Myocardial Contractility, Afterload Mismatch and Ventricular Dysfunction

  • Kirk L. Peterson
Part of the Ettore Majorana International Science Series book series (volume 21)


Although abnormalities in right ventricular function and/or the pulmonary vascular bed can be of pathophysiologic importance, it is more commonly an alteration of one or more determinants of left ventricular function which create an adverse hemodynamic status in the cardiac disease states encountered in man. Of the four major factors which control left ventricular function, i.e. heart rate, myocardial contractility, preload or end-diastolic fiber stretch, and afterload or the force which resists shortening, the latter is now appreciated as playing a particularly critical role in the mechanisms underlying heart failure. For example, the interdependence of wall shortening and afterload, at any given preload, has allowed understanding of the favorable influence of vasodilating agents in treating congestive heart failure. Moreover, the serial application of both invasive and non-invasive diagnostic techniques has provided improved insight into the role of afterload in chronic valvular heart disease, the potential for improving left ventricular shortening by valve surgery, and the relation between postoperative changes in afterload and regression of hypertrophy.


Aortic Stenosis Mitral Regurgitation Wall Stress Myocardial Contractility Mitral Valve Surgery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    H. Dodge, H. Sandler, D. Ballow, and J. Lord, The use of biplane angiography for measurement of left ventricular volume in man, Am.Heart J., 60: 762 (1960).CrossRefGoogle Scholar
  2. 2.
    H. Feigenbaum, R. Popp, R. Wolfe, B. Trot, J. Pombo, C. Haine, and H. Doge, Ultrasound measurements of the left ventricle: A correlative study with angiography, Arch.Intern.Med., 179: 461 (1972).CrossRefGoogle Scholar
  3. 3.
    R. Slutsky, J. Karliner, D. Ricci, R. Kaiser, M. Pfisterer, D. Gordon, K. Peterson, and W. Ashburn, Left ventricular volumes calculated by gated radionuclide angiography: A new method, Circulation, 60: 556 (1979).CrossRefGoogle Scholar
  4. 4.
    H. Sandler and H. T. Dodge, Left ventricular tension and stress in man, Circ.Res., 13: 91 (1963).CrossRefGoogle Scholar
  5. 5.
    Mirsky, I., Left ventricular stresses in the intact human heart, Biophys.J., 9: 189 (1969).CrossRefGoogle Scholar
  6. 6.
    J. W. Burns, J. W. Covell, R. Myers, and J. Ross, Jr., Comparison of directly measured left ventricular wall stress and stress calculated from geometric reference figures, Circ.Res. 28: 611 (1971).CrossRefGoogle Scholar
  7. 7.
    E. S. Imperial, M. N. Levy, and H. Zieske, Jr., Outflow resistance as an independent determinant of cardiac performance, Circ.Res., 9: 1148 (1961).CrossRefGoogle Scholar
  8. 8.
    W. R. Milnor, Arterial impedance as ventricular afterload, Circ.Res., 36: 565 (1975).CrossRefGoogle Scholar
  9. 9.
    W. W. Nichols, C. R. Conti, W. E. Walker, and W. R. Milnor, Input impedance of the systemic circulation in man, Circ.Res., 40: 451 (1977).CrossRefGoogle Scholar
  10. 10.
    H. Pouleur, J. W. Covell, and J. Ross, Jr., Effects of alterations in aortic input impedance on the force-velocity-length relationship in the intact canine heart, Circ.Res., 45: 126 (1979).CrossRefGoogle Scholar
  11. 11.
    J. Ross, Jr., and K. L. Peterson, On the assessment of cardiac inotropic state, Circulation, 47: 435 (1973).CrossRefGoogle Scholar
  12. 12.
    K. L. Peterson, D. Skloven, P. Ludbrook, J. Uther, and J. Ross, Jr., Comparison of isovolumic and ejection phase indices of myocardial performance, Circulation, 49: 1088 (1974).CrossRefGoogle Scholar
  13. 13.
    J. Ross, Jr., Afterload mismatch and preload reserve: A conceptual framework for the analysis of ventricular function, Prog.Cardiovasc.Dis., 18: 225 (1976).CrossRefGoogle Scholar
  14. 14.
    J. H. Gault, J. Ross, Jr., and E. Braunwald, Contractile state of the left ventricle in man: Instantaneous tension-velocitylength relations in patients with and without disease of the left ventricular myocardium, Circ.Res., 22: 451 (1968).CrossRefGoogle Scholar
  15. 15.
