Abstract
When preload and afterload are kept constant, stroke volume is dependent on contractility, or the inotropic state of the myocardium.1 The inotropic state of the myocardium is an intrinsic property that reflects the strength of the muscle fiber, which in turn is influenced by the neurohormonal (especially cardiac sympathetic nerves) and metabolic (pH, Ca++, etc.) milieu. Traditionally, a change in contractility in the intact heart can be defined as an alteration in overall cardiac performance that occurs independently of alterations in preload, afterload or heart rate. Because of the latter confounding variables, it has been difficult to assess left ventricular contractility in humans and particularly in the acute change of settings in surgery.2–3
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References
Braunwald E, Sonnenblick EH, Ross J Jr. Mechanism of cardiac contraction and relaxation. In: Braunwald E, ed, Heart Disease. 4th ed. WB Saunders, Philadelphia, London, pp 351–392, 1992
O’Kelly BF, Tubau JF, Knight AA, London MJ, Verrier ED, Mangano DT. Measurement of left ventricular contractility using transesophageal echocardiography in patients undergoing coronary artery bypass grafting. Am Heart J 122: 1041–1049, 1991
Mulier JP, Vouters PF, Van Aken H, Vermaut G, Vandermeersch E. Cardiodynamic effects of propofol in comparison with thiopental: Assessment with a transesophageal echocardiographic approach. Anesth Analg 72: 28–35, 1991
Heinrich H, Fontaine L, Fosel T, Spilker D, Winter H, Ahnefeld FW. Vergleichende echocardiographische Untersuchungen zur negativen Inotropien von Halothan, En- fluran and Isofluran. Anaethesist 35: 456–472, 1986
Kikura M, Ikeda T, Kazama T, Ikeda K. Effect of prostaglandin Et on myocardial contractility in dogs anesthetized with halothane: Load independent and noninvasive assessment using transesophageal echocardiography. J Cardiothorac Vase Anesth 6: 586–592, 1992
Kikura M, Ikeda K. Comparison of effects of sevoflurane-nitrous oxide and enflurane- nitrous oxide on myocardial contractility in humans: Load-independent and noninvasive assessment with transesophageal echocardiography. Anesthesiology 79: 235–243, 1993
Goertz AW, Seeling W, Heinrich H, Lindner KH, Schmer U. Influence of high thoracic epidural anesthesia on left ventricular contractility assessed using the end-systolic pressure-length relationship. Acta Anesthesiol Scand 37: 38–44, 1993
Huemer G, Kolev N, Kurz A, Zimpfer M. Influence of positive end-expiratory pressure on right and left ventricular performance assessed by Doppler two-dimensional echocardiography. Chest 106: 67–73, 1994
Kolev N, Usunov G, Vlasakov V. Hemodynamic and pharmacologic influences on the left ventricular echo dimension-pressure loop in dogs. J Cardiography (Tokyo) 14: 537–542, 1984
Borow K. Assessment of left ventricular performance. In: Oldershow T, ed. Textbook of adult and pediatric two-dimensional and Doppler echocardiography. Blackwell, London, pp 97–109, 1989
Erbel R. Principles of global left ventricular function analysis. In: Roelandt JRT, Sutherland GR, Iliceto S, Linker DT, eds. Cardiac Ultrasound. Churchill Livingstone, Edinburgh, London, pp 219–231, 1993
Suter PM, Fairley HB, Isenberg MD. Optimum end-expiratory airway pressure in patients with acute pulmonary failure. N Engl J Med 292: 284–292, 1975
Schuster AH, Nanda NC. Doppler echocardiography in cardiac pacing. PACE 5: 607–609, 1982
Foote GA, Schabel SI, Hodges M. Pulmonary complications of the flow-directed balloon-tipped catheter. N Engl J Med 290: 927–931, 1974
Kolev N, Lazarova M, Lengyel M. Doppler determination of right ventricular output and diastolic filling. J Cardiogr (Tokyo) 16: 569–667, 1986
Schuster AH, Nanda NC. Doppler evaluation of cardiac output. In: Nanda NC, ed. Doppler echocardiography. 2nd ed, Lea & Febiger, Philadelphia, London, pp 103–106, 1993
Vuillle C, Weyman AE. Left ventricle I: General considerations, assessment of chamber size and function. In: Weyman, ed. Principles and practice of echocardiography, 2nd ed. Lea & Febiger, Philadelphia, Baltimore, London, p 605, 1994
Kolev N, Huemer G, Steiner W, Leitner K. On-line assessment of left ventricular volumes and ejection fraction by automated boundary detection and backscatter imaging. J Cardiovasc Diag Proc (NY) 11: 141–145, 1993
