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The basics of ventricular function

Published online by Cambridge University Press:  19 August 2008

Daniel J. Penny*
Affiliation:
Department of Paediatrics, The Royal Brompton and Harefield NHS Trust and The National Heart and Lung Institute, London, UK
*
Dr D. J. Penny, Consultant Paediatric Cardiologist-Intensivist, The Royal Brompton & Harefield NHS Trust, Sydney Street, LondonSW3 6NP, UK. Tel: (44) 171-3518430; Fax: (44) 171-3518547; Email:[email protected]

Abstract

There has been increasing interest in the study of ventricular function in the patient with congenital heart disease. Numerous indexes have been derived for the assessment of ventricular function, suggesting that none is ideal. While the derivation of some measures of ventricular function have relied on advanced mathematical principles, it is still possible for the non-mathematician to obtain important insights into ventricular function from an assessment of the events which underpin the cardiac cycle. In this review, I use the mechanics of the cardiac cycle to introduce basic concepts of ventricular function for the non-expert. In this way, I analyse ventricular systolic and diastolic performance and describe the contribution of regional variability of function to overall performance. This approach also highlights the role of the ventricle in overall cardiovascular and metabolic homeostasis.

Type
Continuing Medical Education
Copyright
Copyright © Cambridge University Press 1999

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References

1.Wiggers, CJ. Studies on the duration of the consecutive phases of the cardiac cycle. 1. The duration of the consecutive phases of the cardiac cycle and criteria their precise determination. Am J Physiol 1921; 56: 415438.Google Scholar
2.Brutsaert, DL, Sys, SU. Relaxation and diastole of the heart. Physiol Rev 1989; 69: 12281315.Google Scholar
3.Chen, C, Rodriquez, L, Lether, JP, Levine, RA, Semigran, MS, Fifer, MA, Weyman, AE, Thomas, JD. Continuous wave Doppler echocardiography for noninvasive assessment of left ventricular dP/dt and relaxation time constant from mitral regurgitant spectra in patients. J Am Coll Cardiol 1994; 23 970976.Google Scholar
4.Furnival, CM, Linden, RJ, Snow, NM. Inotropic changes in the left ventricle: the effect of changes in heart rate, aortic pressure and end-diastolic pressure. J Physiol. 1970; 211: 359387.Google Scholar
5.Van den, Bos GC, Elzinga, G, Westerhof, N, Noble, MIM. Problems in the use of indices of myocardial contractility. Cardiovasc Res 1983; 7: 834848.Google Scholar
6.Colan, SD, Borow, KM, Neumann, A. The left ventricular endsystolic wall stress-velocity of fiber shortening relation: a load independent index of myocardial contractility. J Am Coll Cardiol 1984 4: 715724.Google Scholar
7.Upton, MT, Gibson, DG. The study of left ventricular funtion from digitized echocardiograms. Prog Cardiovas Dis 1978; 20: 359384.Google Scholar
8.Frank, O. Zur Dynamik des Herzmuskels. Z Biol 1895; 32: 370447.Google Scholar
9.Baan, J, Buis, B, Senden, J, Temmerman, D, van Dijk, AD, Koops, J, Smeenk, GJ, de Bruin, HG, van der, Velde ET. Continuous measurement of left ventricular volume in animals and humans by conductance catheter. Circulation 1984; 70: 812823.Google Scholar
10.Chaturvedi, RR, Kilner, PJ, White, PA, Bishop, A, Szwarc, R. Redington AN Increased airway pressure and simulated branch pulmonary artery stenosis increase pulmonary regurgitation after repair of tetralogy of Fallot real-time analysis with a conductance catherter technique. Circualtion 1997; 95: 643649.Google Scholar
11.Chaturvedi, RR, Lincoln, C, Gothard, JWW, Scallan, MH, White, PA, Redington, AN, Shore, DF. Left ventricular dysfunction after open repair of simple congenital heart defects in infants and children: quantitation with the use of a conductance catheter immediately after bypass. J Thorac Cardiovasc Surg 1998; 115: 7783.Google Scholar
