The Concept of Systolic Myocardial Stiffness with Applications to the Assessment of Myocardial Contractility in Health and Disease

  • Israel Mirsky


This review article briefly describes the new concept of systolic myocardial stiffness and its application to assessing the myocardial contractile state in patients with aortic and mitral valve disease. The physiologic studies demonstrate linearity of the end-systolic stress-strain relation (ESSSR) which results in nonlinearity of the end-systolic pressure-volume relation. If Vo (volume at zero stress), is not markedly altered by drug interventions, changes in the slope of the ESSSR reflect changes in the inotropic state. The concept also permits the development of the entire ejection fraction-afterload relation (for a given preload) thus enabling contractile states to be compared between ventricles.

An approximate method based on a single beat analysis to assess myocardial contractility is applied to clinical data obtained from patients with aortic and mitral valve disease. The contractile state based on conventional methods shows marked discrepancies compared with those assessed on the basis of the systolic stiffness concept. The value of this concept is demonstrated by comparing contractile states pre- and postoperatively in several patients.


Inferior Vena Cava Aortic Stenosis Mitral Regurgitation Myocardial Contractility Mitral Valve Disease 
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Copyright information

© Springer-Verlag Tokyo 1989

Authors and Affiliations

  • Israel Mirsky
    • 1
  1. 1.Harvard Medical School and Brigham and Women’s HospitalBostonUSA

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