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Left ventricular end-systolic stress/diameter relation as a contractility index and as a predictor of survival. Independence of preload after normalization for end-diastolic diameter

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Abstract

The independence of the slope of the left ventricular (LV) end-systolic stress/end systolic diameter (ESS/ESD) relation of preload (PL) after normalization for end-diastolic diameter (EDD), and the reliability of both the original and the normalized slope as contractility and prognostic indices, were assessed. We studied echocardiographically, hemodynamically, and with carotid pulse tracing, 25 normal subjects, 18 patients with coronary artery disease having a normal ejection fraction (EF), and 30 patients with idiopathic dilated cardiomyopathy (DCM). The arterial pressure was changed with intravenous infusion of phenylephrine. To investigate the effect of PL on the ESS/ESD slope, in 12 normals the PL was decreased with intravenous infusion of 40 mg of furosemide and increased with 1 l isotonic NaCl. The studied population was followed up for 18–61 months. The mean values of the slope after furosemide and after NaCl differed significantly but when the above values were divided by the EDD the differences were nullified. The mean values of the slope differed highly significantly between the three groups. The normalized slope increased the sensitivity in the discrimination. During the follow-up period 10 patients with DCM died. The original and the normalized slopes separated the deceased and survivors significantly (P < 0.002 for both indices) as compared to EF (P < 0.05). The ESS/ESD slope is a very sensitive contractility index and is also superior to EF as a prognostic parameter. The normalization of the slope eliminates its dependence on PL and improves the sensitivity in assessing decreased contractility, although it slightly decreases its prognostic value.

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References

  1. B Carabello (1989) ArticleTitleRatio of end-systolic stress to end-systolic volume: is it a useful clinical tool? J Am Coll Cardiol 14 496–498 Occurrence Handle10.1016/0735-1097(89)90207-6

    Article  Google Scholar 

  2. F Mahler J Ross SuffixJr RA O’Rourke JW Covell (1975) ArticleTitleEffects of changes in preload, afterload, and inotropic state on ejection and isovolumic phase measures of contractility in the conscious dog Am J Cardiol 35 626–634 Occurrence Handle10.1016/0002-9149(75)90048-X Occurrence Handle1124716

    Article  PubMed  Google Scholar 

  3. DA Kass WL Maughan AM Guo A Kono K Sunagawa K Sagawa (1987) ArticleTitleComparative influence of load versus inotropic states on indexes of ventricular contractility: experimental and theoretical analysis based on pressure-volume relationships Circulation 76 1422–1436 Occurrence Handle3454658

    PubMed  Google Scholar 

  4. N Ohte H Narita M Sugawara K Niki T Okada A Harada J Hayano G Kimura (2003) ArticleTitleClinical usefulness of carotid arterial wave intensity in assessing left ventricular systolic and early diastolic performance Heart Vessels 18 107–111 Occurrence Handle10.1007/s00380-003-0700-5 Occurrence Handle12955424

    Article  PubMed  Google Scholar 

  5. K Sagawa (1978) ArticleTitleThe left ventricular pressure-volume diagram revisited Circ Res 43 677–687 Occurrence Handle361275

    PubMed  Google Scholar 

  6. K Sagawa (1981) ArticleTitleEnd-systolic pressure-volume relation of the ventricle: definition, modification, and clinical use Circulation 63 1223–1227 Occurrence Handle7014027

    PubMed  Google Scholar 

  7. KT Weber JS Janicki WC Hunter S Shroff ES Pearlman AP Fishman (1982) ArticleTitleThe contractile behavior of the heart and its functional coupling to the circulation Prog Cardiovasc Dis 24 375–400 Occurrence Handle10.1016/0033-0620(82)90020-2 Occurrence Handle7038766

    Article  PubMed  Google Scholar 

  8. B Berko WH Gaash N Tanigawa D Smith E Craige (1987) ArticleTitleDisparity between ejection and end-systolic indexes of left ventricular contractility in mitral regurgitation Circulation 75 1310–1319 Occurrence Handle3568333

    PubMed  Google Scholar 

  9. MR Zile G Izzi WH Gaash (1991) ArticleTitleleft ventricular diastolic dysfunction limits use of maximum systolic elastance as an index of contractile function Circulation 83 315–327 Occurrence Handle1670628

    PubMed  Google Scholar 

  10. JA Spratt GS Tyson DD Glower JW Davis LH Mulbaier C Olsen et al. (1987) ArticleTitleThe end-systolic pressure-volume relationship in conscious dogs Circulation 75 1295–1309 Occurrence Handle3568332

    PubMed  Google Scholar 

  11. J Ross J Linhart E Braunwald (1965) ArticleTitleEffects of changing heart rate in man by electrical stimulation of the right atrium Circulation 32 549–554 Occurrence Handle5825546