12.Ito, H, Takaki, M, Yamaguchi, H, Tachibana, H, Suga, H. Left ventricular volumetric conductance catheter for rats. Am. J Physiol 1996; 270: H1509-H1514.Google Scholar
13.Suga, H, Sagawa, K, Shoukas, AA. 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 1974; 32: 314322.Google Scholar
14.Suga, H, Sagawa, K. Instantaneous pressure-volume relationships and their ratio in the excised, supported canine left ventricle. Circ Res 1974; 35: 117126.Google Scholar
15.Sagawa, K, Suga, H, Shoukas, AA, Bakalar, KM. End-systolic pressure-volume ratio: A new index of contractility. Am J Cardiol 1979; 40: 748753 @Frist paraGoogle Scholar
16.Glower, DD, Spratt, JA, Snow, ND, Kabas, JS, Davis, JW, Olsen, CO, Tyson, GS, Sabiston, DC, Rankin, JS. Linearity of the Frank-Starling relationship in the intact heart: the concept of preload recruitable stroke work. Circulation 1985; 71: 9941009.Google Scholar
17.Chaturvedi, R, Lincoln, C, Shore, D, White, P, Redington, AN. Modified ultrafiltration improves cardiac systolic and diastolic funtion immediately after cardiopulmonary bypass in children. 45th Annual Scientific Sesion, American College of Cardiology, 1996. (Absract 72274).Google Scholar
18.Kass, DA, Maughan, WL, Gou, ZM, Konon, A, Sunagawa, K, Sagawa, K. Comparative influence of load versus inotropic states on indexes of ventricular contractility: experimental and theoretical analysis based on pressure-volume relationships. Circulation 1987; 14221436.Google Scholar
19.Little, WC, Cheng, C-P, Mumma, M, Igarashi, Y, Vinten-Johansen, J, Johnson, WE. Comparison of measures of left ventricular contractile performance derived from pressure-volume loops in conscious dogs. Circulation 1989; 80: 13781387.Google Scholar
20.Maughan, WL, Sunagawa, K, Hunter, WC, Sagawa, K. Instantaneous but not end-systolic pressure-volume relationship (ESPVR) depends on afterload. (Abstract). Fed Proc 1985; 44: 1017.Google Scholar
21.Burkhoff, D, Sugiura, S, You, DT, Sagawa, K. Contractility dependent curvilinearity of end-systolic pressure-volume relations. Am J Physiol. 1987; 252: H1218-H1227.Google Scholar
22.Triulzi, MO, Wilkins, GT, Gillam, LD. Normal adult cross-sectional echocardiographic values: left ventricular volumes. Echocardiography 1985; 2: 153169.Google Scholar
23.McHale, PA, Greenfield, JC Jr. Evalution of several geometric models for estimation of left ventricular circumferential wall strees. Circ Res 1973; 33: 303312.Google Scholar
24.Brutsaert, DL, Rademakers, FE, Sys, SU, Gillebert, TC, Housmans, PR. Analysis of relaxation in the evalution of ventricular function of the heart. Prog CV, Dis 1985; 28: 143163.Google Scholar
25.Weiss, JL, Frederiksen, JW, Weisfeldt, ML. Hemodynamic determinants of the time couse of fall in canine left ventricular pressure. J Clin Invest 1976; 58: 751760.Google Scholar
26.Raff, GL, Glantz, SA. Volume loading slows left ventricular isovolumic relaxation rate. Circ Res 1981; 48: 813824.Google Scholar
27.Varma, SK, Owen, RM, Smucker, ML, Feldman, MD. Is tau a preload independent measure of isovolumic relaxation? Circulation 1989; 80: 17571765.Google Scholar
28.Matsubara, H, Takaki, M, Yasuhara, S, Araki, J, Duga, H. Logistic time-constant of isovolumic relaxation pressure-time curve in the canine left ventricle. Better alternative to exponential time constant. Circulation 1995; 92; 23182326.Google Scholar
29.Lee, CH, Vancheri, F, Josen, MS, Gibson, DG. Discrepancies in the measurement of isovolumic relaxation time: a study comparing M mode and Doppler echocardiography. Br Heart J 1990; 64: 214218.Google Scholar
30.Nishimiura, RA, Tajik, J. Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician's rosetta stone. J Am Coll Cardiol 1997; 30: 818.Google Scholar
31.Penny, DJ, Lincoln, C, Shore, DF, Xiao, HB, Rigby, ML, Redington, AN. The early response of the systemic ventricle during transition to the Fontan circulation An acute hypertrophic cardiomyopathy? Cardiology in the Young 1992; 2: 7884.Google Scholar
