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Heart. 1996 December; 76(6): 495–501.
PMCID: PMC484601

Effects of incoordination on left ventricular force-velocity relation in aortic stenosis.


OBJECTIVE: Tension development is often incoordinate in the hypertrophic left ventricle (LV). The present study aimed to elucidate the possible effects of incoordination on standard LV force-velocity relations in patients with aortic stenosis (AS). DESIGN: Prospective study during aortic valve replacement with transoesophageal cross sectionally guided M mode echocardiogram, combined with high-fidelity LV pressure recorded by pressure transducer tip catheter, and thermodilution cardiac output. SETTING: Tertiary cardiac referral centre. PATIENTS: 37 patients (mean (SD) age 63 (12)) years were studied before and 20 hours after aortic valve replacement. MAIN OUTCOME MEASURES: LV function was assessed regionally by peak velocity of circumferential fibre shortening (peak Vcf), mean systolic wall stress, and peak myocardial power; and globally by LV stroke work index. LV coordination was quantified as cycle efficiency, derived from LV pressure-dimension loop (lower normal limit > or = 76%). RESULTS: 22 patients with a coordinate LV had significantly higher peak Vcf (1.85 (0.47) v 1.46 (0.64) s-1) peak myocardial power (20.8 (8.5) v 12.0 (6.1) and global stroke work index (440 (155) v 325 (150) mJ.m-2) than those of 15 patients with an incoordinate ventricle, all P < 0.05; though there was no significant difference in LV end diastolic dimension, mean systolic wall stress, LV mass index, or the incidence of coronary artery disease (P > 0.05, respectively). Furthermore, when contraction was coordinate, mean systolic circumferential wall stress correlated inversely with peak Vcf (r = - 0.71) and positively with peak myocardial power (r = 0.83), both P < 0.01. When contraction was incoordinate, these correlations did not apply; instead peak Vcf (r = 0.65) and peak myocardial power (r = 0.73) both correlated positively with cycle efficiency (P < 0.02 and 0.01, respectively). By 20 hours after surgery, values of cycle efficiency, peak Vcf, and myocardial power were indistinguishable in the previously coordinate and incoordinate groups. CONCLUSIONS: In aortic stenosis, incoordination causes a fall in LV peak Vcf proportional to the increase in systolic wall stress, and thus modifies the standard LV force-velocity relation to mimic depressed contractility. However, incoordination and subsequent ventricular dysfunction were largely reversible once the aortic stenosis had been relieved.

