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1 Washington University School of Medicine
2 Washington University
* To whom correspondence should be addressed. E-mail: sjk{at}wuphys.wustl.edu.
In current practice, empirical parameters such as the monoexponential time-constant
or the logistic model time-constant
L, are used to quantitate isovolumic relaxation. Previous work indicates that
and
L are load dependent. A load independent index of isovolumic pressure decline (LIIIVPD) does not exist. In this study, we derive and validate a LIIIVPD. Recently, we have derived and validated a kinematic model of isovolumic pressure decay (IVPD) where IVPD is accurately predicted by the solution to an equation of motion parametrized by stiffness (Ek), relaxation (
c), and pressure asymptote (P
) parameters. In this manuscript, we use this kinematic model to predict, derive and validate the load independent index MLIIIVPD. We predict that the plot of lumped recoil effects [Ek·(P*MAX-P
)] vs. resistance effects [
c·(dP/dtMIN)] defined by a set of load-varying IVPD contours yields a linear relation with a constant (i.e. load-independent) slope MLIIIVPD. To validate load-independence we analyzed an average of 107 IVPD contours in 25 subjects (2669 beats total), undergoing diagnostic catheterization. For the group as a whole we found the Ek·(P*MAX-P
) vs.
c·(dP/dtMIN) relation to be highly linear, with average slope MLIIIVPD=1.107±0.044 and average r2=0.993±0.006. For all subjects, MLIIIVPD was found to be linearly correlated to subject averaged
(r2= 0.65),
L(r2=0.50), and dP/dtMIN (r2=0.63), as well as to ejection fraction (r2=0.52). We conclude that MLIIIVPD is a LIIIVPD because it is load-independent and correlates with conventional IVPD parameters. Further validation of MLIIIVPD in selected pathophysiologic settings is warranted.
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