Author + information
- Received May 3, 1983
- Revision received August 2, 1983
- Accepted September 30, 1983
- Published online March 1, 1984.
- Sherif El-Tobgi, MDb,*,
- Fetnat M. Fouad, MD†,a,
- John R. Kramer, MD†,
- Gustavo Rincon, MD†,
- William C. Sheldon, MD† and
- Robert C. Tarazi, MDb
- ↵aAddress for reprints: Fetnat M. Fouad, MD, Research Division, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44106.
Left ventricular function was assessed by measurement of systolic pressure-volume variables and ejection fraction in seven normal subjects (group I), five patients with coronary artery disease and normal symmetric left ventricular wall motion (group II) and eight patients with remote myocardial infarction and segmental akinesia (group III). Left ventricular volumes were obtained from right anterior oblique ventriculograms and pressures from catheter-tip micromanometer (14 patients) or fluid-filled catheters (6 patients) at two different systolic loads. P/Ves was calculated as the ratio of peak systolic pressure (P) to end-systolic volume (Ves) at rest, Emaxas the slope of the end-systolic pressure volume line constructed at two systolic loads, and Vo as the volume axis intercept of this line.
Emaxwas significantly (p < 0.01) lower in patients with segmental akinesia (group III) (5.0 < 0.5) than in normal subjects (group I) (10.4 ± 0.8) or patients with coronary artery disease and normal wall motion (group II) (9.9 ± 0.8). In contrast, there was no significant difference in P/Vesamong the three groups (6 < 1.0 in group I, 5 < 0.8 in group II, 3.7 < 0.5 in group III). Similarly, Vesand Vofailed to separate the three groups. Although ejection fraction was significantly (p < 0.05) lower in group III (0.56 ± 0.03) than in groups I and II (0.67 ± 0.03 in both groups), there was considerable overlap of individual Values in the three groups. In eight patients, measurements were repeated during isometric exercise. A significant correlation was observed between the percent increase in Emax) and P/Ves) during exercise (r = 0.92, p < 0.001), indicating that the latter is probably a sensitive index of acute changes in myocardial contractility.
In conclusion, Emaxwas the only systolic pressure-volume variable capable of separating normal from abnormal left ventricular function. It appears to be more sensitive than the ejection fraction. The P/Vesratio may be more useful as a measure of acute changes in contractility in the same patient.
↵* Present address: Cardiology Department, Kasr El Eini Hospital, Cairo University, Cairo, Egypt.
This study was supported in part by Grant HL-6835 from the National Institutes of Health, Bethesda, Maryland.
- Received May 3, 1983.
- Revision received August 2, 1983.
- Accepted September 30, 1983.
- American College of Cardiology Foundation