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Influence of timing of the extrasystolic beat on the extent of postextrasystolic potentiation in the intact human left ventricle

Der Einfluß der zeitlichen Lage von Extrasystolen auf die postextrasystolische Potenzierung beim linken Ventrikel des Menschen

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Summary

The analysis of the post-extrasystolic (PES) beat, which follows an at random elicited extrasystole, has been used frequently in clinical studies for the evaluation of the functional reserve of the left ventricle. Therefore, the relation between the PES potentiation and the normalized coupling interval (RR'/RR) and the normalized length of the PES pause (R'R/RR) were investigated in patients with and without coronary heart disease by means of programmed extrasystoles. The PES increase of the maximal rate of left ventricular (LV) pressure rise (max dP/dt) showed a good exponential correlation with the coupling interval in the individual patients (r=0.87–0.99) and with length of the PES pause (r=0.87–0.99), as interpolated extrasystoles were excluded. With interpolated extrasystoles the correlation between the max dP/dt-increase and the length of the PES pause became much weaker (r=0.24 resp. 0.33 in two patients). As an angiographic ejection phase parameter of LV function the ejection fraction was analyzed. The change of EF in the PES beat was completely independent (r=0.05) from the coupling interval of tje preceding extrasystole and showed an only moderate correlation to the length of the PES pause (r=0.67), which became weaker when the interpolated extrasystoles were excluded (r=0.46).

The presented data suggest that max dP/dt in the PES beat is strongly influenced by the length of the PES pause and by the coupling interval of the extrasystole. In contrast, the EF in the PES beat is not influenced by the coupling interval of the preceding extrasystole and only moderately dependent on the length of the PES pause. When the functional LV reserve is evaluated in terms of angiographic ejection phase parameters (e.g. ejection fraction), the use of PES beats following randomly occurring extrasystoles appears to be justified.

Zusammenfassung

Zur Bestimmung der funktionellen Reserve des linken Ventrikels (LV) wird unter klinischen Bedingungen die Analyse des postextrasystolischen (PES) Schlags, der einer zufällig ausgelösten Extrasystole folgt, benutzt. Wir haben deshalb die Beziehung zwischen dem Ausmaß der PES-Potenzierung und dem ng und dem normalisierten Kopplungsintervall (RR'/RR) einerseits und zum anderen die Beziehung zwischen der PES-Potenzierung und der normalisierten Länge der PES-Pause (R'R/RR) untersucht. Dazu wurden bei Patienten mit und ohne koronare Herzkrankheit programmierte Extrasystolen während Tipmanometermessungen und während LV-Angiographie ausgelöst.

Der PES-Zuwachs der maximalen LV-Druckanstiegsgeschwindigkeit (max. dP/dt) zeigte eine enge exponentielle Beziehung zum Kopplungsintervall (r=0,87–0,99) und zur Länge der PES-Pause (r=0,85–0,99) beim einzelnen Patienten, wenn interponierte Extrasystolen nicht berücksischtigt wurden. Wenn die PES-Schläge nach interponierten Extrasystolen (d. h. ohne kompensatorische Pause) mitberücksichtigt wurden, nahm die Schärfe der Beziehung zwischen dem max dP/dt-Zuwachs und der Länge der PES-Pause deutlich ab (r=0,24 bzw. 0,33 bei zwei Patienten).

Als ein Beispiel für einen Parameter der Austreibungsphase der LV-Kontraktion wurde die Austreibungsfraktion (EF) untersucht. Die EF-Veränderung im PES-Schlag zeigte keinen Zusammenhang mit dem Kopplungsintervall der vorausgegangenen Extrasystole (r=0,05), und zeigte eine nur mäßig stark ausgeprägte Beziehung zur Länge der PES-Pause (r=0,67), die noch schwächer wurde, wenn die PES-Schläge nach interponierten Extrasystolen ausgeschlossen wurden (r=0,45).

