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Department of Thoracic and Cardiovascular Surgery, University Hospital of Tromsø, N-9038 Tromsø, Norway
The end-systolic pressure-volume
relationship is regarded as a useful index for assessing the
contractile state of the heart. However, the need for preload
alterations has been a serious limitation to its clinical applications,
and there have been numerous attempts to develop a method for
calculating contractility based on one single pressure-volume loop. We
have evaluated four of these methods. Pressure-volume data were
obtained by combined pressure and conductance catheters in 37 pigs. All
four methods were applied to 88 steady-state pressure-volume files,
including eight files sampled during dopamine infusions. Estimates of
single-beat contractility (elastance) were compared with preload-varied
multiple-beat elastance [Ees(MB)]. All methods
had a low average bias (
0.3 to 0.5 mmHg/ml) but limits of agreement
(±2 SD) were unacceptably high (±2.6 to ±3.8 mmHg/ml). In the
dopamine group, Ees(MB) showed an increase of
1.7 ± 0.8 mmHg/ml (mean ± SD) compared with baseline
(P < 0.001). None of the single-beat methods predicted
this increase in contractility. It is therefore doubtful whether any of
the methods allow for single-beat assessment of contractility.
myocardial contraction; inotropic stimulation; conductance catheter; pigs
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