    PubMed  Google Scholar 

  12. W Grossman E Braunwald T Mann L McLaurin L Green (1977) ArticleTitleContractile state of the left ventricle in man as evaluated from end-systolic pressure-volume relations Circulation 56 845–852 Occurrence Handle71960

    PubMed  Google Scholar 

  13. MA Stefadouros MJ Dougherty W Grossman E Craige (1973) ArticleTitleDetermination of systemic vascular resistance by a noninvasive technique Circulation 47 101–107 Occurrence Handle4686587

    PubMed  Google Scholar 

  14. N Reichek J Wilson M St John Sutton TA Plappert S Goldberg JW Hirshfeld (1982) ArticleTitleNoninvasive determination of left ventricular end-systolic stress: validation of the method and initial application Circulation 65 99–108 Occurrence Handle7053293

    PubMed  Google Scholar 

  15. K Hammermeister T De Ronen H Dodge (1979) ArticleTitleVariables predictive of survival in patients with coronary disease, selection by univariate and multivariate analysis from the clinical, electrocardographic, exercises; arteriographic and quantitative angiographic evaluation Circulation 59 421–430 Occurrence Handle761323

    PubMed  Google Scholar 

  16. AM Katz (1989) ArticleTitleCardiomyopathy of overload N Engl J Med 322 100–110

    Google Scholar 

  17. CS Rihal RA Nishimura LK Hatle KR Bailey AJ Tajik (1994) ArticleTitleSystolic and diastolic dysfunction in patients with clinical diagnosis of dilated cardiomyopathy: relation to symptoms and prognosis Circulation 90 2772–2779 Occurrence Handle7994820

    PubMed  Google Scholar 

  18. GW Dec V Fuster (1994) ArticleTitleIdopathic dilated cardiomyopathy N Engl J Med 331 564–575 Occurrence Handle10.1056/NEJM199412083312307

    Article  Google Scholar 

  19. CN Aroney HC Herman MJ Semigram GW Dec CA Boucher MA Fifer (1989) ArticleTitleLinearity of the left ventricular end-systolic pressure-volume relation in patients with severe heart failure J Am Coll Cardiol 14 127–134 Occurrence Handle10.1016/0735-1097(89)90437-3 Occurrence Handle2738257

    Article  PubMed  Google Scholar 

  20. Fonad F El-Tobgi J Kramer G Rincon W Sheldon R Tarazi (1984) ArticleTitleLeft ventricular function in coronary artery disease. Evaluation of slope of end-systolic pressure-volume line (Emax) and ratio of peak systolic pressure to end-systolic volume (P/Ves J Am Coll Cardiol 3 781–786 Occurrence Handle6693649

    PubMed  Google Scholar 

  21. H Mehmel N Stockins K Ruffman K Olshausen G Schuller W Kubler (1981) ArticleTitleThe linearity of the end-systolic pressure-volume relationship in man and its sensitivity for assessment of the left ventricular function Circulation 63 1216–1222 Occurrence Handle7226470

    PubMed  Google Scholar 

  22. K Ramanathan S Erwin J Sullivan (1984) ArticleTitleRelationship of peak systolic pressure/end systolic volume ratio to standard ejection phase indices and ventricular function curves in coronary disease Am J Med Sci 288 162–168 Occurrence Handle6496562

    PubMed  Google Scholar 

  23. KM Borow LH Green W Grossman E Braunwald (1982) ArticleTitleLeft ventricular end-systolic stress-shortening and stress-length relations in humans Am J Cardiol 50 1301–1308 Occurrence Handle10.1016/0002-9149(82)90467-2 Occurrence Handle7148706

    Article  PubMed  Google Scholar 

  24. AB Carabello FJ Spann (1984) ArticleTitleThe uses and limitations of end systolic indexes of left ventricular function Circulation 69 1058–1063 Occurrence Handle6705160

    PubMed  Google Scholar 

  25. G Daughters G Derby E Alderman A Schwarzkopf C Mead N Ingels C Miller (1985) ArticleTitleIndependence of left ventricular pressure-volume ratio from preload in man early after coronary artery bypass graft surgery Circulation 71 945–950 Occurrence Handle3872741

    PubMed  Google Scholar 

  26. GH Pollack (1970) ArticleTitleMaximum velocity as an index of contractility in cardiac muscle. A critical evaluation Circ Res 26 111–118 Occurrence Handle5410091

    PubMed  Google Scholar 

  27. DL Eckberg DH Gault RL Bouchard JS Karliner J Ross (1973) ArticleTitleMechanics of left ventricular contraction in chronic severe mitral regurgitation Circulation 47 1252–1257 Occurrence Handle4709542

