Relaxation-systolic pressure relation - A load-independent assessment of left ventricular contractility
Relaxation-systolic pressure relation - A load-independent assessment of left ventricular contractility
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DOI：
10.1161/01.cir.95.3.745
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发表时间：
1997-02-04
期刊：
影响因子：
37.8
通讯作者：
DeHert, SG
中科院分区：
文献类型：
--
作者：
Gillebert, TC;LeiteMoreira, AF;DeHert, SG
本文综述了负荷对左心室压力（LVP）下降的调节，并将这种调节与左心室收缩力联系起来。LVP下降的负荷调节必须与神经体液调节、动脉反射波诱导的效应以及长期负荷对收缩性的影响区分开来。LVP下降对收缩期LVP中度升高的反应是高度可变的。它取决于实际收缩压和峰值等容压之间的比值，定义为“相对负荷”。当相对载荷达到81%~ 84%时，LVP下降加速。高于该相对负荷，LVP下降减速。根据相对载荷水平，存在各种各样的影响，从LVP下降的适度加速到LVP下降的显著减速。负荷升高时LVP下降加速与正常心功能相关，而LVP下降减慢与心功能受损相关。收缩期LVP降低时观察到类似但相反的效应。收缩期LVP变化对时间常数tau的影响显示与收缩期弹性（Ees）、峰值dP/dt（max）和局部缩短分数（或射血分数）有良好的相关性。与测得的等容LVP有很好的相关性，表明当收缩性用峰值等容压表示时，收缩-舒张耦合是密切的。收缩力与收缩期LVP-舒张关系的评估是精确的，不依赖于负荷，并且可以单独使用定位在左心室腔中的高保真压力计进行。
This contribution reviews the regulation of left ventricular pressure (LVP) fall by load and relates this regulation to left ventricular contractility. Load regulation of LVP fall has to be distinguished from neurohumoral regulation, from effects induced by arterial reflected waves and from long-term load effects on contractility. The response of LVP fall to a moderate elevation of systolic LVP is highly variable. It depends on the ratio between the actual systolic pressure and peak isovolumetric pressure, defined as ''relative load''. Up to a relative load of 81% to 84%, LVP fall accelerates. Above this relative load, LVP fall decelerates. Depending on the level of relative load there is a wide variety of effects ranging from moderate acceleration of LVP fall to marked deceleration of LVP fall. Acceleration of LVP fall in response to a load elevation is associated with normal cardiac function, while slowing of LVP fall is associated with impaired cardiac function. Similar but opposite effects are observed with reductions of systolic LVP. Effects of changes in systolic LVP on time constant tau reveal a fair correlation with systolic elastance (Ees), peak dP/dt(max) and regional fractional shortening (or ejection fraction). There is an excellent correlation with measured isovolumetric LVP, indicating that contraction-relaxation coupling is close when contractility is expressed in terms of peak isovolumetric pressure. Assessment of contractility with systolic LVP-relaxation relation is precise and load independent and can be performed with the sole use of a high-fidelity pressure gauge positioned in the left ventricular cavity.