The Midwall Stress-Velocity Relationship during Manipulation of Afterload

Abstract

Despite providing a physiological correction, measurements of contractility using the midwall stress-velocity relationship still show evidence of an unexplained hypercontractile state in some children. We investigated if by using midwall shortening indexes, the known overestimation of contractility at low afterload could be prevented. In 12 piglets (5 or 6 weeks old), afterload was manipulated by balloon occlusion of the descending aorta and infusion of sodium nitroprusside up to 5 mg/kg/min, and left ventricular function was measured using multiple variables. The regression line between the echocardiographically derived midwall velocity of circumferential fiber shortening and end systolic wall stress differed from the regression line of the endocardial stress-velocity relationship. Although the midwall regression line was almost horizontal (or afterload independent) for end systolic wall stress values of more than 30 g/cm2, the slope was still steeper below a certain point of afterload. The increased midwall velocity of fiber shortening at low afterload is comparable to the endocardial stress-velocity relationship and could account for the pseudo-hypercontractile state found in some children.