Skip to main content
SpringerLink
Log in

The systolic arterial pressure/end-systolic volume relationship in patients with severe left ventricular dysfunction

  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Performance of the intact left ventricle is well-defined by the end-systolic pressure/end-systolic volume relationship that appears independent of preload and afterload. To determine whether noninvasive measurements of this relationship could distinguish normal from abnormal subjects, we evaluated the relationship between arterial systolic pressure (determined by cuff sphygnonanometry) and radionuclide estimates of end-systolic volume in 12 normal subjects and 24 patients with severe left ventricular dysfunction. Data were acquired at rest, after atropine injection, and then during at least three increments of arterial pressure (average total increase approximately 45 mm Hg) using phenylephrine.

The relationship between peak-systolic pressure (SP) and end-systolic volume (ESV) was found to be linear in all subjects (r≧0.91). The slope of this line was steeper in normal subjects than in myopathic patients (73±21.7 vs 20.8±8.7 mm Hg/volume unit/m2,P<0.001) and the zero pressure intercept also was greater (49.8±30 mm Hg vs 27.1±44.2 mm Hg,P<0.01). Similarly, resting ejection fraction (EF) was greater in the normals (0.71±0.88 vs 0.21±0.07%P<0.001) and end-diastolic volume (EDV) was smaller (4.14±0.88 vs 6.58±0.65 volume units,P<0.01).

Systolic pressure/end-systolic volume relationship determined by these noninvasive methods was linear in both patients with severely reduced cardiac function and normal control subjects, clearly distinguishing normal from severely impaired left ventricles. This noninvasively determined pressure-volume relationship may be a useful index to identify patients who may benefit from inotropic agents—to regulate their long-term inotropic therapy-and possibly to distinguish inotropic vs vasodilator effects on the heart.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Slutsky R (1981) The response of left ventricle to stress: Effects of atrial-pacing, after-load stress and drugs. Am J Cardiol 47:357–364

    Article  PubMed  CAS  Google Scholar 

  2. Slutsky R, Watkins J, Peterson K, Karliner J (1981) The response of left-ventricular function and size to atrial pacing, volume loading and afterload stress in patients with coronary-artery disease. Circulation 63:864–870

    PubMed  CAS  Google Scholar 

  3. Peterson K, Skloven D, Ludbrook P, Uther JB, Ross J Jr (1974) Comparison of isovolumetric and ejection phase indexes of myocardial performance in man. Circulation 49:1088–1101

    PubMed  CAS  Google Scholar 

  4. Suga H, Sagawa K, Shoukas AA (1982) Load independence of the instantaneous pressure-volume ratio of canine left ventricle and effects of epinephrine and heart-rate on ratio. Circ Res 32:314–322

    Google Scholar 

  5. Suga H, Sagawa K, Kostiuk D (1976) Controls of ventricular contractility assessed by the pressure-volume ratio, E max. Cardiovasc Res 10:582–592

    Article  PubMed  CAS  Google Scholar 

  6. Suga H, Sagawa K (1974) Instantaneous pressure-volume relationships and their ratio in the excised, supported canine left ventricle. Circ Res 35:117–134

    PubMed  CAS  Google Scholar 

  7. Mahler F, Covell JW, Ross J Jr (1975) Systolic pressure-diameter relations in the normal conscious dog. Cardiovasc Res 8:447–455

    Google Scholar 

  8. Sagawa K, Suga H, Shoukas AA, Bakalar KM (1977) End-systolic pressure/volume ratio: A new index of ventricular contractility. Am J Cardiol 40:748–753

    Article  PubMed  CAS  Google Scholar 

  9. Grossman W, Braunwald E, Mann T, McLaurin L, Green LH (1977) Contractile state of left-ventricle in man as evaluated from end-systolic pressure-volume relations. Circulation 56:845–852

    PubMed  CAS  Google Scholar 

  10. Marsh JD, Green LH, Wynne J, Cohn PF, Grossman WC (1979) Left ventricular end-systolic pressure-dimension and stress-length relations in normal human subjects. Am J Cardiol 44:1311–1317

    Article  PubMed  CAS  Google Scholar 

  11. Watkins J, Slutsky R, Tubau J, Karliner J (1982) Scintigraphic study of relation between left ventricular peak systolic pressure and end-systolic volume in patients with coronary artery disease and normal subjects. Br Heart J 48:39–47

    PubMed  CAS  Google Scholar 

  12. Sonnenblick E (1965) Instantaneous force-velocity-length determinants in contraction of heart muscle. Circ Res 16:441

    PubMed  CAS  Google Scholar 

  13. Paulus W, Claes VA, Brutsaert DL (1980) End-systolic pressure relation estimated from physiologically loaded cat papillary muscles contractions. Circ Res 47:20–26

    PubMed  CAS  Google Scholar 

  14. Weber KT, Janicki JS (1977) Instantaneous force-velocity-length relations in isolated dog heart. Am J Physiol 232:H241-H249

    PubMed  CAS  Google Scholar 

  15. Weber K, Janicki JS (1977) Instantaneous force-velocity-length relations: Experimental findings and clinical correlates. Am J Card 40:740–747

    Article  PubMed  CAS  Google Scholar 

  16. Osakada G, Hess OM, Gallagher KP, Lavelle JF, Ross J (1980) End-systolic wall thickness-pressure and wall thickness-stress relations for assessing myocardial contractility. Circulation [Suppl III] 62:203

    Google Scholar 

  17. Maughan W, Kallnan CH, Shoukas A (1981). The effect of right ventricular filling on the pressure volume relationship of the ejecting canine left-ventricle. Circ Res 49:382–388

