The performance of the cardiovascular system depends on the interaction of
its components. We propose to investigate the coupling of the left
ventricle (LV) and arterial systems in conscious animals with intact
reflexes at rest, during exercise, and with depressed LV performance. The
analysis of LV and arterial pressure (P)-volume (V) relations to be used in
these studies is based on previous observations in the isolated LV ejecting
into a model of the arterial system. These concepts have not been
evaluated in the circulation of intact, conscious animals and the effects
of exercise and clinically important disease processes have not been
previously investigated. The following specific hypotheses will be
evaluated. Hypothesis 1: The stroke volume (SV) and the LV end-systolic
P (PES) are linearly related over the physiologically relevant range. The
slope of this relation, EA, is the effective elastance of the arterial
system, and is primarily determined under most circumstances by the heart
rate and total peripheral vascular resistance. Hypothesis 2: LV stroke
work is maximal when end-systolic elastance of the LV (EES) is equal to EA,
while mechanical efficiency (the ratio of arterial stroke work to total
pressure-volume area, SW/PVA) is maximum when EES is greater than EA.
Hypothesis 3: The normal cardiovascular system operates at rest with EES
slightly greater than EA, intermediate between points for maximum SW and
mechanical efficiency. Hypothesis 4: During exercise, the LV and arterial
system function closer to the point of maximum mechanical efficiency with
EES > EA; similar increases in heart rate produced by pacing at rest result
in suboptimal matching with EES < EA, Hypotheses 5 and 6: When LV
function is depressed by rapid pacing induced heart failure or coronary
occlusion, the coupling of the LV and arterial system is not optimal, as EA
> EES, but can be returned toward optimal by decreasing EA using
vasodilators.
Hypothesis 1 will be evaluated both in an anesthetized, open-chest
preparation in which stroke volume can be precisely controlled by right
heart bypass in conscious dogs. The other hypotheses will be evaluated by
studying conscious dogs previously instrumented to measure LV pressure and
volume. EES will be determined as the slope of the LV end- systolic
pressure-volume relation produced by varying LV P and V by transient caval
occlusions. EA will be determined as PES/SV.
These studies will supply important new information on the coupling of the
LV and arterial system of the conscious animal with intact reflexes at
rest, during exercise, and following depression of LV performance. These
studies may lead to rational interventions to improve pump function in
patients with common cardiovascular diseases.
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