Altered left ventricular-arterial coupling precedes pump dysfunction in early heart failure

Academic Article


  • The objective of this study was to define alterations in ventricular-arterial (V-A) coupling early in the development of tachycardia-induced heart failure (HF). Although HF is characterized by impaired V-A coupling, the temporal relationship of these derangements to overt left ventricular (LV) dysfunction is unknown. Six anesthetized dogs instrumented with LV manometers and piezoelectric crystals were studied before and after 24 h of rapid ventricular pacing (RVP). V-A coupling was indexed by the ratio between the end-systolic pressure-volume relation slope (endsystolic elastance, E ) and effective arterial elastance (E ), and mechanical efficiency by the ratio of stroke work (SW) to pressure-volume area (PVA). After RVP, there was no significant depression of LV function, but E and total peripheral resistance (R ) were increased (P < 0.05), indicating increased arterial load. After RVP, E /E and SW/PVA were maintained during unstressed conditions, but upon changes in load induced by phenylephrine, E /E declined more precipitously with equivalent increases in R (slope E / E -R relation -6.7 ± 4.6 vs -5.8 ±4.0 ml/mmHg·min, P < 0.025). Furthermore, after RVP there was significant (P < 0.05) blunting of dobutamine-induced augmentation of E , E /E , and SW/ PVA. Thus, after RVP there was a distinct loss of V-A coupling reserve during afterload and catecholamine stress. V-A coupling defects occur early in the development of tachycardia-induced HF prior to significant pump dysfunction, and are manifested primarily during hemodynamic and inotropic stress. © Springer-Verlag Tokyo 2007. ES A A T ES A ES A T ES A T ES ES A
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    Author List

  • Prabhu SD
  • Start Page

  • 170
  • End Page

  • 177
  • Volume

  • 22
  • Issue

  • 3