Contractility and Pump Function of In Vivo Left Ventricle and Its Coupling with Arterial Load: Testing the Assumptions

  • Kiichi Sagawa
  • David A. Kass
  • Seiryo Sugiura
  • Daniel Burkhoff
  • Joe Alexander


In the studies reviewed, we tested the assumptions inherent in applying the ventricular and vascular elastance concepts to in vivo physiology. The greatest difference between in vivo and isolated heart data appeared to be in the frequently nonlinear shape of the end-systolic pressure-volume relationship (ESPVR). This suggests that linear model parameters may be of only limited value for predictive or modeling purposes. Extreme changes in ejection history in isolated hearts revealed an important positive (as well as negative) influence of ejection; however, in vivo where afterload alterations and ejection fraction changes are likely to be much less marked, the relative impact of these factors remains unclear. Finally, while substantial differences exist between real arterial and 3-element Windkessel model impedances, when they are loaded on a simple elastance model of ventricular contraction, we predicted good agreement on many important hemodynamic coupling variables. Furthermore, the effective arterial elastance Ea appeared to be a reasonable representation of in vivo aortic impedance, and thus may be a useful afterload parameter to be coupled with end-systolic elastance(Ees).

Modifications of the coupling equations derived previously for stroke work and myocardial efficiency will likely need to be made to reflect the nonlinear ESPVR. However, as we noted, this may not substantially alter several previously proposed principles and conclusions based on linear models.


Mean Arterial Pressure Stroke Work Contractile State Myocardial Efficiency Inferior Vena Caval Occlusion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Suga H, Sagawa K (1974) Instantaneous pressure-volume relationships and their ratio in the excised, supported canine left ventricle. Circ Res 35: 117PubMedGoogle Scholar
  2. 2.
    Suga H, Sagawa K, Shoukas AA (1973) Load independence of the instantaneous pressure-volume ratio of the canine left ventricle and effects of epinephrine and heart rate on the ratio. Circ Res 32: 314PubMedGoogle Scholar
  3. 3.
    Sunagawa K, Maughan WL, Burkhoff D, Sagawa K (1983) Left ventricular interaction with arterial load studied in isolated canine ventricle. Am J Physiol 245 (Heart Circ Physiol 14): H773PubMedGoogle Scholar
  4. 4.
    Sunagawa K, Maughan WL, Sagawa K (1985) Optimal arterial resistance for the maximal work studied in isolated canine left ventricle. Circ Res 56: 586–595PubMedGoogle Scholar
  5. 5.
    Mehmel HC, Stockinsk B, Ruffnamm K, Olshuausen KV, Schuler G, Kobler W (1981) The linearity of the end-systolic pressure-volume relationship in man and its sensitivity for assessment of left ventricular function. Circulation 63: 1216PubMedCrossRefGoogle Scholar
  6. 6.
    McKay RG, Aroesty JM, Heller GV, Royal HD, Warren WE, Grossman W (1986) Assessment of the end-systolic pressure-volume relationship in human beings with the use of a time varying elastance model. Circulation 74: 97PubMedCrossRefGoogle Scholar
  7. 7.
    Kass DA, Midei M, Graves W, Brinker JA, Maughan WL (1988) Use of a conductance (volume) catheter and inferior vena caval occlusion for rapid determination of pressure-volume relationships in man. Cathet Cardiovasc Diagn 15: 192PubMedCrossRefGoogle Scholar
  8. 8.
    Burkhoff D, Sugiura S, Yue DT, Sagawa K (1987) Contractility-dependent curvilinearity of end-systolic pressure-volume relations. Am J Physiol 252 (Heart Circ Physiol 21): H1218PubMedGoogle Scholar
  9. 9.
    Kass DA, Beyar R, Heard M, Maughan WL, Sagawa K (1987) Curvilinear ESPVR in situ can yield negative estimated volume intercept (Vo) and Vo change with inotropic state, (abstract) Circulation 76 (Suppl IV): IV-428Google Scholar
  10. 10.
    Hibberd MG, Jewell BR (1982) Calcium and length dependent force production in rat ventricular muscle. J Physiol 329: 527PubMedGoogle Scholar
  11. 11.
    Kentish JC, ter Keurs HEDJ, Ricciardi L, Bucx JJ, Nobel MIM (1986) Comparison between sarcomere length-force relations of intact and skinned trabeculae from rat right ventricle. Circ Res 58: 755PubMedGoogle Scholar
  12. 12.
    Suga H, Sàgawa K, Demer L (1979) Determinants of instantaneous pressure in canine left ventricle: time and volume specification. Circ Res 46: 238Google Scholar
  13. 13.
    Schroff SG, Janicki JS, Weber KT (1985) Evidence and quantification of left ventricular systolic resistance. Am J Physiol 249: (Heart Circ Physiol 18): H353Google Scholar
  14. 14.
    Hunter WC, Burkhoff D, Oikawa R, Sagawa K (1985) Evidence for mechanisms opposing deactivation during ejection in canine left ventricles, (abstract) Fed Proc 44: 1736Google Scholar
  15. 15.
    Sugiura S, Hunter WC, Sagawa K (1989) Long term versus intrabeat history of ejection as determinants of canine ventricular end-systolic pressure. Circ Res 64: 255PubMedGoogle Scholar
  16. 16.
    Allen DG, Kurihara S (1982) The effect of muscle length on intracellular calcium transients in mammalian cardiac muscle. J Physiol 327: 79–94PubMedGoogle Scholar
  17. 17.
    Parmley WW, Chuck L (1973) Length-dependent changes in myocardial contractile state. Am J Physiol 224: 1195PubMedGoogle Scholar
  18. 18.
    Baan J, van der Velde E (1988) Sensitivity of left ventricular end-systolic pressure-volume relation to the type of loading intervention in dogs. Circ Res 62: 1247–1258PubMedGoogle Scholar
  19. 19.
    Kass DA, Maughan WL (1988) From ‘Emax’ to pressure-volume relations: a broader view. Circulation 77: 1203PubMedCrossRefGoogle Scholar
  20. 20.
    Liu Z, Brin KP, Yin FCP (1986) Estimation of total arterial compliance: an improved method and evaluation of current methods. Am J Physiol 251: (Heart Circ Physiol 20) H588-H600PubMedGoogle Scholar
  21. 21.
    Burkhoff D, Alexander J, Schipke J (1988) Assessment of windkessel as a model of aortic input impedance. Am J Physiol 255 (Heart Circ Physiol 24): H742-H753PubMedGoogle Scholar
  22. 22.
    Burkhoff D, Sagawa K (1986) Ventricular efficiency predicted by an analytical model. Am J Physiol 250 (Regulatory Integrative Comp Physiol 19): R1021-R1027PubMedGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 1989

Authors and Affiliations

  • Kiichi Sagawa
  • David A. Kass
  • Seiryo Sugiura
  • Daniel Burkhoff
  • Joe Alexander
    • 1
  1. 1.Department of Biomedical Engineering, School of MedicineThe Johns Hopkins UniversityBaltimoreUSA

Personalised recommendations