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PubMed1976

Interaction of interval-force relationship with aortic pressure and stroke volume.

The modification by aortic pressure and stroke volume of the response in cardiac performance to increases in heart rate (interval-force relationship) has not been previously studied. To investigate this interaction, 30 adrenergically blocked anesthetized dogs on right heart bypass were studied. At constant low aortic pressure and stroke volume, increasing heart rate (over the entire range 60-180) is associated with a continuously increasing stroke power, decreasing systolic ejection period, and an unchanging left ventricular end-diastolic pressure and circumference. At increased aortic pressure or stroke volume at low rates (60-120), increases in heart rate were associated with an increased performance. However, at increased aortic pressure or stroke volume at high rates (120-180), increases in heart rate were associated with a leveling or decrease in performance. Thus, an increase in aortic pressure or stroke volume results in an accentuation of the improvement in cardiac performance observed with increases in heart rate, but this response is limited to a low heart rate range. Therefore, the hemodynamic response to given increases in heart rate is critically dependent on aortic pressure and stroke volume.

Animals↗

PubMed1994

Cardiac stimulus intensity and heartbeat detection: effects of tilt-induced changes in stroke volume.

The effects of variations in stroke volume on the intensity of cardiac stimuli was examined in a series of three experiments that employed classical psychophysical methods to assess heartbeat detection. Stroke volume was manipulated by passive body tilt and recorded using impedance cardiography while subjects performed heartbeat detection tasks. The postural manipulation generated little or no change in contractility or momentum but did produce substantial changes in stroke volume. However, this potential source of variation in cardiac stimulus magnitude did not influence either the precision of heartbeat detection or the temporal location of heartbeat sensations. It is concluded that the intensity dimension of the heartbeat stimulus is not determined by stroke volume.

Adolescent↗

PubMed2006

Ability of pulse contour and esophageal Doppler to estimate rapid changes in stroke volume.

OBJECTIVE: Two technologies to acquire beat-to-beat stroke volume values exist, pulse contour analysis and esophageal Doppler monitoring. Pulse contour analysis assumes fixed aortic impedance. Esophageal Doppler assumes a constant proportional descending aortic flow and diameter. These assumptions may not be correct as arterial tone or myocardial contractility vary. We tested these relationships in the setting of rapidly changing stroke volumes and different cardiovascular states over a period of 10-15 cardiac cycles. DESIGN AND SETTING: In a university research facility we compared beat-to-beat changes in stroke volume as measure by aortic root flow probe or conductance catheter to pulse contour analysis and stroke distance as measured by esophageal Doppler. SUBJECTS: Five purpose-bred research hounds. INTERVENTIONS: To obtain a wide range of rapidly changing stroke volumes measurements were made during transient inferior vena cava occlusion. Data were gathered under baseline conditions and during norepinephrine, nitroprusside, and dobutamine infusions. MEASUREMENTS AND RESULTS: The pulse contour stroke volumes and esophageal Doppler stroke distance paralleled flow probe stroke volumes under all conditions (R(2)=0.89 for all measures). However, the absolute changes and proportional changes and the absolute values for both surrogate measures differed from absolute stroke volumes. Bland-Altman analysis showed no consistent bias or degree of precision across all animals under any given cardiovascular state. CONCLUSIONS: Both pulse contour stroke volumes and esophageal Doppler derived stroke distance estimates yield significant correlations with aortic root flow probe. However, the absolute values, absolute changes, or proportional changes may not reflect actual stroke volumes as cardiovascular state varies, making their use in estimating absolute changes in stroke volume potentially inaccurate.

Animals↗

PubMed1983

Effect of blood volume on forearm venous and cardiac stroke volume during exercise.