    PubMed  Google Scholar 

  28. H Sasao R Noda T Hasegawa A Endo H Oimatsu T Takada (2004) ArticleTitlePrognostic value of the Tei-index combining systolic and diastolic myocardial performance in patients with acute myocardial infarction treated by successful primary angioplasty Heart Vessels 19 68–74 Occurrence Handle10.1007/s00380-003-0735-7 Occurrence Handle15042390

    Article  PubMed  Google Scholar 

  29. MJ Likoff SL Chandler HR Kay (1987) ArticleTitleClinical determinants of mortality in chronic congestive heart failure secondary to idiopathic dilated or to ischemic cardiomyopathy Am J Cardiol 59 634–638 Occurrence Handle10.1016/0002-9149(87)91183-0 Occurrence Handle3825904

    Article  PubMed  Google Scholar 

  30. A Keogh J Freund D Baron J Hickie (1988) ArticleTitleTiming of cardiac transplantation in idiopathic dilated cardiomyopathy Am J Cardiol 61 418–422 Occurrence Handle10.1016/0002-9149(88)90297-4 Occurrence Handle3277367

    Article  PubMed  Google Scholar 

  31. RA Diaz A Obasoman CM Oacley (1987) ArticleTitlePrediction of outcome in dilated cardiomyopathy Br Heart J 58 393–399 Occurrence Handle3676026

    PubMed  Google Scholar 

  32. S Huang J Messer P Denes (1983) ArticleTitleSignificance of ventricular tachycardia in idiopathic dilated cardiomyopathy: observations in 35 patients Am J Cardiol 51 507–510 Occurrence Handle6218746

    PubMed  Google Scholar 

  33. J Szlachic B Massie B Kramer N Topic J Tubau (1985) ArticleTitleCorrelates and prognostic implication of exercise capacity in chronic congestive heart failure Am J Cardiol 55 1037–1092 Occurrence Handle10.1016/0002-9149(85)90742-8 Occurrence Handle3984864

    Article  PubMed  Google Scholar 

  34. H Ikram H Willamson M Won I Crozier E Walls (1987) ArticleTitleThe course of idiopathic dilated cardiomyopathy in New Zealand Br Heart J 57 521–527 Occurrence Handle3620228

    PubMed  Google Scholar 

  35. A Gradman P Deedwania R Cody B Massie M Packer B Pitt S Goldstein (1989) ArticleTitlePredictors of total mortality and sudden death in mild to moderate heart failure J Am Coll Cardiol 14 564–570 Occurrence Handle2768707

    PubMed  Google Scholar 

  36. K Borow L Green L Sloss E Braunwald J Collins L Cohn W Grossman (1980) ArticleTitleEnd systolic volume as a predictor of postoperative left ventricular performance in volume overload from valvular regurgitation Am J Med 68 655–663 Occurrence Handle10.1016/0002-9343(80)90251-X Occurrence Handle7377221

    Article  PubMed  Google Scholar 

  37. MR Starling (1995) ArticleTitleEffects of valve surgery on left ventricular contractile function in patients with long term mitral regurgitation Circulation 92 811–818 Occurrence Handle7641361

    PubMed  Google Scholar 

  38. BA Carabello SP Nolan LB McGuire (1981) ArticleTitleAssessment of preoperative left ventricular function in patients with mitral regurgitation: value of the end-systolic wall stress/end-systolic volume ratio Circulation 64 1212–1217 Occurrence Handle7296794

    PubMed  Google Scholar 

  39. BA Carabello H Williams AK Gash R Kent D Belber A Maurer J Siegel K Blasius JF Spann (1986) ArticleTitleHaemodynamic predictors of outcome in patients undergoing valve replacement Circulation 74 1309–1316 Occurrence Handle3779916

    PubMed  Google Scholar 

  40. K Taniguchi S Nakano H Matsuda Y Shimazaki K Sakai T Kawamoto S Sakaki J Kobayashi H Shintani M Mitsuno (1990) ArticleTitleTiming of operation for aortic regurgitation: relation to postoperative contractile state Ann Thorac Surg 50 779–785 Occurrence Handle2241343

    PubMed  Google Scholar 

  41. MR Starling MM Kirsh DG Montgomery MD Gross (1993) ArticleTitleImpaired left ventricular contractile function in patients with long-term mitral regurgitation and normal ejection fraction J Am Coll Cardiol 22 239–250 Occurrence Handle8509547

