0 +/- 3.6 mm
Hg for early, 11.6 +/- 0.6 mm Hg for mid, and negligible for late
occlusions. The course of LVP fall appeared to be more complex than
previously appreciated. Pressure fall might be subdivided in an initial
accelerative phase, an intermediate decelerative phase, and a terminal
decelerative phase. The initial phase accelerated with mid and late
occlusions. The intermediate phase slowed down with early and to a lesser
extent with mid occlusions. The terminal phase was never affected by aortic
clamp occlusions. In protocol B, early elevations of systolic LVP were
obtained with multiple graded aortic occlusions. The effects of matched LVP
elevations of 12 mm Hg on rate of LVP fall were evaluated with the time
constant of LVP fall (tau) and showed an interanimal variability ranging
from acceleration and a 20% decrease in tau to deceleration and a 35%
increase in tau. Changes in tau were moderately correlated with commonly
used indexes of contractility (peak +dP/dt, r = -.78; regional fractional
shortening, r = -.63). These changes in tau showed a close correlation with
the systolic LVP of the test beat, expressed as a percentage of the peak
isovolumetric LVP, obtained with total aortic occlusion (r = .984). This
suggested that the contraction-relaxation coupling should be analyzed in
terms of peak force development rather than contraction velocity or
ejection fraction. CONCLUSIONS--LVP fall could be subdivided into an
initial accelerative phase, an intermediate decelerative phase, and a
terminal decelerative phase. Effects of elevations in systolic LVP on rate
of LVP fall could be predicted by knowing peak isovolumetric LVP.
Nonuniformity of LVP fall and adequate interpretation of load effects
should be taken into account when clinical situations or pharmacological
interventions are considered. In congestive heart failure, slow LVP fall
could mainly reflect working conditions close to isovolumetric rather than
relaxation disturbances.
ARTICLES
Nonuniform course of left ventricular pressure fall and its regulation by load and contractile state
Department of Physiology and Medicine, University of Antwerp, Belgium.
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