Nach diesen Ergebnissen wird max. dP/dt im PES-Schlag sowohl vom Kopplungsintervall der vorangegangenen Extrasystole als auch von der Länge der PES-Pause stark beeinflußt. Im Gegensatz dazu ist die EF nicht abhängig vom Kopplungsintervall der Extrasystole und nur mäßig abhängig von der Länge der PES-Pause. Wenn die funktionelle LV-Reserve mit Parametern der Austreibungsphase, z. B. mit der EF, beurteilt wird, erscheint die Analyse von PES-Schlägen nach nichtprogrammierten Extrasystolen zulässig.

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References

  1. Cohn, P. F., R. Gorlin, J. J. Collins Jr., L. Cohn The left ventricular ejection fraction as a prognostic guide in the surgical treatment of coronary and valvular heart disease. Amer. J. Cardiol.34, 136 (1974).

    PubMed  Google Scholar 

  2. Cohn, P. F., R. Gorlin, M. V. Herman, E. H. Sonnenblick, H. R. Horn, L. H. Cohn, J. J. Collins Jr.: Relation between contractile reserve and prognosis in patients with coronary artery disease and a depressed ejection fraction. Circulation51, 414–420.

  3. Nelson, G. R., P. F. Cohn, R. Gorlin: Prognosis in medically treated coronary artery disease. Influence of ejection fraction compared to other parameters. Circulation22, 408–412 (1975).

    Google Scholar 

  4. Dyke, S. H., P. F. Cohn, R. Gorlin, E. H. Sonnenblick: Detection of residual myocardial function in coronary artery disease using post-extrasystolic potentiation. Circulation50, 694 (1974).

    PubMed  Google Scholar 

  5. Dyke, S. H., C. W. Urschel, E. H. Sonnenblick, R. Gorlin, P. F. Cohn: Detection of latent function of acutely ischemic myocardium in the dog: Comparison of pharmacologic inotropic stimulation and post-extrasystolic potentiation. Circulat. Res.36, 490 (1975).

    PubMed  Google Scholar 

  6. Hamby, R. I., A. Aintablian, G. Wisoff, M. L. Hartstein: Response of the left ventricle in coronary artery disease to post-extrasystolic potentiation. Circulation51, 428 (1975).

    PubMed  Google Scholar 

  7. Klausner, S. C., R. A. Ratshin, J. V. Tyberg, K. Chatterjee, W. W. Parmley: The similarity of changes in segmental contraction patterns induced by postextrasystolic potentiation and nitroglycerin. Circulation54, 615–625 (1976).

    PubMed  Google Scholar 

  8. Helfant, R. H., R. Pine, S. G. Meister, M. S. Feldman, V. S. Banka: Nitroglycerin to unmask reversible asynergy: Correlation with post coronary bypass ventriculography. Circulation50, 108 (1974).

    PubMed  Google Scholar 

  9. Banka, V. S., M. M. Bodenheimer, R. Shah, R. H. Helfant: Intervention ventriculography: Comparative value of nitroglycerin, post-extrasystolic potentiation and nitroglycerin plus post-extrasystolic potentiation. Circulation53, 632 (1976).

    PubMed  Google Scholar 

  10. Hoffmann, B. F., E. Bindler, E. E. Suckling: Postextrasystolic potentiation of contraction in cardiac muscle. Amer. J. Physiol.185, 95 (1956).

    PubMed  Google Scholar 

  11. Blinks, J. R., J. Koch-Weser: Analysis of the effects of changes in rate and rhythm upon myocardial contractility. J. Pharmacol. Exptl Therap.134, 373 (1961).

    Google Scholar 

  12. Koch-Weser, J., J. R. Blinks: Influence of the interval between beats an myocardial contractility. Pharmacol. Rev.15, 601 (1963).

    PubMed  Google Scholar 

  13. Hoffmann, B. F., H. J. Bartelstone, B. J. Scherlag, P. F. Cranefield: Effects of post-extrasystolic potentiation on normal and failing hearts. Bull. N. Y. Acad. Med.41, 489–534 (1965).

