The Ventricle pp 225-236 | Cite as

Pressure Overload: Human Studies

  • Blase A. Carabello
  • William Grossman

Abstract

When a pressure overload is placed on the myocardium, systolic wall stress is initially increased. The increased load, through an unknown mechanism, is a stimulus to the laying down of sarcomeres in parallel, producing concentric hypertrophy. The resulting increased wall thickness “absorbs” the increase in pressure and helps reestablish wall stress at a normal level [1, 2]. Since afterload is a key determinant of ejection performance of the ventricle, this compensation is adaptive, because by normalizing stress, ventricular ejection performance is maintained. However, when the pressure overload is severe and prolonged, muscle dysfunction may occur. Thus, pressure-overload concentric hypertrophy may be either compensatory or pathologic, depending on the clinical situation. The following is a synopsis of current knowledge regarding the effects of pressure overload and hypertrophy on the human left and right ventricles.

Keywords

Depression Ischemia Lactate Rubber Radionuclide 

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References

  1. 1.
    Hood, W.P., Rackley, C.E., and Rolett, E.L. Wall stress in the normal and hypertrophied left ventricle. Am. J Cardiol 22: 550, 1968.PubMedCrossRefGoogle Scholar
  2. 2.
    Grossman, W., Jones, D., and McLaurin, L.P. Wall stress and patterns of hypertrophy in the human left ventricle. J. Clin. Invest 56: 56, 1975.PubMedCrossRefGoogle Scholar
  3. 3.
    Rapaport, E. Natural history of aortic and mitral valve disease. Am. J. Cardiol 35: 221, 1975.PubMedCrossRefGoogle Scholar
  4. 4.
    Smith, N., McAnuly, J.H., and Rahimtoola, S.H. Severe aortic stenosis with impaired left ventricular function and clinical heart failure: Results of valve replacement. Circulation 58: 255, 1978.PubMedGoogle Scholar
  5. 5.
    Schwarz, E., Baumann, P., Manthey,J., Hoffman, M., Schuler, G., Mehmel, H., Schmitz, W., and Kubler, W. Effect of aortic valve replacement on survival. Circulation 66: 1105–1109, 1982.PubMedCrossRefGoogle Scholar
  6. 6.
    Carabello, B.A., Green, L.H., Grossman, W., Cohn, L.H., Koster, J.K., and Collins, J. Jr. Hemodynamic determinants of prognosis of aortic valve replacement in clinical aortic stenosis and advanced congestive heart failure. Circulation 62: 42–48, 1980.PubMedGoogle Scholar
  7. 7.
    Croake, R.P., Pifarre, R., Sullivan, W., Gunnar, R., and Loeb, H. Reversal of advanced left ventricular dysfunction following aortic valve replacement for aortic stenosis. Ann. Thorac. Surg 24: 38, 1977.CrossRefGoogle Scholar
  8. 8.
    Cohn, P.F., Gorlin, R., Cohn, L.H., and Collins, J J., Jr. Left ventricular ejection fraction as a prognostic guide in surgical treatment of coronary and valvular heart disease. Am. J. Cardiol 34: 136, 1974.PubMedCrossRefGoogle Scholar
  9. 9.
    Thompson, R., Yacoub, M., Ahmed, M., SeabraGomes, R., Rickards, A., and Towers, M. Influence of preoperative left ventricular function on results of homograft replacement of the aortic valve for aortic stenosis. Am. J. Cardiol 43: 929, 1979.PubMedCrossRefGoogle Scholar
  10. 10.
    Forman, R., Firth, B.G., and Barnard, M.S. Prognostic significance of preoperative left ventricular ejection fraction and valve lesion in patients with aortic valve replacement. Am. J. Cardiol 45: 1120–1125, 1980.PubMedCrossRefGoogle Scholar
  11. 11.
    Gunther, S. and Grossman, W. Determinants of ventricular function in pressure-overload hypertrophy in man. Circulation 59: 679–688, 1979.PubMedGoogle Scholar
  12. 12.
    Huber, D., Grimm, J., Koch, R., and Krayenbuehl, H.P. Determinants of ejection performance in aortic stenosis. Circulation 64: 126, 1980.CrossRefGoogle Scholar
  13. 13.
    Carabello, B.A., Wynne, J., and Holman, B.L. Assessment of left ventricular function after aortic valve replacement. Circulation 60 (Suppl. II): 192, 1979.Google Scholar
  14. 14.
    Donner; R., Carabello, B.A., Black, I., and Spann, J.F. Left ventricular wall stress in compensated aortic stenosis in children. Am. J. Cardiol 51: 946–951, 1983.CrossRefGoogle Scholar
  15. 15.
