Assessment of Cardiac Contractility

It was considered that the relationship between dp/dt and simultaneously developed pressure during the course of isovolumic contraction might afford a more accurate measure of contractility than the maximum rate of intraventricular pressure rise (peak dp/dt). In six cat papillary muscles contracting isometrically from any given preload, the ratio of the rate of tension development (dT/dt) to simultaneously occurring isometric tension always varied directly with the contractile state. This ratio rose slightly as preload was increased, but it was not affected by changes in afterload. In 17 experiments in an intact canine heart preparation in which left ventricular end-diastolic pressure was constant, dp/dt at any given pressure during isovolumetric contraction again was observed to be a function of the contractile state when the latter was enhanced by norepinephrine and acetylstrophanthidin. High-fidelity left ventricular pressures and dp/dt were recorded throughout isovolumic contraction in eight patients. Isoproterenol and exercise raised the level of dp/dt at any given pressure prior to ejection. Interventions known to alter ventricular loading but not to influence the contractile state, such as elevation of ventricular end-diastolic pressure by leg raising and increases in aortic pressure induced by methoxamine, did not influence this relation significantly. In conclusion, the determination of dp/dt and intraventricular pressure throughout isovolumic contraction in the presence of variable arterial pressure and small changes of preload provides a useful, simple, and experimentally verified approach to the assessment of alterations of the contractile state of the heart in intact man.