    Google Scholar 

  14. Conference on paired pulse stimulation and post-extrasystolic potentiation in the heart. Bull. N. Y. Acad. Med. 41, 415, 473 (1965).

  15. Greene, D. G., R. Carlisle, C. Grant, I. L. Bunnel: Estimation of leftventricular volume by one plane cineangiography. Circulation35, 61 (1967).

    PubMed  Google Scholar 

  16. Vine, D. L., T. D. Hegg, H. T. Dodge, D. K. Stewart, M. Frimmer: Immediate effect of contrast medium injection on left ventricular volumes and ejection fraction: A study using metallic epicardial markers. Circulation56, 379–385 (1978).

    Google Scholar 

  17. Mahler, F., J. Ross Jr., R. A. O'Rourke, J. W. Covell: Effects of changes in preload, afterload and inotropic state on ejection and isovolumic phase measures of contractility in the conscious dog. Amer. J. Card.35, 626–634 (1975).

    Google Scholar 

  18. Jewell, B. R.: A reexamination of the influence of muscle length on myocardial performance. Circulat. Res.,40, 221–231 (1977).

    PubMed  Google Scholar 

  19. Lakatta, F. G., B. R. Jewell: Length-dependent activation: Its effect on the length-tension relation in cat papillary muscle. Circulat. Res.40, 251–258 (1977).

    PubMed  Google Scholar 

  20. Mason, D. T. Usefulness and limitations of the rate of rise of intraventricular pressure (dP/dt) in the evaluation of myocardial contractility in man. Amer J. Cardiol.23, 516–527 (1969).

    PubMed  Google Scholar 

  21. Noble, M. I. M., J. Wyler, E. N. C. Milne, D. Trenchard, A. Guz: Effect of changes in heart rate on left ventricular performance in conscious dog. Circulat. Res.24, 285–295 (1969).

    PubMed  Google Scholar 

  22. Anderson, P. A. W., J. S. Rankin, C. E. Arentzen, R. W. Anderson, E. A. Johnson: Evaluation of the force-frequency relationship as a descriptor of the inotropic state of canine left ventricular myocardium. Circulat. Res.39, 832–840 (1976).

    PubMed  Google Scholar 

  23. Arentzen, C. E., J. S. Rankin, P. A. W. Anderson, M. D. Feezor, R. W. Anderson: Force-frequency characteristics of the left ventricle in the conscious dog. Circulat. Res.42, 65–71 (1978).

    Google Scholar 

  24. Grossman, W., F. Haynes, J. A. Paraskos, S. Saltz, J. E. Dalen, L. Dexter: Alterations in preload and myocardial mechanics in the dog and man. Circulat. Res.31, 83–94 (1972).

    PubMed  Google Scholar 

  25. Meijler, F. L., J. Strackee, F. J. L. v. Capelle, J. C. du Perron: Computer analysis of the RR-interval-contractility-relationship during random stimulation of the isolated heart. Circulat. Res.22, 695–702 (1968).

    PubMed  Google Scholar 

  26. Markis, J. E., P. F. Cohn, B. H. Roberts et al: Effect of varying the coupling interval on postextrasystolic potentiation (abstr). Clin. Res.24, 229 (1976).

    Google Scholar 

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Author notes

  1. H. C. Mehmel

    Present address: Department of Internal Medicine III (Cardiology), Medical University Clinic, Bergheimer Straße 58, D-6900, Heidelberg 1

Authors and Affiliations

  1. Department of Internal Medicine III (Cardiology), Medical University Clinic, Bergheimer Straße 58, D-6900, Heidelberg 1

    H. Katus, K. v. Olshausen, B. Stockins & W. Kübler

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With 8 figures

und mit freundlicher Unterstützung der Deutschen Forschungsgemeinschaft, Sonderforschungsbereich 90.

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Katus, H., Mehmel, H.C., v. Olshausen, K. et al. Influence of timing of the extrasystolic beat on the extent of postextrasystolic potentiation in the intact human left ventricle. Basic Res Cardiol 75, 657–667 (1980). https://doi.org/10.1007/BF01907695

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