    K. L. Peterson, J. B. Uther, R. Shabetai, and E. Braunwald, Assessment of left ventricular performance in man: Instantaneous tension-velocity-length relations obtained with the aid of an electromagnetic velocity catheter in the ascending aorta, Circulation, 47: 924 (1973).CrossRefGoogle Scholar
  16. 16.
    K. T. Weber and J. S. Janicki, Instantaneous force-velocitylength relations in isolated dog heart, Am.J.Physiol., 232: H241 (1977).Google Scholar
  17. 17.
    M. A. Quinones, W. H. Gaasch, and J. K. Alexander, Influence of acute changes in preload, afterload, contractile state and heart rate on ejection and isovolumic indices of myocardial contractility in man, Circulation, 53: 293 (1976).CrossRefGoogle Scholar
  18. 18.
    S. Sasayama, D. Franklin, and J. Ross, Jr., Hyperfunction with normal inotropic state of the hypertrophied left ventricle, Am.J.Physiol., 232: H418 (1977).Google Scholar
  19. 19.
    H. Suga, K. Sagawa, and A. A. Shoukas, Load independence of the instantaneous pressure-volume ratio of the canine left ventricle and effects of epinephrine and heart rate on the ratio, Circ.Res., 32: 314 (1973).CrossRefGoogle Scholar
  20. 20.
    K. Sagawa, The end-systolic pressure-volume relation of the ventricle: definition, modifications and clinical use, Circulation, 63: 1223 (1981).CrossRefGoogle Scholar
  21. 21.
    F. Mahler, J. W. Covell, and J. Ross, Jr., Systolic pressure-diameter relations in the normal conscious dog, Cardiovasc. Res., 9: 447 (1975).Google Scholar
  22. 22.
    W. Grossman, E. Braunwald, T. Mann, L. P. McLaurin, and L. H. Green, Contractile state of the left ventricle in man as evaluated from end-systolic pressure-volume relations, Circulation, 56: 845 (1977).CrossRefGoogle Scholar
  23. 23.
    T. Tajimi, T. F. Widmann, M. Matsuzaki, and K. L. Peterson, Differing effects of Angiotensin II and phenylephrine on end-systolic pressure-volume relationship in conscious dogs, J.Am.Coll.Cardiol., 3: 523 (1984).Google Scholar
  24. 24.
    T. Tajimi, T. F. Widmann, M. Matsuzaki, and K. L. Peterson, The sensitivity of Emax in comparison to other parameters of ventricular contractility, Clin.Res., 32, No. 1: 13A (1984).Google Scholar
  25. 25.
    C. Yoran, J. W. Covell, and J. Ross, Jr., Structural basis for the ascending limb of left ventricular function, Circ.Res., 32: 297 (1973).CrossRefGoogle Scholar
  26. 26.
    C. W. Urschel, J. W. Covell, E. H. Sonnenblick, J. Ross, Jr., and E. Braunwald, Myocardial mechanics in aortic and mitral valvular regurgitation. The concept of instantaneous impedance as a determinant of the performance of the intact heart, J.Clin.Invest., 47: 867 (1968).CrossRefGoogle Scholar
  27. 27.
    D. L. Eckberg, J. H. Gault, R. L. Bouchard, J. S. Karliner, and J. Ross, Jr., Mechanics of left ventricular contraction in chronic severe mitral regurgitation, Circulation, 47: 1252 (1973).CrossRefGoogle Scholar
  28. 28.
    D. Ricci, Afterload mismatch and preload reserve in chronic aortic regurgitation, Circulation, 66: 827 (1982).CrossRefGoogle Scholar
  29. 29.
    J. N. Cohn and J. A. Franciosa, Vasodilator therapy of cardiac failure, N.Engl.J.Med., 297: 27, 254 (1977).Google Scholar
  30. 30.
    K. L. Peterson, Instantaneous force-velocity-length relations of the left ventricle: Methods, limitations, and applications in man, in: “Heart Failure,” A. Fishman, ed., Hemisphere Publishing Corp., ch. 9 (1978).Google Scholar
  31. 31.
    N. Smith, J. H. McAnulty, and S. H. Rahímtoola, Severe aortic stenosis with impaired left ventricular function and clinical heart failure: Results of valve replacement, Circulation, 58: 255 (1978).CrossRefGoogle Scholar
  32. 32.
    G. Schuler, K. L. Peterson, A. Johnson, G. Francis, G. Dennish, J. Utley, P. 0. Daily, W. Ashburn, and J. Ross, Jr., Temporal response of left ventricular performance to mitral valve surgery, Circulation, 59: 1218 (1979).CrossRefGoogle Scholar
  33. 33.
    C. Y. H. Wong and H. M. Spotnitz, Systolic and diastolic properties of the human left ventricle during valve replacement for chronic mitral regurgitation, Am.J.Cardiol., 47: 40 (1981).CrossRefGoogle Scholar

Copyright information

© Plenum Press, New York 1985

Authors and Affiliations

  • Kirk L. Peterson
    • 1
  1. 1.University of CaliforniaSan DiegoUSA

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