SENSITIVITY OF END-SYSTOLIC PRESSURE-DIMENSION AND PRESSURE-VOLUME RELATIONS TO THE INOTROPIC STATE IN HUMANS
SENSITIVITY OF END-SYSTOLIC PRESSURE-DIMENSION AND PRESSURE-VOLUME RELATIONS TO THE INOTROPIC STATE IN HUMANS
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DOI：
10.1161/01.cir.65.5.988
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发表时间：
1982-01-01
期刊：
影响因子：
37.8
通讯作者：
WYNNE, J
中科院分区：
文献类型：
--
作者：
BOROW, KM;NEUMANN, A;WYNNE, J
提出了左心室收缩末期压力-尺寸和压力-容积关系的斜率值作为左心室变力状态的定量测量。LV变力性状态的这种测量是有吸引力的，因为它独立于前负荷并包含后负荷。为了研究这些关系的斜率对收缩状态改变的敏感性，在输注甲氧胺以改变收缩末期压和输注多巴酚丁胺（5 μ g/kg/min）以增加LV变力状态期间，使用M-模式超声心动图、心音图和间接颈动脉脉搏记录来研究10名正常受试者。每例受试者的心率维持在较窄范围内。通过标准方法从收缩末期超声心动图尺寸计算收缩末期容积。收缩末期压由重搏切迹压估计，重搏切迹压由校准的颈动脉脉搏记录确定;峰值收缩压也被测量。无论采用哪种方法来近似收缩末期压，正性肌力干预均导致收缩末期压-维度和压力-容积线的显著偏移。多巴酚丁胺组收缩末期压力-容积关系的斜率增加25%（16- 46%，P < 0.001），收缩末期压力-容积关系的斜率增加55%（37- 85%，P < 0.001）。在所有情况下，曲线呈线性，并随着正性肌力干预而变陡。相反，收缩压峰值-收缩末期内径关系的斜率值显示了对多巴酚丁胺输注的可变反应（平均变化13%，范围77-73%; NS [不显著]）。虽然收缩压峰值-收缩末期内径曲线的位置随着变力状态的改变而一致地移动，但是这些曲线的斜率值不是LV收缩力变化的可靠指标。然而，将收缩末期压力（通过重搏切迹压力估计）与收缩末期尺寸或体积相关的线的斜率的值对人类受试者中变力状态的变化高度敏感。
The value for the slope of the left ventricular (LV) end-systolic pressure-dimension and pressure-volume relations was proposed as a quantitative measure of the LV inotropic state. This measure of LV inotropic state is attractive because it is independent of preload and incorporates afterload. To investigate the sensitivity of the slope of these relations to alterations in contractile state, 10 normal subjects were studied using M-mode echocardiographic, phonocardiographic and indirect carotid pulse recordings during infusion of methoxamine to alter end-systolic pressure and during infusion of dobutamine (5 .mu.g/kg per min) to increase LV inotropic state. Heart rate was maintained within a narrow range for each subject. End-systolic volume was calculated from end-systolic echocardiographic dimension by standard methods. End-systolic pressure was estimated from the dicrotic notch pressure determined from a calibrated carotid pulse recording; peak systolic pressure was also measured. Regardless of the method of approximating end-systolic pressure, the positive inotropic intervention caused a leftward shift in the end-systolic pressure-dimension and pressure-volume lines. With the dobutamine infusion, the value for the slope of the end-systolic pressure-dimension relation increased by 25% (range 16-46%, P < 0.001), while the slope of the end-systolic pressure-volume relation increased by 55% (range 37-85%, P < 0.001). In all cases, the curves were linear and became steeper with the positive inotropic intervention. In contrast, the value of the slope of the peak systolic pressure-end-systolic dimension relation showed a variable response to the dobutamine infusion (mean change 13%, range 77-73%; NS [not significant]). Although the position of the peak systolic pressure-end-systolic dimension curve is consistently shifted with an alteration in inotropic state, the values of the slope of these curves are not reliable indicators of change in LV contractility. The values for the slope of the line relating end-systolic pressure (estimated by dicrotic notch pressure) to end-systolic dimension or volume, however, are highly sensitive to a change in inotropic state in human subjects.