The Pressure—Volume Relationship of the Intact Heart

  • Mark I. M. Noble
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 89)


The relationship of isometric force to sarcomere length transforms, in the intact heart, to the relationship between left ventricular isovolumic pressure and volume. The assumption that this latter relationship is straight and represents an elastance, Emax, implies the visco-elastic model which was disproved for muscle in general by Fenn. If the force-length curve is straight, no resulting pressure-volume curve will be convex to the pressure axis due to geometry. There are also data to show that the pressure-volume relationship is non-linear, thus invalidating Emax. The uniqueness of the pressure-volume diagram as a unique descriptor of left ventricular mechanical function would be invalidated if the slow response of force to length change proved to be present in the intact heart; present data on that point is contradictory between different laboratories. As long as contractility is normal and systole of sufficient duration, the end-systolic pressure-volume curve is identical to the isovolumic one. Then an increase in end-diastolic volume results in an identical increase in stroke volume (at the same ejection pressure) and end-systolic volume is constant. A shift to the left of the end-systolic pressure-volume curve indicates increased myocardial contractility. A shift to the right indicates either a negative inotropic effect or an abbreviation of systole.


Stroke Volume Aortic Pressure Sarcomere Length Negative Inotropic Effect Positive Inotropic Effect 
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  1. 1.
    Frank O (1985). Zur Dynamik des Herzmuskels. Zeitschrift faar Biologie 32: 37–M47, translated by Chapman CB and Wasserman E (1959). Am Heart J 58: 282–317, 467–478.Google Scholar
  2. 2.
    Patterson SW, Piper H and Starling EH (1914). The regulation of the heart beat. J Physiol 8: 465–513.Google Scholar
  3. 3.
    Patterson WS and Starling EH (1914). On the mechanical factors which determine the output of the ventricles. J Physiol 48: 357–379.PubMedGoogle Scholar
  4. 4.
    Sagawa K (1981). Editorial. The end-systolic pressure-volume relation of the ventricle: Definition, modifications and clinical use. Circulation 63: 1223–1227.PubMedCrossRefGoogle Scholar
  5. 5.
    Hefner LL, Sheffield LT, Cobbs GC and Klip W (1962). Relation between mural force and pressure in the left ventricle of the dog. Circ Res 811: 654–663.Google Scholar
  6. 6.
    Noble MIM, Wyler J, Milne ENC, Trenchard D and Guz A (1969). Effect of changes in heart rate on left ventricular performance in conscious dogs. Circ Res 24: 285–295.PubMedGoogle Scholar
  7. 7.
    Ciba Foundation Symposium (1974). The Physiological Basis of Starling’s Law of the Heart. Elsevier:Excerpta Medica:North Holland, Amsterdam.Google Scholar
  8. 8.
    Suga H and Sagawa K (1974). Instantaneous pressure-volume relationships and their ratio in the excised supported canine left ventricle. Circ Res 35: 117–126.PubMedGoogle Scholar
  9. 9.
    Sagawa K, Suga H, Shoukas A and Bakalar K (1977). End-systolic pressure/volume ratio: a new index of ventricular contractility. Am J Cardiol 40: 748–753.PubMedCrossRefGoogle Scholar
  10. 10.
    Blix M (1982). Die Lange und die Spannung des Muskels. Skand Arch Physiol 3: 295–318.Google Scholar
  11. 11.
    Elzinga G (1986). Cardiac pump functions; what would Starling say Proceedings of the IUPS 16: L354.01.Google Scholar
  12. 12.
    Fenn WO (1923). A quantitative comparison between the energy liberated and the work performed by the isolated sartorius muscle of the frog. J Physiol 58: 175–203.PubMedGoogle Scholar
