Left Ventricular Contractile Function at Rest and During Isometric Exercise in the Pressure Overloaded Heart

Abstract

For the evaluation of left ventricular contractile function, pressure derived as well as ejection phase indexes have been proposed. The usefulness of these two types of parameters for detecting abnormal basal contractility was recently reappraised in a series of 41 patients with chronic left ventricular pressure overload from aortic stenosis (AS). In all patients left ventricular high-fidelity pressure measurements and quantitative left cineventriculography were carried out. The pressure-derived isovolumic indexes, that is peak-measured velocity of shortening (Vpm), and total pressure Vmax were depressed (<1.14 and 1.47 ML/sec, respectively) in 16 (39%) and in 17 (42%) patients, respectively. The angiographically determined ejection phase parameters, mean velocity of circumferential fiber shortening (mean VCF), and mean normalized systolic ejection rate (MNSER) were depressed (<1.0 circ/sec and <2.0 enddiastolic volumes/sec, respectively) in 12 (29%) and in 14(34%) patients, respectively. The highest number of abnormal left ventricular function (24 patients, i.e., 59%) was obtained by the combination of both the isovolumic and the ejection phase indexes. Thus in AS, we cannot confirm a superior sensitivity of the ejection phase contractile indexes recently described in patients with diffuse cardiac involvement.