EVALUATION OF CONTRACTILE STATE BY MAXIMAL VENTRICULAR POWER DIVIDED BY THE SQUARE OF END-DIASTOLIC VOLUME

Article

关键词: SYSTOLIC PRESSURE-VOLUME;    CANINE LEFT-VENTRICLE;    CONDUCTANCE CATHETER;    CONSCIOUS DOGS;    STROKE WORK;    PERFORMANCE;    EJECTION;    IMPEDANCE;    HEART;   

DOI  :  10.1161/01.CIR.84.4.1698

来源: SCIE

【 摘 要 】

Background. Maximal ventricular power (PWR(max)) 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 intraortic balloon inflation. Inotropic state was pharmacologically altered by lidocaine, dobutamine, propranolol, or verapamil. PWR(max) 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 PWR(max) by EDV but was virtually eliminated when PWR(max) was divided by EDV2. This latter index also displayed little change in response to as much as 60% increases in afterload resistance. PWR(max)/EDV2 varied directly with inotropic state, correlating to both the slope (E(es)) of the end-systolic pressure-volume relation (PWR(max).1,000/EDV2 = 0.31 . E(es)-0.04, r = 0.82, p < 0.001) and the slope (A) of the dP/dt(max)-EDV relation (PWR(max).1,000/EDV2 = 0.025.A + 0.02, r = 0.86, p < 0.001). PWR(max) 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 PWR(max) may be noninvasively assessed (i.e., without requiring left ventricular chamber pressure). Conclusions. PWR(max) divided by EDV2 provides a measure of contractile function that is little influenced by loading conditions and has potential for noninvasive clinical use.

【 授权许可】

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