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Am J Physiol Heart Circ Physiol 281: H2385-H2391, 2001;
0363-6135/01 $5.00
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Vol. 281, Issue 6, H2385-H2391, December 2001

Ventricular interaction and external constraint account for decreased stroke work during volume loading in CHF

Thomas D. Moore1, Michael P. Frenneaux1, Rozsa Sas2,1, J. J. Atherton3, Jayne A. Morris-Thurgood1, Eldon R. Smith2, John V. Tyberg2, and Israel Belenkie2,1

2 Departments of Medicine and Physiology and Biophysics, University of Calgary, Calgary, Alberta T2N 4N1, Canada; 3 University of Queensland, Brisbane Q4029, Australia; and 1 Department of Cardiology, Wales Heart Research Institute, University of Wales College of Medicine, Cardiff CF14 4XN, United Kingdom

The slope of the stroke work (SW)-pulmonary capillary wedge pressure (PCWP) relation may be negative in congestive heart failure (CHF), implying decreased contractility based on the premise that PCWP is simply related to left ventricular (LV) end-diastolic volume. We hypothesized that the negative slope is explained by decreased transmural LV end-diastolic pressure (LVEDP), despite the increased LVEDP, and that contractility remains unchanged. Rapid pacing produced CHF in six dogs. Hemodynamic and dimension changes were then measured under anesthesia during volume manipulation. Volume loading increased pericardial pressure and LVEDP but decreased transmural LVEDP and SW. Right ventricular diameter increased and septum-to-LV free wall diameter decreased. Although the slopes of the SW-LVEDP relations were negative, the SW-transmural LVEDP relations remained positive, indicating unchanged contractility. Similarly, the SW-segment length relations suggested unchanged contractility. Pressure surrounding the LV must be subtracted from LVEDP to calculate transmural LVEDP accurately. When this was done in this model, the apparent decrease in contractility was no longer evident. Despite the increased LVEDP during volume loading, transmural LVEDP and therefore SW decreased and contractility remained unchanged.

congestive heart failure; hemodynamics; pericardium


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