Assessment of Cardiac Function in Diseased Heart by Catheterization Study
The assessment of cardiac function by catheterization began with the application of Frank-Starling’s mechanism in clinical practice. Although numerous indexes of contractility have been proposed in the past 20 years, the most reliable methods currently used are: (1) Emax (the slope of end-systolic pressure volume line obtained by changing afterload) by means of pressure and volume recordings, (2) the force-length (end-systolic stress-end-systolic volume) relationship either in the two-dimensional framework or these ratio, and (3) the stress-shortening (afterload-shortening) relationship in the two-dimensional framework for the analysis of systolic function.
Left ventricular relaxation is usually assessed by obtaining the time constant of the pressure fall during the isovolumic relaxation period. The assessment of chamber compliance can be obtained by analysis of the diastolic pressure-volume relationship, and that of muscle compliance can be done by analysis of the stress-strain relationship.
For these evaluations of systolic and diastolic function, the accurate measurement of pressure, volume, and wall thickness are mandatory. Every index proposed in the past, and in current use, has theoritical as well as methodological limitations; there is no golden standard for the assessment of cardiac function.
KeywordsLeft Ventricular Pressure Sarcomere Length Constrictive Pericarditis Peak Filling Rate Restrictive Cardiomyopathy
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