    Strauer, B. Ventricular function and coronary hemodynamics in hypertensive heart disease. Am. J. Cardiol 44: 999, 1979.PubMedCrossRefGoogle Scholar
  16. 16.
    Graham, T.P., Lewis, B.W., Jarmakani, M.M., Canent, R.V., and Capp, M.P. Left heart volume and mass quantification in children with left ventricular pressure overload. Circulation 41: 203–212, 1970.PubMedGoogle Scholar
  17. 17.
    Fifer, M.A., Gunther, S., Grossman, W., Mirsky, I., Carabello, B., and Barry, W.H. Myocardial contractile function in aortic stenosis as determined from the rate of stress development during isovolumic systole. Am. J. Cardiol 44: 1318–1325, 1979.PubMedCrossRefGoogle Scholar
  18. 18.
    Liedtke, AJ., Gentzler, R.D., Babb, J.D., Hunter, A.S., and Gault, J.H. Determinants of cardiac performance in severe aortic stenosis. Chest 69: 192–197, 1976.PubMedCrossRefGoogle Scholar
  19. 19.
    Spann, J.F., Bove, A.A., Natarajan, G., and Kreulen, T. Ventricular performance, pump function and compensatory mechanisms in patients with aortic stenosis. Circulation 62: 576, 1980.PubMedGoogle Scholar
  20. 20.
    Lappe, D.L. and Lakatta, E.G. Intensity fluctuation spectroscopy monitors contractile activation in “resting” cardiac muscle. Science 207: 1369–1371, 1980.PubMedGoogle Scholar
  21. 21.
    Lakatta, E.G. and Lappe, D.L. Diastolic scattered light fluctuation, resting force and twitch force in mammalian cardiac muscle. J. Physiol. (London) 315: 369–394, 1981.Google Scholar
  22. 22.
    Hoffman, B.F., Bassett, A.L., and Bartelstone, H J. The mechanical properties of isolated mammalian cardiac muscle. Circ. Res 23: 291–312, 1968.PubMedGoogle Scholar
  23. 23.
    Glantz, S.A. Computing indices of diastolic stiffness has been counterproductive. Fed. Proc 39: 162–168, 1980.PubMedGoogle Scholar
  24. 24.
    Grossman, W., McLaurin, L.P., and Stefadoros, M.A. Left ventricular stiffness associated with chronic pressure and volume overloads in man. Circ. Res 35: 793–800, 1974.PubMedGoogle Scholar
  25. 25.
    Gaasch, W.H., Battle, W.E., Oboler, A.A., Banas, J.S., and Levine, H.J. Left ventricular stress and compliance in man: With special reference to normalized ventricular function curves. Circulation 45: 746, 1972.PubMedGoogle Scholar
  26. 26.
    Grossman, W., McLaurin, L.B., Moss, S.P., et al. Wall thickness and diastolic properties of the left ventricle. Circulation 49: 129–135, 1974.PubMedGoogle Scholar
  27. 27.
    Schwarz, F., Flameng, W., Schaper, J., and Hehr-lein, F. Correlation between myocardial structure and diastolic properties of the heart in chronic aortic valve disease. Effects of corrective surgery. Am. J. Cardiol 42: 895–903, 1978.PubMedCrossRefGoogle Scholar
  28. 28.
    Peterson, K.L., Tsuji, J., Johnson, A., et al. Diastolic ventricular pressure-volume and stress-strain relations in patients with valvular aortic stenosis and left ventricular hypertrophy. Circulation 58: 77–85, 1978.PubMedGoogle Scholar
  29. 29.
    Mirsky, I. Assessment of passive elastic stiffness of cardiac muscle: Mathematical concepts, physiologic and clinical considerations, directions of future research. Prog. Cardiovasc. Dis 18: 277–304, 1976.CrossRefGoogle Scholar
  30. 30.
    Hess, D.M., Schmeider, J., Koch, R., Bamert, C., Grimm, J., and Krayenbuehl, H.P. Diastolic function and myocardial hypertrophy. Circulation 63: 360–371, 1981.PubMedCrossRefGoogle Scholar
  31. 31.
    Miller, D.L., Stinson, E.B., Oyer, P.E. Rossiter, S.J., Reitz, B.A., and Shumway, N.E.’ Surgical implications and results of combined aortic valve replacement and myocardial revascularization. Am. J. Cardiol 43: 494–501, 1979.PubMedCrossRefGoogle Scholar
  32. 32.
    Rowe, G.G., Afonso, S., Lugo, J.E., Castillo, C.A., Boake, W.C., and Crumpton, C.W. Coronary blood flow and myocardial oxidative metabolism at rest and during exercise in subjects with severe aortic valve disease. Circulation 32: 251, 1965.PubMedGoogle Scholar
  33. 33.
    Trenouth, R.S., Phelps, N.C., and Neill, W.A. Determinants of left ventricular hypertrophy and oxygen supply in chronic aortic valve disease. Circulation 53: 644, 1976.PubMedGoogle Scholar
  34. 34.
    Fallen, E.L., Elliott, W.C., and Gôrlin, R. Mechanisms of angina in aortic stenosis. Circulation 36: 480, 1967.PubMedGoogle Scholar
