Series elasticity in the intact heart. Evidence for the application of the Hill model for muscle to the intact left ventricle

The step response of left ventricular pressure to ejection flow: a system oriented approach

Left ventricular pressure is dependent on both ventricular volume and ventricular ejection flow. These dependencies are usually expressed by ventricular elastance, and resistance, respectively. Resistance is a one-valued effect only, when ejection flow either is constant or increases. Decreasing ejection flow elicits a third effect: a decrease of elastance. The effects of elastance, resistance and elastance depression were modeled in a three-compartment model consisting of a dead-volume compartment, an elastance compartment, and a second series-elastance compartment connected to the elastance compartment by a resistance. This model was identified with the pressure response determined experimentally by imposing pumped constant-flow ejection epochs on isolated rabbit hearts. The experimental flow epochs consisted of two phases of constant flow separated by an increasing or decreasing flow step. It was found that elastance is not changed after the flow step if this is positive or zero. Negative flow steps induced a deactivation of elastance that is linearly dependent on the difference between isovolumic pressure that would be developed at the volume existing at the time of measurement and actual pressure. The parameters found from the identification procedure are ventricular active volume, nondepressed elastance, series-elastance, resistance, and the elastance deactivation factor. The first four parameter values were found in agreement with other results reported in literature. The elastance depression factor is a new parameter that could be of physiological or clinical significance since it may be related to the inability of the force generators in the heart muscle to be restored to their full number, after being inactivated or decoupled by filament sliding associated with ejection. On the basis of the results, an alinear state-model of the ventricle, for arbitrary, including physiological flow patterns is proposed.

Non-linear pressure development during velocity controlled volume releases in isolated contracting rabbit left ventricle

Pressure responses obtained during steady-volume releases performed on isolated contracting rabbit left ventricle reveal a typical non-linear time course, dependent on velocity of volume release (VVR) and on amplitude of volume release (AVR). For values of VVR = 4.8 ml/s and of AVR = 0.28 ml (about 20% of the EDV at preload 0.5 kPa) a shoulder shaped pressure-time course is observed. The shoulder is seen during releases independently of the time during systole at which the release starts. When releases are compared which start at the same time during systole but have different velocities then the shoulder appears at higher amplitudes for the higher velocities. The shoulder can be explained by an active actin-myosin interaction within the scheme of a multi-state contraction model.

Systolic mechanical properties of the left ventricle. Effects of volume and contractile state

To characterize the mechanical properties of the contracting left ventricle, we studied the changes in left ventricular systolic pressure following step-like perturbations (+/- 3 ml) in ventricular volume, using an isovolumically beating, isolated canine heart preparation. Three mechanical properties (elasticity, resistance, and a deactivation effect) were identified. The elastic property differs from the traditional parallel and series elastic elements; it is a time-varying elasticity that includes active and passive effects of volume changes. Furthermore, it could not be represented by a simple time-varying elasticity, but required a second factor to express the dependence of end-systolic elasticity on the timing of the volume step. This effect was represented by a "volume influence factor," which may arise from length-dependent activation. The resistive property appeared to be related to force-velocity behavior of the myocardium. Each mechanical property reacted characteristically to steady state changes in ventricular filling volume or contractile state produced by dobutamine (2-13 micrograms/min). Our findings indicate that elasticity was the property most sensitive to changes in contractile state; these changes increased peak isovolumetric pressure 54% on average, and raised elastic stiffness 40% above control (which was 5.1 mm Hg/ml). Changes in ventricular filling volume only prolonged, but did not alter, the level of elastic stiffness attained at peak pressure. These results support the view that elasticity--or the end-systolic pressure-volume relationship--serves in a given heart to quantify contractility. The "volume influence factor" was not affected by either filling volume or contractile state. Resistance increased in direct proportion with ventricular pressure, but this linear relation was not altered greatly by changes in contractile state or in ventricular filling volume. At 100 mm Hg, ventricular resistance averaged 0.11 mm Hg/ml per sec. Finally, deactivation was greater the later in systole a volume step was imposed, and this pattern was independent of changes in ventricular filling volume and in contractile state.

Left ventricular active stiffness: dependency on time and inotropic state

Left ventricular systolic stiffness was measured by rapidly changing ventricular volume (within 7 ms) of isovolumically contracting isolated rabbit hearts. Instantaneous pressure-volume relations were found to be linear with slopes that depended upon the moment during contraction at which the volume change was induced. These slopes were proportional to the total pressure developed in the ventricle just prior to the volume change. The same was found when the time course of pressure was influenced by changing the Ca++ content of the perfusate. An influence, however, also could be detected when end-diastolic volume was changed. At the same pre-release pressure a greater volume caused a decrease of active stiffness. The results indicate the possibility of an active component in ventricular systolic stiffness.

Cardiac amyloidosis, contrictive pericarditis and restrictive cardiomyopathy

Cardiac amyloidosis is not characterized by a single hemodynamic pattern. Some of the cases present the clinical findings of restrictive cardiomyopathy and in these differentiation from constrictive pericarditis remains difficult in spite of the introduction of techniques designed to assess myocardial contractility and ventricular diastolic compliance. The clinical features and the demonstration of left ventricular diastolic pressure greater than right remain the most useful means of distinguishing restrictive cardiomyopathy from constrictive pericarditis. In other cases of cardiac amyloidosis the diastolic pressure is elevated throughout diastole and ventricular ejectile ability is lost. These cases do not simulate constrictive pericarditis and should not be classified as restrictive cardiomyopathy.