Shinobu Tomimoto

Single-beat estimation of the slope of the end-systolic pressure-volume relation in the human left ventricle.

This study assessed a new method of estimating the slope (Ees) of the end-systolic pressurevolume relation (ESPVR) from a single beat of the human heart. Left ventricular pressure was recorded with a high-fidelity micromanometer in patients with heart disease during left ventriculography. Peak isovolumic pressure at the end-disastolic volume was estimated by a curve-fitting technique from an isovolumic left ventricular pressure curve. The ESPVR line was drawn from the estimated peak isovolumic pressure-volume point tangential to the left upper corner of the pressure-volume loop. The slope of this estimated ESPVR line from single-beat analysis was compared with the slope of the ESPVR line obtained from three pressure-volume loops in 16 patients given angiotensin II or nitroglycerin infusion. The estimated Ees was 5.0 ± 2.2 mm Hg/m1/m2, and the conventional Ees was 4.9 ± 2.7 mm Hg/mlm2. The estimated Ees showed a positive correlation with the conventional Ees (r = 0.91, p < 0.001, SEE= 1.2 mm Hg/ml/m2). In the other 13 patients, after dobutamine infusion (5, μg/kg/min i.v.) the estimated Ees increased significantly from 5.6 ± 1.4 to 7.4 ± 2.0 mm Hg/ml/m2 (p < 0.01). Thus, the estimated Ees approximated the conventional Ees and was sensitive to a positive inotropic intervention. We conclude that this single-beat analysis method facilitates assessment of the beat-by-beat ESPVR of the human heart.