Atrial transport function in coronary artery disease: Relation to left ventricular function
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Stroke
End-systolic volume
End-diastolic volume
The purpose of this study was to determine the mechanism of the decrease in left ventricular stroke volume during spontaneous inspiration. We determined the transmural pressures of the left heart by measuring left atrial and diastolic left ventricular pressures relative to esophageal pressure. We estimated the directional changes in end-systolic and end-diastolic volumes of the left ventricle by determining the transit time of sound transmission between two ultrasonic crystals facing each other across the minor axis of the left ventricle. Left ventricular stroke volume decreased with spontaneous inspiratory effort as pleural pressure fell, regardless of whether lung volume increased or remained constant. The stroke volume was decreased during the fall in pleural pressure because of an increase in end-systolic volume with an essentially unchanged diastolic volume. Thus, the decrease in stroke volume was due to a decrease in ejection, rather than a decrease in filling of the left ventricle. We believe that ...
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To evaluate the extent to which the Frank-Starling mechanism is utilized during successive stages of vigorous upright exercise, absolute left ventricular end-diastolic volume and ejection fraction were determined by gated blood pool scintigraphy at rest and during multilevel maximal upright bicycle exercise in 30 normal males aged 26-50 yr, who were able to exercise to 125 W or greater. Left ventricular end-systolic volume, stroke volume, and cardiac output were calculated at rest and during each successive 3-min stage of exercise [25, 50, 75, 100, and 125–225 W (peak)]. During early exercise (25 W), end-diastolic and stroke volumes increased (+17 +/- 1 and +31 +/- 4%, respectively), with no change in end-systolic volume. With further exercise (50–75 W) end-diastolic volume remained unchanged as end-systolic volume decreased (-12 +/- 4 and -24 + 5%, respectively). At peak exercise end-diastolic volume decreased to resting level, stroke volume remained at a plateau, and end-systolic volume further decreased (-48 +/- 7%). Thus the Frank-Starling mechanism is used early in exercise, perhaps because of a delay in sympathetic mobilization, and does not appear to play a role in the later stages of vigorous exercise.
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Physical exercise
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This study investigated whether a small volume of 7.2% hypertonic saline solution (HSS) could affect M-mode echocardiographic indices in dogs. HSS induced significant increase in heart rate, stroke volume and cardiac index, when the fluid infusion was completed (P<0.05). In the HSS group, the left ventricular end-diastolic volume index, as an index of preload, significantly increased (P<0.05), whereas left ventricular end-systolic volume index were not altered. HSS induced slight increases in ejection fraction at end of infusion despite significantly differences were not observed. In conclusion, HSS did not induce a demonstrable effect on M-mode echocardiographic indices of systolic function-enhance cardiac contractility, but it caused preload augmentation that may contribute to an abrupt and transient increase in cardiac output just after HSS infusion.
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The applicability of Starling's law of the heart to the circulation of intact human subjects was studied by means of serial biplane angiocardiography utilizing injections into the left ventricle in nine patients, four of whom were unanesthetized. The end-diastolic and end-systolic volumes of the left ventricle were determined from the angiocardiograms by the method described by Dodge, and stroke volumes were calculated by subtracting the end-systolic from the end-diastolic volumes. In four patients large beat-to-beat variations in left ventricular end-diastolic volume occurred. These were accompanied by changes in stroke volume which varied directly with the preceding left ventricular end-diastolic volume. In four patients the left ventricular end-diastolic volume remained about constant, and in these patients the stroke volume showed little or no change. From these observations it was concluded that the ventricular stroke volume is a function of the end-diastolic volume and that therefore Starling's law of the heart is applicable to man. In the ninth patient pulsus alternans occurred; this was accompanied by concordant alternation of the left ventricular end-diastolic volume; i.e., the larger end-diastolic volumes resulted in larger stroke volumes and higher systolic pressures than did the smaller end-diastolic volumes. These observations are compatible with the concept that alternation of ventricular contraction can be explained by alternation of end-diastolic volume.
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The effect of valvular insufficiency on left ventricular volumes was studied by an angiographic method in 37 patients. Ejection of the additional volume load imposed by valvular insufficiency was achieved by an increase in end-diastolic volume and not by increasing the proportion of end-diastolic volume ejected. Of the 37 patients, 16 (43 per cent) had a significant reduction in the fraction of end-diastolic volume ejected per beat. These patients performed significantly less stroke work from a given end-diastolic fiber length (end-diastolic volume) than did the others and evidence is presented that they had impaired myocardial function. An index of myocardial contractility is derived which relates stroke work to end-diastolic volume. The magnitude of left ventricular volumes is determined in part by the severity of the volume load but a further increase in volume without necessarily a further increase in ejection occurs in those patients with impaired myocardial function. Valvular insufficiency is quantitated from the difference between left ventricular ejection volume determined angiographically and forward stroke volume determined from indicator-dilution curves. The results show good agreement with subsequent surgical findings in the 15 patients who underwent operation.
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End-systolic volume
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End-diastolic volume
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A method is described which allows sequential measurements of absolute ventricular volumes from a single intravenous injection of 99Tcm-labelled human serum albumin. The indicator dilution curve detected by a gamma camera is used to make the initial determination of cardiac output and stroke volume, and to calibrate the left ventricular end-systolic and end-diastolic volumes determined from subsequent gated blood pool imaging. Further changes in left ventricular end-diastolic volume can be related to changes in the end-diastolic counts. Thus each measurement of ejection fraction can be used to determine absolute changes in ventricular volume, stroke volume and cardiac output. In 12 patients resting, repeat measurements of end-diastolic volume showed no significant difference (coefficient of variation 2.4%). In 6 normal subjects the infusion of isoprenaline (2 mu g min-1) caused a significant increase (P<0.01) in cardiac output and ejection fraction and a significant decrease (P<0.01) in end-diastolic volume. Propranolol (0.14 mg kg-1) caused a significant decrease in stroke volume and cardiac output. The relationship between stroke volume and end-diastolic volume was depressed.
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Objective To develop a new method for measuring stroke volume and ejection fraction in the infarct and non infarct area with three dimensional color kinesis(CK) technique.Methods A set of left ventricular two dimensional CK images at end systole were acquired in 20 patients with old myocardial infarction using multiplane transesophageal echocardiographic technique and inputted into a self made three dimensional reconstruction system to reconstruct three dimensional CK images of the entire left ventricle,infarct area and non infarct area.The following parameters were calculated from the three groups of three dimensional CK images: stroke volume,wall segment averaged stroke volume,ejection fraction and wall segment averaged ejection fraction.Results Stroke volume and ejection fraction in the infarct and non infarct area were significantly lower than the corresponding values in the entire left ventricle(P 0.01 ).The wall segment averaged stroke volume and ejection fraction decreased progressively in the order of non infarct area,entire left ventricle and infarct area(P 0.01 ～ 0.05 ).The regional and wall segment averaged stroke volume and ejection fraction were the lowest in the infarct area(P 0.01 ).Conclusions The systolic function in the entire left ventricle,infarct area and non infarct area can be accurately measured with three dimensional CK technique.This new method is of value in assessing left ventricular regional function and myocardial viability as well as in therapeutic decision making and prognostic estimation,and therefore,deserves further investigation.
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