Assmann PE. Quantitative echocardiographic analysis of global and regional left ventricular function: a problem revisited. J Am Soc Echocardiog 3: 478 - 482, 1990
Clements FM, Harpole DH, Quill T, Jones RH, McCann RL. Estimation of left ventricular volume and ejection fraction by two-dimensional echocardiography: Comparison of short axis imaging and simultaneous radionuclide angiography. Br J Anaesth 64: 331–336, 1990
Smith MD. Value and limitations of transesophageal echocardiography in determination of left ventricular volumes and ejection fraction. J Am Coll Cardiol 19: 1213–1219, 1992
Katz WE, Gasior TA, Quinland JJ, Gorscan III. Transgastric continuous wave Doppler to determine cardiac output. Am J Cardiol 71: 853–857, 1993
Darmon PL, Hillel Z, Mogtabar A, Mindich B, Thys D. Cardiac output by transesophageal echocardiography using continuous wave Doppler across the aortic valve. Anesthesiology 80: 796–805, 1994
Gorcsan J II, Diana P, Ball BA, Hattler BG. Intraoperative determination of cardiac output by transesophageal continuous wave Doppler. Am Heart J 123: 171–176, 1992
Muhiudeen IA, Kuecherer HF, Lee E, Cahalan MK, Schieller NB. Intraoperative estimation of cardiac output by transesophageal pulsed Doppler echocardiography. Anesthesiology 79: 9–14, 1991
Akamatsu S, Kondo Y, Ueda N, Takeda N, Takeda T, Dohi S. Continuos cardiac output measurements with newly developed pulmonary artery Doppler catheter (Abstr). Anesthesiology 81 (Suppl): A515, 1994
Kolev N, Zimpfer M. Impact of ischemia on diastolic function: Clinical relevance and recent Doppler echocardiographic results. Eur J Anaesth (in press), 1995
Castor G, Klocke K, Stoll M, Helms J, Niedermark I. Simultaneous measurements of cardiac output by thermodilution, thoracic electrical impedance and Doppler ultrasound. Br J Anaesth 72: 133–138, 1994
Fisher DC, Sahn DJ, Friedman MJ. The effect of variations on pulsed Doppler sampling site on calculations of cardiac output. An experimental study in open-chest dogs. Circulation 67: 370–379, 1983
Schuster S, Erbel R, Weilemann LS, Lu W, Wellek S. Monitoring during PEEP ventilation in patients with severe left ventricular failure using transesophageal echocardiography. In: Erbel R, ed. Transesophageal echocardiography. Springer, Berlin, Heidelberg, pp 206–217, 1989
Kumar A, Minagoe S, Thangathurai D. Noninvasive measurement of cardiac output during surgery using a new continuous wave Doppler esophageal probe. Am J Cardiol 64: 793–782, 1989
Haude M, Gerber T, Brennecke R, Erbel R, Meyer J. Continuous and noninvasive monitoring of cardiac output by transesophageal Doppler ultrasound. In: Erbel R, ed. Transesophageal echocardiography. Springer, Berlin, Heidelberg, pp 260–2266, 1989
Kumar A, Minagoe, S, Thangathurai D, Mikhali M, Novia D, Vilijoen JF, Rachim- toola SH, Chandraratna PAN. Noninvasive measurement of cardiac output during surgery using a new continuous wave Doppler esophageal probe. Am J Cardiol 64: 739–798, 1989
Hoit BD, Rash wan M, Watt C, Sahn D, Bharvgrara V. Calculating cardiac output from transmitral volume flow using Doppler and M-mode echocardiography. Am J Cardiol 62: 131–135, 1988
Smith JS, Cahalan MK, Benefield DJ, Byrd BF, Lurz FW, Shapiro WA, Roizen MF, Pouchard MF, Schieller NB. Intraoperative detection of myocardial ischemia in high risk patients. Electrocardiography versus two-dimensional transesophageal echocardiography. Circulation 72: 1015–1021, 1985
Robotham JL, Takata M, Berman M, Harasawa Y. Ejection fraction revisited. Anesthesiology 74: 172–183, 1991
de Bruijn NP, Clements FM, Kisslo JA. Intraoperative transesophageal color flow mapping: Initial experience. Anesth Analg 66: 386–390, 1987
Mangano DT. Preoperative assessment. In: Kaplan JA, ed. Cardiac Anesthesia. 2nd ed. WB Saunders, Philadelphia, pp 341–392, 1987
Baron JF, Coriat P, Mundler TM, Bousseau D, Viars P. Left ventricular global and regional function during lumbar epidural anesthesia in patients with and without angina pectoris. Influence of volume loading. Anesthesiology 66: 621–627, 1987
Thys DM, Kaplan JA. Cardiovascular physiology. In: Miller RD, ed. Anesthesia. 3rd ed. Churchill Livingstone, New York, pp 551–583, 1990
