Assessment of contractility changes in humans by transoesophageal echocardiography: The peak-systolic pressure end-systolic diameter relationship (PSPESDRS)

  • H. Heinrich
  • Th. Fösel
  • L. Fontaine
  • D. Spilker
  • H. Winter
  • F. W. Ahnefeld


The peak-systolic pressure end-systolic diameter relationship (PSPESDRS) was determined in ten healthy subjects under general anaesthesia by using the radial artery pressure tracing (peak-systolic pressure) and transoesophageal 2d-and m-mode echocardiography (left ventricular diameters) without blocking of autonomic reflexes. Left ventricular load was changed by injection of a single intravenous dose of 0,2 mg nitroglycerin (NTG). Linear regression analysis showed a close linear relationship during the pressure decrease between peak-systolic pressures and end-systolic diameters.

During infusion of dobutamine 5 μg/kg/min there was also a close linear relationship during pressure decrease with increased slope and unchanged Do (D0=diameter at theoretical pressure zero). Values taken during pressure returning to control level were shifted leftward indicating transient increased contractility.

We conclude, that the PSPESDRS can reliably be measured in humans without autonomic blockade during the decrease of arterial pressure after NTG, where reflex changes in inotropy are not yet present. This relationship increases in slope with dobutamine, reflecting the increased contractile state.

Key words

Contractility peak-systolic pressure end systolic diameter relationship—transoesophageal echocardiography 


