Freeman G L
Department of Medicine/Cardiology, University of Texas Health Science Center, San Antonio 78284.
Am J Physiol. 1990 Aug;259(2 Pt 2):H619-25. doi: 10.1152/ajpheart.1990.259.2.H619.
Mechanical response of the left ventricle (LV) in an intact circulatory system to steady-state increases in afterload may differ from that of an isolated LV, because secondary hemodynamic changes cannot be independently manipulated when the circulation is intact. To evaluate the integrated response of the LV in closed-chest dogs to sustained increases in afterload, six animals chronically instrumented with three orthogonal diameter gauges and LV manometers were studied after autonomic blockade and fentanyl-droperidol anesthesia. End-systolic pressure-volume (PES-VES) and stroke work end-diastolic volume (SW-EDV) relations and the relations between pressure-volume area (PVA, area bounded by PV loop and PES-VES relation) and EDV were quantified. Balloon inflation (BI) in the proximal descending aorta increased LV PES from 100.7 +/- 13.4 to 140.2 +/- 19.3 mmHg (P less than 0.002) and LVEDV from 39.1 +/- 11.3 to 43.3 +/- 12.2 ml (P less than 0.01). The slope of the PES-VES relation was not significantly changed, whereas V100, a volume intercept in the common range of pressures, was reduced from 27.5 +/- 7.3 to 23.7 +/- 6.1 ml (P less than 0.005). PVA-EDV relation was highly linear; its slope was increased after BI. Comparison of beats with matched LVEDV before and after BI showed significant increases in maximum rate of pressure development and PVA; the change in SW after BI was modest and not significant. The efficiency of energy transfer from PVA to SW (TransPVA, SW/PVA X 100) decreased from 52.5 +/- 8.6 to 42.6 +/- 6.3% (P less than 0.002).(ABSTRACT TRUNCATED AT 250 WORDS)
在完整循环系统中,左心室(LV)对后负荷稳态增加的机械反应可能与孤立左心室不同,因为当循环完整时,继发性血流动力学变化无法独立控制。为了评估闭胸犬左心室对后负荷持续增加的综合反应,对六只长期植入三个正交直径测量仪和左心室压力计的动物在自主神经阻滞和芬太尼-氟哌利多麻醉后进行了研究。对收缩末期压力-容积(PES-VES)和每搏功-舒张末期容积(SW-EDV)关系以及压力-容积面积(PVA,由压力-容积环和PES-VES关系界定的面积)与EDV之间的关系进行了量化。降主动脉近端的球囊膨胀(BI)使左心室PES从100.7±13.4 mmHg增加到140.2±19.3 mmHg(P<0.002),左心室舒张末期容积(LVEDV)从39.1±11.3 ml增加到43.3±12.2 ml(P<0.01)。PES-VES关系的斜率没有显著变化,而V100(压力常见范围内的容积截距)从27.5±7.3 ml减少到23.7±6.1 ml(P<0.005)。PVA-EDV关系呈高度线性;BI后其斜率增加。比较BI前后左心室舒张末期容积匹配的心动周期,压力最大上升速率和PVA显著增加;BI后每搏功的变化较小且不显著。从PVA到每搏功的能量转移效率(TransPVA,SW/PVA×100)从52.5±8.6%降至42.6±6.3%(P<0.002)。(摘要截断于250字)