Effects of chronic volume overload on left ventricular response to tachycardia

Abstract

The aim of the study was to determine the effects of chronic volume overload on the inotropic response of the left ventricle to a change in frequency of stimulation. Ten normal dogs (normal) and eight dogs with a chronic left ventricular (LV) volume overload (aortocaval fistula) were studied by cardiac catheterization after sedation with morphine (1 mg/kg). In normal dogs, increasing heart rate from 122 to 172 beats/min produced insignificant changes in peak +dP/dt (+2%; NS) or (dP/dt)/DP40 (+6%; NS). In volume overload, these indexes increased by 16% (P less than 0.01) and 31% (P less than 0.01), respectively, when heart rate increased from 135 to 173 beats/min. Conversely, the poststimulation potentiation appeared greater in normal than in volume overload; (dP/dt)/DP40 increased by 40% in normal vs. 1% in volume overload (P less than 0.01). These differences between normal and volume overload persisted after propranolol (1 mg/kg) and atropine (0.25 mg) administration. In both groups, AR-L115 BS, a nonsympathomimetic positive inotrope with caffeinelike properties, reduced the inotropic response to tachycardia, thereby normalizing the peak +dP/dt changes in volume overload. We conclude that the positive inotropic effects of tachycardia are enhanced in LV volume overload. Changes in LV compliance or alterations in the cellular mechanisms responsible for the force-frequency phenomenon might explain these findings.