has a considerable O 2 wasting effect [1,2] and various approaches have elucidated its mechanisms [2][3][4]. However, this O 2 wasting effect remains to be characterized by the E max -PVA-VO 2 relation, which at present seems one of the most powerful integrative frameworks of cardiac mechanoenergetics [5,6]. Here, E max is the end-systolic maximum pressure-volume ratio (or elastance) and serves as an index of contractility reasonably independent of cardiac loading conditions [5][6][7]. PVA is the systolic pressure-volume (P-V ) area that quantitates the total mechanical energy of ventricular contraction [5,6,8]. VO 2 is O 2 consumption by ventricular contraction. The E max -PVA-VO 2 framework is compatible with the Starling law of the heart [9]. In this framework, the O 2 cost of E max serves as a physiologically sound quantitative measure of the O 2 demand for unit increment in E max [5,[10][11][12][13][14][15][16].We have already shown that calcium, catecholamines, digitalis, and phosphodiesterase inhibitors (DPI 201-106, OPC-8212, EMD-53998, milrinone, sulmazole, etc.) have comparable O 2 cost of E max in the normal canine heart [5,10,11,15]. We have also shown that the O 2 cost of E max increases by 50-100% of the control in failing hearts produced by myocardial acidosis [12], postischemic and post-acidotic Key words: Cardiac energetics, E max , myocardial O 2 consumption, pressure-volume area, PVA.Abstract: Caffeine causes a considerable O 2 waste for positive inotropism in myocardium by complex pharmacological mechanisms. However, no quantitative study has yet characterized the mechanoenergetics of caffeine, particularly its O 2 cost of contractility in the E max -PVA-VO 2 framework. Here, E max is an index of ventricular contractility, PVA is a measure of total mechanical energy generated by ventricular contraction, and VO 2 is O 2 consumption of ventricular contraction. The E max -PVA-VO 2 framework proved to be powerful in cardiac mechanoenergetics. We therefore studied the effects of intracoronary caffeine at concentrations lower than 1 mmol/l on left ventricular (LV) E max and VO 2 for excitationcontraction (E-C) coupling in the excised crosscirculated canine heart. We enhanced LV E max by intracoronary infusion of caffeine after -blockade with propranolol and compared this effect with that of calcium. We obtained the relation between LV VO 2 and PVA with E max as a parameter. We then calculated the VO 2 for the E-C coupling by subtracting VO 2 under KCl arrest from the PVA-independent (or zero-PVA) VO 2 and the O 2 cost of E max as the slope of the E-C coupling VO 2 -E max relation. We found that this cost was 40% greater on average for caffeine than for calcium. This result, for the first time, characterized integratively cardiac mechanoenergetics of the O 2 wasting effect of the complex inotropic mechanisms of intracoronary caffeine at concentrations lower than 1 mmol/l in a beating whole heart.