    PubMed  CAS  Google Scholar 

  18. Crozatier B, Caillet D, Thuillez C, Chevrier JL, Peronneau P, Hatt PY (1981) Preload changes modify systolic pressure-diameter relations in the conscious dog. Am J Physiol 240:H354-H360

    PubMed  CAS  Google Scholar 

  19. Slutsky R, Watkins J, Costello D (1983) Radionuclide evaluation of systolic-blood pressure end-systolic volume relationship: Response to pharmacologic agents in patients with coronary-artery disease. Am Heart J 105:53–59

    Article  PubMed  CAS  Google Scholar 

  20. Smith TD, Richards P (1976). A simple kit for the preparation of99mTc-labeled red cells. J Nucl Med 17:126–132

    PubMed  CAS  Google Scholar 

  21. Pavel D, Zimmer AM, Patterson NV (1977) In vivo labelling of red blood-cells with99mTc: New approach to blood pool visualization (note). J Nucl Med 18:305–308

    PubMed  CAS  Google Scholar 

  22. Slutsky R, Pfisterer M, Verba J, Battler A, Ashburn W (1980) Influence of different background and left-ventricular assignments on the ejection fraction in radionuclide angiography equilibrium. Radiology 135:725–730

    PubMed  CAS  Google Scholar 

  23. Slutsky R, Karliner J, Ricci D, Kaiser R, Pfisterer M, Gordon D, Peterson K, Asburn W (1979) Left-ventricular volumes by gated equilibrium radionuclide angiography-new method. Circulation 60:556–564

    PubMed  CAS  Google Scholar 

  24. Slutsky R, Karliner J, Battler A, Pfisterer M, Swanson S, Ashburn W (1979) Reproducibility of ejection fraction and ventricular volume by gated radionuclide angiography after myocardial-infarction. Radiology 132:155–159

    PubMed  CAS  Google Scholar 

  25. Slutsky R, Battler A, Gerber K, Gordon D, Verba J, Peterson K, Murray JP, Asburn W (1980) A simplified method for the calculation of left-ventricular volume by equilibrium radionuclide angiography. Cathet Cardiovasc Diagn 6:49–60

    PubMed  CAS  Google Scholar 

  26. Dehmer GJ, Lewis SE, Hillis LD, Tweig D, Falkoff M, Parkey RW, Willerson JT (1980) Nongeometic left-ventricular volumes from equilibrium determination of blood pool scans. Am J Cardiol 45:293–300

    Article  PubMed  CAS  Google Scholar 

  27. Links JM, Becker LC, Schindledecker JG, Guzman P, Burow RD, Nickoloff EL, Alderson PO, Wagner HN (1982) Measurement of absolute left-ventricular volume from gated blood pool studies. Circulation 65:82–91

    PubMed  CAS  Google Scholar 

  28. Konstam MJ, Wynne J, Holman BL, Brown EJ, Neill JM, Kozlowski J (1981) Use of equilibrium (gated) radionuclide ventriculography to quantitate left-ventricular output in patients with and without left-sided valvular regurgitation. Circulation 64:578–586

    PubMed  CAS  Google Scholar 

  29. Massie BM, Kramer BL, Gertz EW, Henderson SG (1982) Radionuclide measurement of left-ventricular volume. Comparison of geometric and counts-based methods. Circulation 65:725–730

    PubMed  CAS  Google Scholar 

  30. Clements ID, Brown ML, Smith HC (1981) Radionuclide measurement of left-ventricular volume. Mayo Clin Proc 56:733–739

    PubMed  CAS  Google Scholar 

  31. Parrish M, Graham T, Born M, Jones J, Boucek R, Partain C (1984) Radionuclide ventriculography for assessment of absolute right and left ventricular volumes in children. Circulation (in press)

  32. Borow KM, Wynne J, Marsh JD (1980) Sensitivity of the end-systolic pressure-volume relation to the inotropic state in humans (abstract). Circulation [Suppl III] 62:91

    Google Scholar 

  33. Pouleur H, Covell JW, Ross J (1979) Effects of alterations in aortic input impedance on the force-velocity-length relationship in the intact canine heart. Circ Res 45:126–136

    PubMed  CAS  Google Scholar 

  34. Condick R Jr, Gardner R (1980) Clinical comparison of pressure-pulse and indicator dilution cardiac output determinations. Circulation 62:372

    Google Scholar 

  35. Holt JP (1957) Regulation of the degree of emptying of the left ventricle by the force of ventricular contraction. Circ Res 5:281–287

    PubMed  CAS  Google Scholar 

  36. Reichek N, Wilson J, Sutton MS, Plappert TA, Goldberg S, Hirshfeld JW (1982) Non-invasive determination of leftventricular end-systolic stress: Validation of the method and initial application. Circulation 65:99–108

    PubMed  CAS  Google Scholar 

  37. Borow KM, Neumann A, Wynne J (1982) Sensitivity of end-systolic pressure-dimension and pressure-volume relations to the inotropic state in humans. Circulation 65:988–997

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Medicine and Radiology, San Diego Veterans Administration Medical Center and University of California, 225 Dickinson St., 92103, San Diego, California, USA

    Robert A. Slutsky M.D., John Watkins & Robert Engler

Authors
  1. Robert A. Slutsky M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John Watkins
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert Engler
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Slutsky, R.A., Watkins, J. & Engler, R. The systolic arterial pressure/end-systolic volume relationship in patients with severe left ventricular dysfunction. Cardiovasc Intervent Radiol 7, 59–64 (1984). https://doi.org/10.1007/BF02552680

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02552680

Key words

Search

Navigation