Linearity of the Frank-Starling relationship in the intact heart: the concept of preload recruitable stroke work.

Abstract

The Frank-Starling relationship generally has been examined with filling pressure as the index of preload, resulting in a curvilinear function that plateaus at higher filling pressures. To investigate this relationship further in the intact heart, 32 dogs were chronically instrumented with left ventricular and pleural micromanometers and with regional (10 dogs) or global (22 dogs) ultrasonic dimension transducers. Seven days after implantation, left ventricular pressure and regional or global dimensions were recorded in the conscious state. After autonomic blockade, preload was varied by vena caval occlusion. Myocardial function was assessed by calculating regional or global stroke work, and preload was measured as end-diastolic segment length or chamber volume. The relationship between stroke work and either end-diastolic segment length or chamber volume (termed the preload recruitable stroke work relationship) was highly linear in every study (mean r = .97) and could be quantified by a slope (Mw) and x-intercept (L,). Previous nonlinear relationships between stroke work and filling pressure seemed to reflect the exponential diastolic pressure-volume curve. Over the physiologic range of systolic arterial pressures produced by infusion of nitroprusside or phenylephrine, no significant change was observed in Mw or Lw in the normal dog. Calcium infusion increased both regional and global M, by 71 + 19% and 65 + 9%, respectively (p < .02), with no significant change in LW. To normalize for ventricular geometry and heart rate, stroke work was computed from circumferential stress-strain data and converted to myocardial power output, which was then plotted against enddiastolic circumferential strain. This relationship also was highly linear, and the slope, Mmp (mW/cm3 of myocardium), is proposed as a potential measure of intrinsic myocardial performance independent of loading, geometry, and heart rate. Circulation 71, No. 5, 994-1009, 1985 QUANTIFICATION of cardiac function has been the goal of physiologists for nearly a century, but it has been difficult if not impossible to establish practical or reliable measures of intrinsic myocardial performance in the intact heart. Some indexes, such as ventricular function curves relating stroke work to filling pressures, were nonlinear and difficult to quantify.' Other parameters suffered from lack of preload or afterload From the

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