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  1. 1.
    Borow KM, Neumann A, Wynne J: Sensitivity of end-systolic pressure-dimension and pressure-volume relations to the inotropic state in humans. Circulation 65: 988, 1982.PubMedGoogle Scholar
  2. 2.
    Bow ditch HP: Über die Eigenthümlichkeiten der Reizbarkeit, welche die Muskelfasern des Herzens zeigen. Arbeiten aus der Physiologischen Anstalt zu Leipzig. In: Berichte der Ges d Wiss zu Leipzig math physt: CL 652, 1871.Google Scholar
  3. 3.
    Davidson DM, Covell JW, Malloch CJ, Ross R: Factors influencing indices of left ventricular contractility in the dog. Cardiovasc Res 8: 299, 1974.PubMedCrossRefGoogle Scholar
  4. 4.
    Gilber BW, Hew EM: Physiologic significance of hemodynamic measurements and their derived indices. CMA Journal 121: 871, 1979.Google Scholar
  5. 5.
    Grossman W, Braunwald E, Maun T, Mc Laurin LP, Green LH: Contractile state of the left ventricle in man as evaluated from end-systolic pressure-volume relations. Circulation 56: 845, 1977.PubMedGoogle Scholar
  6. 6.
    Heinrich H, Fontaine L, Fösel Th, Spilker D, Winter H, Ahnefeld FW: Vergleichende echokardiographische Untersuchungen zur negativen Inotropie von Halothan, Enfluran und Isofluran. Anaesthesist 35: 465, 1986.PubMedGoogle Scholar
  7. 7.
    Hillel Z, Thys D, Goldman ME, Salek M, Kaplan JA: Intraoperative measurement of the effects of dopamine on LV contractility. Anesthesiology 63: A 25, 1985.CrossRefGoogle Scholar
  8. 8.
    Hirshleifer J, Crawford M, O’Rourke RA, Karliner JS: Influence of acute alterations in heart rate and systemic arterial pressure on echocardiographic measures of left ventricular performance in normal humans subjects. Circulation 52: 835, 1975.PubMedGoogle Scholar
  9. 9.
    Kass DA, Yamazaki T, Burkhoff D, Maughan WL, Sagawa K: Left ventricular end-systolic pressure-volume relationships by the conductance (volume) catheter technique. Circulation 73: 586, 1986.PubMedGoogle Scholar
  10. 10.
    Koch-Weser J, Blinks JR: The influence of the interval between beats on myocardial contractility. Pharmacol Rev 15: 601, 1963.PubMedGoogle Scholar
  11. 11.
    Little WC, Freeman GL: Effect of nitroprusside and angiotensin II on the left ventricular end-systolic pressure-volume relation in closed chest dogs. Circulation 70, Supp II: II-236 (Abstract), 1984.Google Scholar
  12. 12.
    Mahler F, Yoran C, Ross R: Inotropic effect of tachycardia and poststimulation potentiation in the conscious dog. Am J Physiol 227: 569, 1974.PubMedGoogle Scholar
  13. 13.
    Mahler F, Covell JW, Ross R: Systolic pressure-diameter relations in the normal conscious dog. Cardiovasc Res 9: 447, 1975.PubMedCrossRefGoogle Scholar
  14. 14.
    Marsh JD, Green LH, Wynne J, Cohn PF, Grossman WC: Left ventricular end-systolic pressure-dimension and stress-length relations in normal human subjects. Am J Cardiol 44: 1311, 1979.PubMedCrossRefGoogle Scholar
  15. 15.
    Maughan WL, Sunagawa K, Burkhoff D, Sagawa K: Effect of arterial impedance changes on the end-systolic pressure-volume relation. Circ Res 54: 595, 1984.PubMedGoogle Scholar
  16. 16.
    Monroe RG, Gamble WJ, La Farge CG, Stark HJ, Sanders GL, Phornphutkul C, Davis M: The Anrep effekt reconsidered. J Clin Invest 51: 2573, 1972.PubMedCrossRefGoogle Scholar
  17. 17.
    Noble MJM: Left ventricular load, arterial impedance and their interrelationships. Cardiovasc Res 13: 183, 1979.PubMedCrossRefGoogle Scholar
  18. 18.
    Sagawa K: The end-systolic pressure-volume relation of the ventricle: Definition, modifications and clinical use. Circulation 63: 1223, 1981.PubMedGoogle Scholar
  19. 19.
    Scher AM: Carotid and aortic regulation of arterial blood pressure. Circulation 56: 521, 1977.PubMedGoogle Scholar
  20. 20.
    Suga H, Sagawa K, Shoukas AA: Load independence of the instantaneous pressure-volume ratio of the canine left ventricle and effects of epiuephrine and heart rate on the ratio. Circ Res 32: 314, 1973.PubMedGoogle Scholar
  21. 21.
    Suga H, Hisano R, Goto Y, Yamada O: Normalization of end-systolic pressure-volume relation and Emax of different sized hearts. Jap Circ J 48: 136, 1984.PubMedGoogle Scholar
  22. 22.
    Tuttle RR, Mills J: Development of a new catecholamine to selectively increase cardiac contractility. Circ Res 36: 185, 1975.PubMedGoogle Scholar
  23. 23.
    Vatner SF, Higgins CB, Millard RW, Franklin D: Direct and reflex effects of nitroglycerin on coronary and left ventricular dynamics in conscious dogs. J Clin Invest 51: 2872, 1972.PubMedCrossRefGoogle Scholar
  24. 24.
    Vatner SF, Monroe RG, Mc Ritchie RJ: Effects of anesthesia, tachycardia, and autonomic blockade on the Anrep effect in intact dogs. Am J Physiol 226: 1450, 1974.PubMedGoogle Scholar
  25. 25.
    Vatner SF, Braunwald E: Cardiovascular control mechanisms in the conscious state. New Engl J Med 293: 970, 1975.PubMedGoogle Scholar

Copyright information

© Martinus Nijhoff Publishers 1987

Authors and Affiliations

  • H. Heinrich
    • 1
  • Th. Fösel
    • 1
  • L. Fontaine
    • 1
  • D. Spilker
    • 1
  • H. Winter
    • 1
  • F. W. Ahnefeld
    • 1
  1. 1.Centre of AnaesthesiaUniversity of UlmUlmBRD

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