Grein C, Roewer N, Laux G, Schulte J. Perioperative assessment of myocardial contractility by transesophageal echocardiography (Abstr). Anesthesiology 79: A547, 1993
Connelly GP, Arkoff H, Dempsey A, Gillespie D. Left ventricular diastolic dysfunction associated with infrarenal aortic crossclamp (Abstr). Anesthesiology 79: A86, 1993
Fontes ML, Leung J, Mangano DT, SPI Study Group. Should transesophageal echocardiography monitoring be used routinely in the cardiac intensive care unit (Abstr)? Anesthesiology 79: A288, 1993
Ryan T, Burwash I, Graham M, Otto C, Hofer B, Verier E, Spiess B. Is agreement of transesophageal echocardiographic fractional area change and radionuclide ejection fraction dependent on ventricular function (Abstr). Anesthesiology 79: A67, 1993
Berguist BD, Lemon KW, Bellows WH, Leung JM, SPI Study Group. Real-time determination of ejection fraction by transesophageal echocardiography: How accurate are ‘eyeball’ estimates (Abstr)? Anesthesiology 79: A69, 1993
Stamm RB, Carabello BA, Mayers DL, Martin NP. Two-dimensional echocardiographic measurement of left ventricular ejection fraction: prospective analysis of what constitutes an adequate determination. Am Heart J 104–109, 1982
Erbel R, Krebs W, Henn G, Schweizer P, Richter HA, Meyer J, EfFert S. Comparison of single-plane and biplane volume determination by two-dimensional echocardiography. Eur Heart J 3: 469–574, 1982
Amoore JH, Santamore WP. Model studies of the contribution of ventricular interdependence of the transient changes in ventricular function with respiratory effort. Cardiovasc Res 23: 683–687, 1989
Antani J A, Wayne HH, Kuzman WJ. Ejection phase indexes by invasive and noninvasive methods: an apexcardiographic, echocardiographic and ventriculographic study. Am J Cardiol 43: 239–243, 1979
Kolev N. Evaluation of contractile state of the left ventricle from the peak of the first derivative of the apex cardiogram. Am Heart J 100: 600–604, 1980
Chen C, Rodriguez L, Cuerrero L, Marshall S, Levine RA, Weyman AE, Thomas JD. Noninvasive estimation of instantaneous first derivative of left ventricular pressure using continuous wave Doppler echocardiography. Circulation 83: 2101–2110, 1991
Bove AA, Santamore WP. Mechanical performance of the heart: In: Giulian ER, Fuster V, Gersh BJ, McCoon MD, McCoon DC, eds. Cardiology. Fundamental and practice, 2nd ed. Mosby, St Louis, Baltimore, 1987, pp 154–157.
Kolev N, Zimpfer M, Black AM. Ventricular function curves revisited. Eur J Anaesth (in press), 1995
Shuga H, Sagawa K. Determinants of instantaneous pressure in canine left ventricle: time and volume specification. Circul Res 46: 256–259, 1980
Huemer G, Kolev N, Zimpfer M. Echocardiographic assessment of left ventricular systolic function - the anesthesiologist’s view. Eur J Anaesth 11: 437–441, 1994
Goertz AW, Lindner KH, Seefelder C, Schirmer U, Beyer M, Georgieff M. Effect of phenylephrine bolus administration on global left ventricular function in patients with coronary artery disease and patients with valvular aortic stenosis. Anesthesiology 78: 834–841, 1993
Gorcsan J, Denault A, Gasior TA, Mandarino WA, Kancel MJ, Deneault LG, Hattler BG, Pinsky MR. Rapid estimation of left ventricular contractility from end-systolic relations by echocardiographic automated border detection and femoral arterial pressure. Anesthesiology 81: 553–562, 1994
Parker MM, Ognibene FP, Parrillo JE Peak-systolic pressure/end-systolic volume ratio, a load-independent measure of ventricular function, is reversely decreased in human septic shock. Crit Care Med 22: 1955–1959, 1994
Carabello BA, Spann JF. The use and limitations of end-systolic indexes of left ventricular function. Circulation 69: 1058–1064, 1984
Zimpfer M, Kolev N. Positive inotropic and vasoactive drugs: their therapeutic use in perioperative heart failure. Int J Anaesth (in press) 1994
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Kolev, N., Huemer, G., Zimpfer, M. (1995). Contractility. In: Transesophageal Echocardiography. Springer, Vienna. https://doi.org/10.1007/978-3-7091-7676-4_6
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DOI: https://doi.org/10.1007/978-3-7091-7676-4_6
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