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Am J Physiol Heart Circ Physiol (May 20, 2004). doi:10.1152/ajpheart.00123.2004
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Submitted on February 5, 2004
Accepted on May 17, 2004

Preload-adjusted right ventricular maximal power: concept and validation

Soren Schenk1, Zoran B. Popoviz2, Yoshie Ochiai1, Fernando Casas1, Patrick M. McCarthy3, Randall C. Starling2, Michael W. Kopcak1, Raymond Dessoffy1, Jose L. Navia4, Neil L. Greenberg2, James D. Thomas2, and Kiyotaka Fukamachi1*

1 Department of Biomedical Engineering, The Cleveland Clinic Foundation, Cleveland, OH, USA
2 Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, OH, USA
3 Department of Biomedical Engineering, The Cleveland Clinic Foundation, Cleveland, OH, USA; Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA
4 Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA

* To whom correspondence should be addressed. E-mail: fukamach{at}ccf.org.

Right ventricular (RV) maximal power (PWRmx) is dependent on preload. The objective of this study was to test our hypothesis that the PWRmx vs end-diastolic volume (EDV) relationship, analogous to the load-independent stroke work vs EDV relationship (PRSW), is linear, with x-axis intercept (V0PWR) corresponding to PRSW intercept (V0SW). If our hypothesis is correct, the preload sensitivity of PWRmx could be eliminated by adjusting for EDV and V0PWR. Ten dogs were instrumented with pulmonary flow probe, micromanometers, and RV conductance catheter. Data were obtained during bicaval occlusions under various conditions and fitted to PWRmx = a.(EDV- V0PWR){beta}. The PWRmx vs EDV relationship did not deviate from linearity ({beta} = 1.09, P NS vs 1), and V0PWR correlated with V0SW (r = 0.93, P <0.0001). V0PRW was related to steady-state EDV and left ventricular end-diastolic pressure, allowing for estimation of V0PWR (V0Est) and single beat PWRmx preload adjustment. Dividing PWRmx by the difference of EDV and V0PWR (PAMPV0pwr) eliminated preload dependency down to 50% of baseline EDV. PWRmx adjustment using V0Est (PAMPV0est) showed similar preload independency. Enhancing contractility increased PAMPV0pwr and PAMPV0est from 176 ± 52 to 394 ± 205 W/ml.104 and 145 ± 51 to 404 ± 261 W/ml.104, respectively, accompanied by an increase of PRSW from 13.0 ± 4.5 to 29.7 ± 16.4 mm Hg (all P <0.01). PAMPV0pwr and PAMPV0est correlated with PRSW (r = 0.85; r = 0.77; both P <0.001). Numerical modeling confirmed experimental data. Thus, preload adjustment of PWRmx should consider a linear PWRmx vs EDV relationship with distinct V0PWR. PAMPV0pwr is a preload-independent estimate of RV contractility that may eventually be determined non-invasively.




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Am. J. Physiol. Heart Circ. Physiol.Home page
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[Abstract] [Full Text] [PDF]




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