Independence of left ventricular pressure-volume ratio from preload in man early after coronary artery bypass graft surgery.

Abstract

The response of the maximum value of the left ventricular pressure-volume ratio to preload augmentation by blood or plasma expanders was studied in 11 patients during the first 24 hr after coronary artery bypass graft surgery. Increasing the mean left atrial pressure from 10 to 15 and 20 mm Hg resulted in no change in the maximum pressure-volume ratio in the group as a whole. In certain individual patients, however, the maximum pressure-volume ratio changed with volume infusion, and these changes were accompanied by simultaneous changes in afterload. The observed changes in pressure-volume ratio were in the same direction as the changes in afterload (systolic pressure), suggesting a dependence of maximum pressure-volume ratio on afterload. These results show that the maximum pressure-volume ratio is independent of preload in the first 24 hr after coronary artery bypass graft surgery with the pericardium open; thus the maximum pressure-volume ratio is a useful index of postoperative left ventricular function when afterload is unchanged. However, because this ratio (a single-point assessment of the pressure-volume relationship) may not be a good estimate of Emax, we recommend a more complete determination of the locus of the "upper left corners" of the pressure-volume loops for measurement of Emax to provide a more accurate indicator of the myocardial contractile state.