    PubMed  Google Scholar 

  42. MJ Pirwitz RA Lange JE Willard C Landau B Glamann D Hillis (1994) ArticleTitleUse of left ventricular peak systolic pressure/end-systolic volume ratio to predict symptomatic improvement with valve replacement in patients with aortic regurgitation and enlarged end-systolic volume J Am Coll Cardiol 24 1672–1677 Occurrence Handle7963114

    PubMed  Google Scholar 

  43. KB Ramanathan J Knowles MJ Connor R Tribble FW Kroetz JM Sullivan DM Mirvis (1984) ArticleTitleNatural history of chronic mitral insufficiency: relation of peak systolic pressure/end systolic volume ratio to morbidity and mortality J Am Coll Cardiol 3 1412–1416 Occurrence Handle6715701

    PubMed  Google Scholar 

  44. A Branzi C Lolli G Piovaccari C Rapezzi G Binetti S Specchia R Zannoli B Magnani (1984) ArticleTitleEchocardiographic evaluation of the response to afterload stress test in young asymptomatic patients with chronic severe aortic regurgitation: sensitivity of the left ventricular end systolic pressure-volume relationship Circulation 70 561–569 Occurrence Handle6478562

    PubMed  Google Scholar 

  45. W Henry R Bonow D Rosing S Epstein (1980) ArticleTitleObservations on the optimum time for operative intervention for aortic regurgitation. Serial echocardiographic evaluation of asymptomatic patients Circulation 61 484–491 Occurrence Handle7353237

    PubMed  Google Scholar 

  46. SD Colan KM Borow WJ Gamble SP Sanders (1983) ArticleTitleEffects of enhanced afterload (methoxamine) and contractile state (dobutamine) on the left ventricular late systolic wall stress-dimension relation Am J Cardiol 52 1304–1309 Occurrence Handle10.1016/0002-9149(83)90593-3 Occurrence Handle6650421

    Article  PubMed  Google Scholar 

  47. G Hausdorf J Gluth CA Nienaber (1987) ArticleTitleNon-invasive assessment of end-systolic pressure-length and stress-shortening relationships in normal individuals: significance of different loading conditions induced by methoxamine and angiotensin II Eur Heart J 8 1099–1108 Occurrence Handle3678239

    PubMed  Google Scholar 

  48. GL Freeman WC Little RA O’Rourke (1986) ArticleTitleThe effect of vasoactive agents on the left ventricular end-systolic pressure-volume relation is closed chest dogs Circulation 74 1107–1113 Occurrence Handle3769168

    PubMed  Google Scholar 

  49. J Baan ET Van Der Velde (1988) ArticleTitleSensitivity of left ventricular end-systolic pressure-volume relation to type of loading intervention in dogs Circ Res 62 1247–1258 Occurrence Handle3383368

    PubMed  Google Scholar 

  50. D Burkhoff PP De Tombe WC Hunter (1993) ArticleTitleImpact of ejection on magnitude and time course of ventricular pressure-generating capacity Am J Physiol 265 H899–H909 Occurrence Handle8214125

    PubMed  Google Scholar 

  51. D Burkhoff S Sugiura DT Yue K Sagawa (1987) ArticleTitleContractility-dependent curvilinearity of end-systolic pressure-volume relations Am J Physiol 252 H1218–H1227 Occurrence Handle2438948

    PubMed  Google Scholar 

  52. DA Kass R Beyar E Lankford M Heard L Maughan K Sagawa (1989) ArticleTitleInfluence of contractile state on curvilinearity of in situ end-systolic pressure-volume relation Circulation 79 167–178 Occurrence Handle2910541

    PubMed  Google Scholar 

  53. WC Little CP Cheng T Peterson JV Johansen (1988) ArticleTitleResponse of the left ventricular end-systolic pressure-volume relation in conscious dogs to a wide range of contractile states Circulation 78 736–745 Occurrence Handle3409508

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, Laiko Hospital of Athens, 17 Agiou Thomas Street, GR-157 27 Goudi, Athens, Greece

    Ioannis Moyssakis, Youssef Hallaq, Nick Pantazopoulos & Athanasios Aessopos

  2. First Cardiac Department, Evangelismos Hospital, Athens, Greece

    Nikitas Moschos & Miltiades Kolettis

  3. Cardiac Department, Larissa University, Larissa, Greece

    Filipos Triposkiadis

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  1. Ioannis Moyssakis
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  2. Nikitas Moschos
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  3. Filipos Triposkiadis
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Correspondence to Ioannis Moyssakis.

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Moyssakis, I., Moschos, N., Triposkiadis, F. et al. Left ventricular end-systolic stress/diameter relation as a contractility index and as a predictor of survival. Independence of preload after normalization for end-diastolic diameter. Heart Vessels 20, 191–198 (2005). https://doi.org/10.1007/s00380-005-0832-x

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