Five healthy men exercised at 65-70% of maximum O2 uptake (VO2 max) for 30 min in an ambient temperature of 30 degrees C. Duplicate experiments were conducted at three levels of plasma volume:control, hypovolemia, in which blood volume (BV) was reduced an average of 490 ml (9.7%) with diuretics, and hypervolemia, in which BV was increased an average of 440 ml (7.8%) by infusing an isotonic solution containing 5% human serum albumin. Marked venoconstriction occurred during exercise in all conditions and persisted despite large increases in deep body temperature. The degree of venoconstriction was similar during control and hypervolemic conditions, but was potentiated during hypovolemia. The observed venoconstriction appeared to consist of two components: an early one related to autonomic adjustments at the onset of exercise, and a later one possibly related to progressive decreases in cardiac filling. Heart rate, cardiac stroke volume (SV), and cardiac output during exercise were significantly affected by changes in BV. During hypovolemia the average differences from control values were 10 beats X min-1, -14 ml, and -2.2 l X min-1, respectively; during hypervolemia the differences from control were -7 X min-1, 10 ml, and 1.0 l X min-1, respectively. The pattern of SV over the course of exercise indicates that pooling of blood in veins may be quantitatively more important than plasma water loss in reducing cardiac filling pressure in the heat.

Adult↗

PubMed2003

Usefulness of left ventricular stroke volume variation to assess fluid responsiveness in patients with reduced cardiac function.

OBJECTIVE: Stroke volume variation as measured by the analysis of the arterial pressure waveform enables prediction of volume responsiveness in ventilated patients with normal cardiac function. The aim of this study was to investigate the ability of monitoring stroke volume variation to predict volume responsiveness and to assess changes in preload in patients with reduced left ventricular function after cardiac surgery. DESIGN: Prospective study. SETTING: University hospital. PATIENTS: Fifteen mechanically ventilated patients with a left ventricular ejection fraction <0.35 (study group) and 15 patients with an ejection fraction >0.50 (control group) after coronary artery bypass grafting following admission to the intensive care unit. INTERVENTIONS: Volume loading with 10 mL of hetastarch 6% times body mass index. If stroke volume index increased >5%, successive volume loading was performed until no further increase in stroke volume index was reached. MEASUREMENTS AND MAIN RESULTS: Stroke volume variation, central venous pressure, pulmonary artery occlusion pressure (PAOP), and left ventricular end-diastolic area index (LVEDAI) were measured at baseline and immediately after each volume loading step. In both groups, stroke volume variation at baseline correlated significantly with changes in stroke volume index caused by volume loading (p <.01). Further, changes in stroke volume variation as a result of volume loading correlated significantly with the concomitant changes in stroke volume index in both groups (p <.01). Using receiver operating characteristic analysis, in the study group areas under the curve for stroke volume variation, PAOP, central venous pressure, and LVEDAI did not differ significantly. In the control group, the area under the curve for stroke volume variation was statistically larger than for PAOP, central venous pressure, and LVEDAI. CONCLUSIONS: Continuous and real-time monitoring of stroke volume variation by pulse contour analysis can predict volume responsiveness and allows real-time assessment of the hemodynamic effect of volume expansion in patients with reduced left ventricular function after cardiac surgery.

Aged↗

PubMed2005

Formerly preeclamptic women with a subnormal plasma volume are unable to maintain a rise in stroke volume during moderate exercise.

INTRODUCTION: In formerly preeclamptic women with a low plasma volume, the recurrence rate of preeclampsia is higher than in women with a normal prepregnant plasma volume. In a recent study, we demonstrated that the low plasma volume subgroup also had a subnormal venous capacitance. In the present study, we determined the impact of subnormal plasma volume on the hemodynamic response to moderate exercise. PATIENTS AND METHODS: We performed this study in the follicular phase of the menstrual cycle, in 31 formerly preeclamptic women with a subnormal plasma volume (low-PV) and eight parous controls. The exercise consisted of 60 minutes of cycling in the supine position at 35% of the individualized maximum capacity. Before, during, and after cycling, we measured the percentage change in heart rate, stroke volume, and cardiac output. Before and after exercise, we measured the effective renal plasma flow (ERPF, para-amino-hippurate [PAH] clearance), glomerular filtration rate (GFR, inulin clearance), circulating levels of alpha-atrial natriuretic peptide (alpha-ANP), and active plasma renin concentration (APRC). RESULTS: The response to exercise of formerly preeclamptic women with a subnormal plasma volume differed from that in controls by a lack of rise in stroke volume, a smaller rise in cardiac output and alpha-ANP, and a greater fall in GFR. The responses in heart rate, ERPF, and APRC did not differ between the two groups. CONCLUSION: The response to moderate exercise of formerly preeclamptic women with a subnormal plasma volume differs from that in healthy parous controls with a normal plasma volume and suggests a lower capacity to raise venous return in conditions of a higher demand for systemic flow. The lower capacity to raise venous return in these conditions is associated with more cardiovascular drift. The physiologic consequence is a lower aerobic endurance performance during moderate exercise.