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Selected References

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  • Ross J., Jr Afterload mismatch and preload reserve: a conceptual framework for the analysis of ventricular function. Prog Cardiovasc Dis. 1976 Jan-Feb;18(4):255–264. [PubMed]
  • Gunther S, Grossman W. Determinants of ventricular function in pressure-overload hypertrophy in man. Circulation. 1979 Apr;59(4):679–688. [PubMed]
  • Spann JF, Bove AA, Natarajan G, Kreulen T. Ventricular performance, pump function and compensatory mechanisms in patients with aortic stenosis. Circulation. 1980 Sep;62(3):576–582. [PubMed]
  • Carabello BA, Green LH, Grossman W, Cohn LH, Koster JK, Collins JJ., Jr Hemodynamic determinants of prognosis of aortic valve replacement in critical aortic stenosis and advanced congestive heart failure. Circulation. 1980 Jul;62(1):42–48. [PubMed]
  • Dilsizian V, Bonow RO. Current diagnostic techniques of assessing myocardial viability in patients with hibernating and stunned myocardium. Circulation. 1993 Jan;87(1):1–20. [PubMed]
  • Zile MR, Izzi G, Gaasch WH. Left ventricular diastolic dysfunction limits use of maximum systolic elastance as an index of contractile function. Circulation. 1991 Feb;83(2):674–680. [PubMed]
  • Schwinger RH, Böhm M, Koch A, Schmidt U, Morano I, Eissner HJ, Uberfuhr P, Reichart B, Erdmann E. The failing human heart is unable to use the Frank-Starling mechanism. Circ Res. 1994 May;74(5):959–969. [PubMed]
  • Mirsky I, Corin WJ, Murakami T, Grimm J, Hess OM, Krayenbuehl HP. Correction for preload in assessment of myocardial contractility in aortic and mitral valve disease. Application of the concept of systolic myocardial stiffness. Circulation. 1988 Jul;78(1):68–80. [PubMed]
  • Sonnenblick EH, Parmley WW, Urschel CW. The contractile state of the heart as expressed by force-velocity relations. Am J Cardiol. 1969 Apr;23(4):488–503. [PubMed]
  • WIGGERS CJ. Dynamics of ventricular contraction under abnormal conditions. Circulation. 1952 Mar;5(3):321–348. [PubMed]
  • Weber KT, Brilla CG. Pathological hypertrophy and cardiac interstitium. Fibrosis and renin-angiotensin-aldosterone system. Circulation. 1991 Jun;83(6):1849–1865. [PubMed]
  • Gibson DG. Disordered left ventricular contraction associated with abnormalities of conduction: an echocardiographic study. Postgrad Med J. 1972 Dec;48(566):756–759. [PMC free article] [PubMed]
  • Gibson DG, Brown DJ. Assessment of left ventricular systolic function in man from simultaneous echocardiographic and pressure measurements. Br Heart J. 1976 Jan;38(1):8–17. [PMC free article] [PubMed]
  • Jin XY, Pepper JR, Brecker SJ, Carey JA, Gibson DG. Early changes in left ventricular function after aortic valve replacement for isolated aortic stenosis. Am J Cardiol. 1994 Dec 1;74(11):1142–1146. [PubMed]
  • Devereux RB, Reichek N. Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation. 1977 Apr;55(4):613–618. [PubMed]
  • Falsetti HL, Mates RE, Grant C, Greene DG, Bunnell IL. Left ventricular wall stress calculated from one-plane cineangiography. Circ Res. 1970 Jan;26(1):71–83. [PubMed]
  • Hess OM, Murakami T, Krayenbuehl HP. Does verapamil improve left ventricular relaxation in patients with myocardial hypertrophy? Circulation. 1986 Sep;74(3):530–543. [PubMed]
  • Herman MV, Gorlin R. Implications of left ventricular asynergy. Am J Cardiol. 1969 Apr;23(4):538–547. [PubMed]
  • Lima JA, Weiss JL, Guzman PA, Weisfeldt ML, Reid PR, Traill TA. Incomplete filling and incoordinate contraction as mechanisms of hypotension during ventricular tachycardia in man. Circulation. 1983 Nov;68(5):928–938. [PubMed]
  • Ray CA, Rea RF, Clary MP, Mark AL. Muscle sympathetic nerve responses to dynamic one-legged exercise: effect of body posture. Am J Physiol. 1993 Jan;264(1 Pt 2):H1–H7. [PubMed]
  • Ford LE. Effect of afterload reduction on myocardial energetics. Circ Res. 1980 Feb;46(2):161–166. [PubMed]
  • Jin XY, Gibson DG, Pepper JR. Early changes in regional and global left ventricular function after aortic valve replacement. Comparison of crystalloid, cold blood, and warm blood cardioplegias. Circulation. 1995 Nov 1;92(9 Suppl):II155–II162. [PubMed]
  • Shimizu G, Zile MR, Blaustein AS, Gaasch WH. Left ventricular chamber filling and midwall fiber lengthening in patients with left ventricular hypertrophy: overestimation of fiber velocities by conventional midwall measurements. Circulation. 1985 Feb;71(2):266–272. [PubMed]
  • Heyndrickx GR, Vilaine JP, Knight DR, Vatner SF. Effects of altered site of electrical activation on myocardial performance during inotropic stimulation. Circulation. 1985 May;71(5):1010–1016. [PubMed]

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