32.Mattheos, M, Shapiro, E, Oldershaw, PJ, Sacchetti, R, Gibson, DG. Non-invasive assessment of changes in left ventricular relaxation by combined phone- echo- and mechanocardiography. Br Heart J 1982; 47: 253260.Google Scholar
33.Venco, A, Gibson, DG, Brown, DJ. relation between apex cardiogram and changes in left ventricular pressure and dimension. Br Heart J 1977; 39: 117125.Google Scholar
34.Kuecherer, HF, Kusumoto, F, Muhiudeen, IA, Cahalan, MK, Schiller, NB. Pulmonary venous flow patterns by transesophageal pulsed Doppler echocardiography: relation to parameters of left ventricular systolic and diastolic funtion. Am Heart J 1991; 122: 16831693.Google Scholar
35.Sun, Y, Sjoberg, BJ, Ask, P, Loyd, D, Wranne, B. Mathematical model that characterizes transmitral and pulmonary venous flow patterns. Am J Physiol 1995; 268: H476-H489.Google Scholar
36.Kremastinos, DT, Tsiapras, DP, Tsetsos, GA, Rentoukas, EI, Vretou, HP, Toutouzas, PK. Left ventricular diastolic Doppler characteristics in beta-thalassemia major. Circulation 1993; 88: 11271135.Google Scholar
37.Chan, KY, Redington, AN, Rigby, ML, Gibson, DG. Cardiac function after surgery for subaortic stenosis: non-invasive assessment of left ventricular perfomance. Br Heart J 1991; 66: 161165.Google Scholar
38.Redington, AN, Penny, DJ. Rigby, ML. Hayes, A. Antegrade diastolic pulmonary arterial flow as a marker of right ventricular restrction after complete repair of pulmonary atresia with intact septum and critical pulmonary value stenois. Cardiology in the Young 1992; 2: 382386.Google Scholar
39.Cullen, S, Shore, D, Redington, A. Characterisation of right ventricular diastolic performance after complete repair of tetralogy of Fallot. Circulation 1995; 91: 17821789.Google Scholar
40.Appleton, CP, Hatle, LK, Popp, RL. Superior vena cava and hepatic vein Doppler echocardiography in healthy adults. J Am Coll Cardiol 1987; 10: 10321039.Google Scholar
41.Aoyagi, T, Iizuka, M, Takahashi, T, Ohya, T, Serizawa, T, Momomura, S, Sato, H, Mochizuki, T, Matsui, H, Ikenouchi, H et al. Wall motion asynchrony prolongs time constant of left ventricular relaxation. Am J Physiol. 1989; 257: H883890.Google Scholar
42.Greenbaum, RA, Gibson, DG. Regional non-uniformity of left ventricular wall movement in man. Br Heart J 1981; 45: 2934.Google Scholar
43.Penny, DJ, Redington, AN. Angiographic demonstration of incoordinate motion of the ventricular wall after the Fontan operation. Br Heart J 1991; 66: 456459.Google Scholar
44.Fogel, MA, Gupta, KB, Weinberg, PM, Hoffman, EA. Regional wall motion and strain analysis across stages of Fontan reconstruction by magnetic resonance tagging. Am J Physiol 1995; 269: H1132-H1152.Google Scholar
45.Sasson, Z, Hatle, L, Appleton, CP, Jewett, M, Alderman, EL, Popp, RL. Intraventricular flow during isovolumic relaxation: description and characterization by Doppler echocardiography. J Am Coll Cardiol. 1987; 10: 539546.Google Scholar
46.Penny, DJ, Rigby, ML, Redington, AN. Abnormal patterns of intraventricular flow and diastolic filling after the Fontan operation: evidence for incoordinate ventricular wall motion. Br Heart J 1991: 66: 375378.Google Scholar
47.Binkley, PF, Van Fossen, DB, Nunziata, E, Unverferth, DV, Leier, CV. Influence of positive inotropic therapy on pulsarile hydraulic load and ventricular-vascular coupling in congestive heart failure. J Am Coll Cardiol 1990 15: 11271135.Google Scholar
48.Vincent, J-L, Roman, A, De Backer, D and Kahn, RJ. Oxygen uptake/supply dependency Effects of short-term dobutamine infusion. Am Rev Respir Dis 1990; 142: 27.Google Scholar
49.Penny, DJ, Sano, T, Forster, KM, Smolich, JJ. Increases in systemic oxygen consumption offset improvements in systemic oxygen delivery during dobutamine infusion in newborn lambs. (Abstract). British Cardiac Society. Annual Meeting 1996.Google Scholar