Relations between ejection fraction and ventricular volume, and their alteration by chronic beta-blockade.

Abstract

SUMMARY This study describes the newly discovered relation between ejection fraction and endsystolic volume index (ESVI) of the left ventricle as obtained by angiography at the time of cardiac catheterisation. Linear regression analysis shows that ejection fraction (%)=82 0-0 62 ESVI (ml/m2) but the correlation for patients receiving beta-adrenergic blocking drugs is significantly lower compared with the untreated group. Non-linear analysis, applied to cover also the asymptotic range for ejection fraction <20%, shows similar results. The good relation between the two indices indicates that the index ejection fraction may derive its clinical importance directly from the more fundamental index end-systolic volume index by virtue ofthe operation ofthe beta-adrenergic system on the heart. Generally, ejection fraction has been accepted clinically as a useful index to assess ventricular performance.I To date, no basis other than empirical observations has been provided on which the importance2 of ejection fraction is founded. Moreover, some investigators have questioned seriously the relevance of ejection fraction as a unique discriminator ofventricular performance.34 End-diastolic volume index (EDVI) has been regarded as a primary determinant of ventricular function, mainly in conjunction with the Frank-Starling law of the heart. Several studies have shown a more or less hyperbolic relation between ejection fraction and enddiastolic volume index.5-7 Recently, however, considerable attention has been given to systolic events during the cardiac cycle, and particularly to the endsystolic volume index89 and related quantities such as systolic elastance. [10][11][12] Since end-systolic volume is the volume to which the heart is able to contract under given conditions of preload and afterload this index is just as fundamental as end-diastolic volume to judge cardiac performance. Consequently, it seems logical to investigate the relation between the two systolic indices, ejection fraction and end-systolic volume index (ESVI). The present study documents a remarkable relation between the empirical index ejection fraction and the functional variable end-systolic volume index in a large group of patients. In addition, the effect of adrenergic blockade on this relation is studied by way ofanalysis ofa separate group ofpatients under chronic treatment with beta-blockade.Received for publication 12 November 1980 17 Patients and methodsThe population under consideration consisted of 165 unselected patients having angina and admitted to our clinic for medical examination. Their suitability for coronary bypass surgery was evaluated by selective angiocardiography, employing the Judkins technique. Fifty-two patients were not receiving any sympatholytic medication, while all the others (113) continued to receive their usual doses of beta-adrenergic blocking agents during the period of diagnostic catheterisation. Left ventricular cavity volume was determined angiographically using the right anterior oblique projection and the area-le...

Left ventricular volume regulation in heart failure with preserved ejection fraction

“…Regarding the latter aspect, we published data which clearly document the inverse linear relationship between EF and ESVI, but emphasized that r′ is significantly ( P < 0.02) lower in patients chronically using beta‐blockers compared to control patients with coronary artery disease (Kerkhof et al. ). Interestingly, also the slope of the ASC for this group was significantly ( P < 0.001) lower compared to the control group, suggesting that volume regulation of the LV affects the behavior of EF.…”

“…For example, our earlier investigations on the EF–ESV relationship show that the correlation r′ is significantly reduced in patients under chronic beta‐blockade, leading to a further dissociation between EF and ESV (Kerkhof et al. ). Importantly, the linearity of ESV versus EDV still applies under these specific conditions.…”

“…Remarkably, EF versus ESV is fairly linear (for EF >20%) even when EDV is allowed to vary (Kerkhof et al. ). Strictly speaking this finding implies that ESV embodies similar information as EF.…”

Relation between coupling index and ejection fraction and the alternative starting curve

“…We developed a unifying framework to describe the interrelationships between volumetric parameters and clinically interesting indicators of ventricular functioning such as EF and the coupting indicator Emax/Ea. Allthough for this particular set of patient data EF vs. ESV (Fig.2) yields a higher correlation than the ASC, we prefer to apply the ASC approach because of its documented clinical implications [4]. As the slope / 3 of the ASC depends on beta-adrenergic stimulation of the heart [2], the precise behavior of EF at a particular value of Emax/Ea is likely to be affected by the actual value of 0, in particular during beta-adrenergic blockade and in cardiac transplant patients.…”

“…As new element in our formalism we introduce an expression on the dynamic volumetric behavior of the left ventricle. This relationship has initially been documented for the relation between EF and end-systolic volume (ESV) [4]. Later, the model has been extended to enddiastolic volume (EDV), resulting in the Alternative Starling curve (ASC) relating ESV to EDV, and exhibiting a highly linear relationship.…”