Statistical analysis of the different factors which could affect postextrasystolic potentiation in the human heart

Abstract

The effect of different coupling indices and intervals that could theoretically affect postextrasystolic potentiation has been investigated. A total of 150 ventricular premature beats corresponding to 20 patients submitted to routine cardiac catheterization were studied. Only single ventricular premature contractions following at least four regular sinus beats were considered. Percentage changes in left ventricular systolic pressure, end-diastolic pressure, and max dp/dt were correlated against seven indices and intervals. Index 2 (coupling interval/coupling interval + postextrasystolic pause) gave the better correlations. Besides, this Index includes two intervals that were demonstrated to have statistical significance when individually considered. It has been proved that in the first postextrasystolic beat the highest values of max dt/dt, or left ventricular systolic pressure occurred in early ventricular premature beats, giving a negative regression with Index 2, while in the second postextrasystolic beat the highest values of max dp/dt and left ventricular systolic pressure corresponded to late prematuring beats, giving therefore positive regressions with Index 2 (slope inversion phenomenon). The third and fourth postextrasystolic beats had similar positive regressions but with progressively smaller slopes. Correlations between left ventricular end-diastolic pressure and Index 2 were very poor. It is suggested that variations in baroreceptor activity could account for the different forms of potentiation observed in early and late extrasystoles. In five cases, there were no consistent differences in potentiation when premature beats were elicited from either right or left ventricles.