Minimum left ventricular pressure during β-adrenergic stimulation in human subjects : evidence for elastic recoil and diastolic suction in the normal heart

• Published in: Circulation (New York, N.Y.) N.Y.), 1990-10, Vol.82 (4), p.1174-1182
• Main Authors: UDELSON, J. E, BACHARACH, S. L, CANNON, R. O, BONOW, R. O
• Format: Article
• Language: English
• Subjects: Adrenergic beta-Agonists - pharmacology; Adult; Biological and medical sciences; Cardiac Pacing, Artificial; Diastole; Elasticity; Female; Fundamental and applied biological sciences. Psychology; Heart - drug effects; Heart - physiology; Heart Atria; Heart Ventricles; Humans; Isoproterenol - pharmacology; Male; Middle Aged; Pressure; Reference Values; Vertebrates: cardiovascular system
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.cir.82.4.1174

The influence of elastic recoil and restoring forces on diastolic left ventricular pressure decay and minimum left ventricular pressures has been demonstrated in animal models but has not been studied in the human heart. To investigate this issue in the normal human left ventricle, we studied eight patients with chest pain and normal coronary arteries with simultaneous measurement of left ventricular volume (by radionuclide angiography) and pressure (by micromanometer catheter) and coronary sinus blood flow. Electrocardiographic-gated data were obtained in the basal state, during rapid atrial pacing, and during isoproterenol infusion to a similar heart rate. Compared with pacing, isoproterenol increased ejection fraction and reduced end-systolic volume (p less than 0.005), end-systolic pressure (p less than 0.005), and the half-time of pressure decline after peak negative dP/dt (T1/2) (p less than 0.001). Negative diastolic pressure developed in seven of eight patients during isoproterenol (range, -0.5 to -2.4 mm Hg) but in only one of eight during pacing (-0.2 mm Hg). These reduced diastolic pressures during isoproterenol were accompanied by increased stroke volume (reflecting increased transmitral flow) and diminished pulmonary wedge pressure (reflecting left atrial pressure). The magnitude of reduction in minimum diastolic pressure during pacing and isoproterenol was related to the change in end-systolic volume (r = 0.79, p less than 0.001), ejection fraction (r = -0.74, p less than 0.001), T1/2 (r = -0.57, p less than 0.02), and coronary sinus flow (r = 0.73, p less than 0.005). Stronger correlations were observed in analyzing changes during isoproterenol alone.