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1 Department of Cardiovascular Dynamics, National Cardiovascular Center Research Institute, Suita, Osaka, Japan
2 Department of Cardiovascular Dynamics, National Cardiovascular Center Research Institute, Suita, Osaka, Japan; The Organization for Pharmaceutical Safety and Research, Tokyo, Japan
* To whom correspondence should be addressed. E-mail: kuemura{at}ri.ncvc.go.jp.
A novel framework of circulatory equilibrium was developed by extending Guyton's original concept. In this framework, venous return (COV) for a given stressed volume (V) was characterized by a flat surface as a function of right atrial pressure (PRA) and left atrial pressure (PLA) as COV = V/W - GSPRA - GPPLA, where W, GS, and GP denote linear parameters. In 7 dogs under total heart bypass, COV, PRA, PLA and V were varied to determine the 3 parameters in each animal using multivariate analysis. The coefficient of determination, which ranged from 0.92 to 0.99, indicated the flatness of the venous return surface. The averaged surface was COV =V/0.129 - 19.61PRA - 3.49PLA. To examine the invariability of the surface parameters among animals, we predicted the circulatory equilibrium in response to changes in stressed volume in another 12 dogs under normal and heart failure conditions. This was achieved by equating the standard surface with the individually measured cardiac output curve. In this way, we could predict cardiac output (y=0.90x + 5.6, r2 = 0.95, SEE = 8.7 ml.min-1.kg-1), PRA (y = 0.96x, r2=0.98, SEE = 0.2 mmHg) and PLA (y= 0.89x + 0.5, r2 = 0.98, SEE = 0.8 mmHg) reasonably well. We conclude that the venous return surface accurately represents the venous return properties of the systemic and pulmonary circulations. The characteristics of the venous return surface are invariable enough among animals; thereby making it possible to predict circulatory equilibrium, even if those characteristics are unknown in individual animals.
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