  35. 35.
    Johnson, L.L., Sciacca, R.R., Ellis, K., Weiss, M.B., and Cannon, P.J. Reduced ventricular myocardial blood flow per unit mass in aortic stenosis. Circulation 57: 582, 1978.PubMedGoogle Scholar
  36. 36.
    Pichard, A.D., Gorlin, R., Smith, H., Ambrose, J., and Meller, J. Coronary flow studies in patients with left ventricular hypertrophy of the hypertensive type. Am. J. Cardiol 47: 547, 1981.PubMedCrossRefGoogle Scholar
  37. 37.
    Marcus, M.L., Doty, D.B., Hiratzka, L.F., Wright, C.B., and Eastham, C.L. Decreased coronary reserve. N. Engl, J. Med 307: 1362–1367, 1982.Google Scholar
  38. 38.
    McKee, P.A., Castelli, W.P., McNamara, P.M., and Kannel, W.B. The natural history of congestive heart failure. N. Engl. J. Med 285: 1441, 1971.PubMedCrossRefGoogle Scholar
  39. 39.
    Frohlich, E.D., Tarazi, R.C., and Dustan, H.P. Clinical-physiological correlations in the development of hypertensive heart disease. Circulation 44: 446–455, 1971.PubMedGoogle Scholar
  40. 40.
    Guazzi, M., Fiorentini, C., Olivari, M.T., and Polese, A. Cardiac load and function in hypertension. Am. J. Cardiol 44: 1007–1012, 1979.PubMedCrossRefGoogle Scholar
  41. 41.
    Karliner, J.S., William, D., Gorwit, W., Crawford, M.H., and O’Rourke, R.A. Left ventricular performance in patients with left ventricular hypertrophy caused by systemic hypertension. Br. Heart J 39: 1239–1245, 1977.CrossRefGoogle Scholar
  42. 42.
    Nichols, A.B., Sciacca, R.R., Weiss, M.B., Blood, D.K., Brennan, D.L., and Cannon, PJ. Effect of left ventricular hypertrophy on myocardial blood flow and ventricular performance in systemic hypertension. Circulation 62: 329–340, 1980.PubMedGoogle Scholar
  43. 43.
    Takahashi, M., Sasayama, S., Kawai, C., and Kotoura, H. Contractile performance of the hypertrophied ventricle in patients with systemic hypertension. Circulation 62: 116–125, 1980.PubMedGoogle Scholar
  44. 44.
    Marsh, J.D., Green, L.H., Wynne, J., Cohn, P.F., and Grossman, W. Left ventricular end-systolic pressure-dimension and stress-length relations in normal human subjects. Am. J. Cardiol 44: 1311, 1979.PubMedCrossRefGoogle Scholar
  45. 45.
    Suga, H., Sagawa, K., and Shoukas, A.A. Load independence of the instantaneous pressure-volume ratio of the canine left ventricle and effect of epinephrine and heart rate on the ratio. Circ. Res 32: 314, 1973.PubMedGoogle Scholar
  46. 46.
    Weber, K.T. and Janicki, J.S. Instantaneous forcevelocity-length relations: Experimental findings and clinical correlates. Am. J. Cardiol 40: 740, 1977.PubMedCrossRefGoogle Scholar
  47. 47.
    Weber, K.T., Janicki, J.S., and Hefner, L.L. Left ventricular force-length relations of isovolumic and ejecting contractions. Am. J. Physiol 213: 337, 1976.Google Scholar
  48. 48.
    Liberthson, R.R., Boucher, C.A., Strauss, H.W., Dinsmore, R.E., McKusick, K.A., and Pro-host, G.M. Right ventricular function in adult atrial septal defect. Am. J. Cardiol 47: 56–60, 1981.PubMedCrossRefGoogle Scholar
  49. 49.
    Konstam, M.A., Idoine,J., Wynne, J., Grossman, W., Cohn, LJ., Beck, R., Kozlowski, J., and Holman, B.L. Right ventricular function in adults with pulmonary hypertension with and without atrial septal defect. Am. J. Cardiol 51: 1144–1148, 1983.PubMedCrossRefGoogle Scholar
  50. 50.
    Friedman, B J. and Holman, B.L. Scintigraphic prediction of pulmonary artery pressure by regional right ventricular ejection fraction during the second half of systole. Am. J. Cardiol 50: 1114–1119, 1982.PubMedCrossRefGoogle Scholar
  51. 51.
    Wroblewski, E., James, F., Spann, J.F., and Bove, A.A. Right ventricular performance in mitral stenosis. Am. J. Cardiol 47: 51–55, 1981.PubMedCrossRefGoogle Scholar
  52. 52.
    Stein, P.D., Sabbah, H.N., Anbe, D.T., and Marzilli, M. Performance of the failing and non-failing right ventricle of patients with pulmonary hypertension. Am. J. Cardiol 44: 1050–5, 1979.PubMedCrossRefGoogle Scholar

Copyright information

© Martinus Nijhoff Publishing, Boston 1985

Authors and Affiliations

  • Blase A. Carabello
    • 1
  • William Grossman
    • 1
  1. 1.Section of CardiologyTemple University Health Sciences CenterPhiladelphiaUSA

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