Preload dependence of dP/dt max, VCE max and calculated V max compared to the inotropic sensitivity of these indices of cardiac contractility.

In five canine heart-lung preparations the preload dependence of dP/dt max, V max, VCE max and (dP/dt:P-EDP + C) max was related to the inotropic sensitivity of these indices. V max and (dP/dt:P-EDP + C) max are less affected by preload changes than dP/dt max and therefore should be more suitable for inotropic measurements. But even if the preload changes caused by inotropic interventions are not taken into account, V max shows the same inotropic sensitivity as dP/dt max when the contractile state is reduced and an even lower sensitivity when the contractile state is enhanced. The sensitivity of (dP/dt:P-EDP + C) max, however, is much lower over the whole range of tested inotropic states. If enddiastolic pressure is kept constant during inotropic interventions, dP/dt max is a much more sensitive inotropic index than V max. VCE max usually shows a negative correlation to the diastolic filling of the heart. In the improved inotropic state this correlation can become positive, thus making it impossible to evaluate the influence of the preload dependence on the result. None of the tested parameters shows a higher inotropic sensitivity than dP/dt max, though the preload dependence of dP/dt max is more evident. Therefore, none of these more complicated parameters has any advantage over the simple measure dP/dt max for evaluation of acute changes in contractility.