External Constraint

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Chun-sing Lee - One of the best experts on this subject based on the ideXlab platform.

K.c. Lee - One of the best experts on this subject based on the ideXlab platform.

Israel Belenkie - One of the best experts on this subject based on the ideXlab platform.

  • ventricular interaction and External Constraint account for decreased stroke work during volume loading in chf
    American Journal of Physiology-heart and Circulatory Physiology, 2001
    Co-Authors: Thomas Moore, John V Tyberg, J A Morristhurgood, Michael P Frenneaux, Rozsa Sas, J Atherton, Eldon R Smith, Israel Belenkie
    Abstract:

    The slope of the stroke work (SW)-pulmonary capillary wedge pressure (PCWP) relation may be negative in congestive heart failure (CHF), implying decreased contractility based on the premise that PCWP is simply related to left ventricular (LV) end-diastolic volume. We hypothesized that the negative slope is explained by decreased transmural LV end-diastolic pressure (LVEDP), despite the increased LVEDP, and that contractility remains unchanged. Rapid pacing produced CHF in six dogs. Hemodynamic and dimension changes were then measured under anesthesia during volume manipulation. Volume loading increased pericardial pressure and LVEDP but decreased transmural LVEDP and SW. Right ventricular diameter increased and septum-to-LV free wall diameter decreased. Although the slopes of the SW-LVEDP relations were negative, the SW-transmural LVEDP relations remained positive, indicating unchanged contractility. Similarly, the SW-segment length relations suggested unchanged contractility. Pressure surrounding the LV must be subtracted from LVEDP to calculate transmural LVEDP accurately. When this was done in this model, the apparent decrease in contractility was no longer evident. Despite the increased LVEDP during volume loading, transmural LVEDP and therefore SW decreased and contractility remained unchanged.

Y.p. Zeng - One of the best experts on this subject based on the ideXlab platform.

Michael P Frenneaux - One of the best experts on this subject based on the ideXlab platform.

  • left ventricular pacing minimizes diastolic ventricular interaction allowing improved preload dependent systolic performance
    Circulation, 2004
    Co-Authors: Robert A Bleasdale, Mark Turner, Catherine Mumford, Paul Steendijk, Vince Paul, John V Tyberg, J A Morristhurgood, Michael P Frenneaux
    Abstract:

    Background— Left ventricular (LV) pacing improves hemodynamics in patients with heart failure. We hypothesized that at least part of this benefit occurs by minimization of External Constraint to LV filling from ventricular interaction. Methods and Results— We present median values (interquartile ranges) for 13 heart failure patients with LV pacing systems implanted for New York Heart Association class III/IV limitation. We used the conductance catheter method to measure LV pressure and volume simultaneously. External Constraint was measured from the end-diastolic pressure-volume relation recorded during inferior vena caval occlusion, during LV pacing, and while pacing was suspended. External Constraint to LV filling was reduced by 3.0 (4.6 to 0.6) mm Hg from 4.8 (0.6 to 7.5) mm Hg (P<0.01) in response to LV pacing; effective filling pressure (LV end-diastolic pressure minus External Constraint) increased by 4.0 (2.2 to 5.8) mm Hg from 17.7 (13.3 to 22.6; P<0.01). LV end-diastolic volume increased by 10 (3...

  • ventricular interaction and External Constraint account for decreased stroke work during volume loading in chf
    American Journal of Physiology-heart and Circulatory Physiology, 2001
    Co-Authors: Thomas Moore, John V Tyberg, J A Morristhurgood, Michael P Frenneaux, Rozsa Sas, J Atherton, Eldon R Smith, Israel Belenkie
    Abstract:

    The slope of the stroke work (SW)-pulmonary capillary wedge pressure (PCWP) relation may be negative in congestive heart failure (CHF), implying decreased contractility based on the premise that PCWP is simply related to left ventricular (LV) end-diastolic volume. We hypothesized that the negative slope is explained by decreased transmural LV end-diastolic pressure (LVEDP), despite the increased LVEDP, and that contractility remains unchanged. Rapid pacing produced CHF in six dogs. Hemodynamic and dimension changes were then measured under anesthesia during volume manipulation. Volume loading increased pericardial pressure and LVEDP but decreased transmural LVEDP and SW. Right ventricular diameter increased and septum-to-LV free wall diameter decreased. Although the slopes of the SW-LVEDP relations were negative, the SW-transmural LVEDP relations remained positive, indicating unchanged contractility. Similarly, the SW-segment length relations suggested unchanged contractility. Pressure surrounding the LV must be subtracted from LVEDP to calculate transmural LVEDP accurately. When this was done in this model, the apparent decrease in contractility was no longer evident. Despite the increased LVEDP during volume loading, transmural LVEDP and therefore SW decreased and contractility remained unchanged.