  13. 13.
    Gibbs CL, Mommaerts WFHM and Ricchiuti NV (1967). Energetics of cardiac contractions. J Physiol 191: 25–46.PubMedGoogle Scholar
  14. 14.
    Allen DG and Kurihara S (1982). The effects of muscle length on intracellular calcium transients in mammalian cardiac muscle. J Physiol 273: 597–615.Google Scholar
  15. 15.
    Jewell BR (1977). A re-examination of the influence of muscle length on myocardial performance. Circ Res 40: 221–230.PubMedGoogle Scholar
  16. 16.
    Tucci PJF, Bregagnollo EA, Spadaro J, Cicogna AC and Ribiero MCL (1984). Length dependent activation studied in the isovolumic blood-perfused dog heart. Circ Res: 5559–66.Google Scholar
  17. 17.
    Weber KT, Janicki JS and Hefner LL (1976). Left ventricular force-length relations of isovolumic and ejecting contractions. Am J Physiol 231: 337–343.PubMedGoogle Scholar
  18. 18.
    Sagawa K (1978). The ventricular pressure-volume diagram revisited. Circ Res 43: 677–687.PubMedGoogle Scholar
  19. 19.
    Pettersson K, Drake-Holland AJ and Noble MIM (1985). Isometric contractions in the isovolumically beating dog heart. Cardiovasc Res 19: 521.CrossRefGoogle Scholar
  20. 20.
    Maughan WL, Sunagawa K, Burkhoff D and Sagawa K (1984). Effect of arterial impedence changes on the end-systolic pressure-volume relation. Circ Res 54: 595–602.PubMedGoogle Scholar
  21. 21.
    Noble MIM, Milne ENC, Goerke RJ, Carlsson E, Domenech RJ, Saunders KB and Hoffman JIE (1969a). Left ventricular filling and diastolic pressure-volume relations in the conscious dog. Circ Res 24: 269–283.PubMedGoogle Scholar
  22. 22.
    Pidgeon J, Lab M, Elzinga G, Papadoyannis D and Noble MIM (1980). The contractile state of cat and dog heart in relation to the interval between beats. Circ Res 47: 559–567.PubMedGoogle Scholar
  23. 23.
    Monroe RG, Gamble WJ, LaFarge CG, Kumar AE and Manasek FJ (1970). Left ventricular performance at high end-diastolic pressures in isolated perfused dog hearts. Circ Res 26: 85–100.PubMedGoogle Scholar
  24. 24.
    Sarnoff SJ and Mitchell JH (1962). The control of the function of the heart. Handbook of Physiology, section 2 Circulation, vol 1, 489–532. American Physiological Society, Washington DC.Google Scholar
  25. 25.
    Parmley WW, Brutsaert DL and Sonnenblick (1969). Effects of altered loading on contractile events in isolated cat papillary muscle. Circ Res 24: 521–532.PubMedGoogle Scholar
  26. 26.
    Donald TC, Peterson DM, Walker AA and Hefner LL 91976). Afterload-induced homeo-metric autoregulation in isolated cardiac muscle. Am J Physiol 231: 545–550.PubMedGoogle Scholar
  27. 27.
    Elzinga G, Noble MIM and Stubbs J (1977). The effect of an increase in aortic pressure upon the inotropic state of cat and dog left ventricles. J Physiol 273: 597–615.PubMedGoogle Scholar
  28. 28.
    Starling EH (1918). The Linacre Lecture on the Law of the Heart, Longmans, Green & Co, London.Google Scholar
  29. 29.
    Noble MIM (1978). The Frank-Starling curve. Clinical Science 54: 1–7.Google Scholar
  30. 30.
    Bos GC van den, Elzinga G, Westerhoff N and Noble MIM (1973). Problems in the use of indices of myocardial contractility. Cardiovasc Res 7: 834–848.PubMedCrossRefGoogle Scholar
  31. 31.
    Noble MIM, Trenchard D and Guz A (1966). Left ventricular ejection in conscious dogs. I. Measurement and significance of the maximum acceleration of blood from the left ventricle. Circ Res 19: 139–147Google Scholar

Copyright information

© Kluwer Academic Publishers 1988

Authors and Affiliations

  • Mark I. M. Noble
    • 1
  1. 1.King Edward VII HospitalWest SussexUK

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