Adult↗

PubMed1981

The influence of ectopic beats and tachyarrhythmias on stroke volume and cardiac output.

The potentially adverse influence of premature ectopic beats or tachyarrhythmias on cardiac performance was studied by assessing the echocardiographic left ventricular stroke volume in 21 patients with cardiac rhythm disturbances. The beat to beat stroke volume correlated closely with end-diastolic volume in each patient (average R = .9). Premature ventricular contractions decreased stroke volume by an average of 48 +/- 8 ml (-71%) compared with sinus beats; whereas the postextrasystolic beats, although preceded by a pause and higher end-diastolic volume, increased stroke volume by only 16 +/- 7 ml (18%) over the sinus beats. Those postextrasystolic beats with equivalent timing and end-diastolic volume to the sinus beats had a mean stroke volume only 8 ml higher, suggesting that postextrasystolic potentiation plays only a minor role in augmenting stroke volume. Transient aberrant ventricular conduction of intermittent left bundle branch block, ectopic beats or atrial fibrillation failed to alter stroke volume. Ventricular bigeminy, trigeminy and quadrigeminy lowered cardiac output by 1.3, .9 and .7 l/min. The onset of tachyarrhythmias was oftentimes associated with a continuously changing end-diastolic volume and stroke volume, with either alternation or progressive increment of these variables. It is apparent that premature contractions decrease stroke volume by virtue of their infringement on diastolic filing, the principle beat to be determinant of stroke volume in arrhythmias being left ventricular end-diastolic volume. Since premature beats decrease stroke volume to an extent greater than postextrasystolic beats increase it, they may reduce cardiac output by a substantial degree, depending on their frequency of occurrence and degree of prematurity.

Arrhythmias, Cardiac↗

PubMed1984

Impedance cardiograms reliably estimate beat-by-beat changes of left ventricular stroke volume in humans.

Linear regression was used to compare stroke volumes calculated from tetrapolar impedance cardiograms and simultaneous left ventriculograms in 14 patients undergoing diagnostic left heart catheterisation. We calculated three to five consecutive stroke volumes from each ventriculogram. Left ventricular stroke volumes estimated by the two methods correlated closely: the correlation coefficients from pairs of data obtained from individual patients ranged between 0.77 and 1.00 (average = 0.91), and the correlation coefficient for pooled data (all pairs from all subjects) was 0.79 (p less than 0.001). Changes in left ventricular stroke volume measured with the two methods also correlated well (r = 0.89 for pooled data, p less than 0.001). The results suggest that impedance cardiograms provide reliable estimates of changes of beat-by-beat left ventricular stroke volumes and reasonable estimates of absolute levels of beat-by-beat stroke volumes in humans.

Aged↗

PubMed1983

Measurement of cardiac stroke volume by impedance cardiography in the last trimester of pregnancy.

Simultaneous determination of cardiac stroke volume by impedance cardiography and the dye dilution technique was compared in 10 women during the last trimester of pregnancy. Measurements were performed in different body positions to investigate the influence of body position on stroke volume. The correlation coefficient for all measurements was 0.87. Mean stroke volume determined by impedance cardiography was significantly (p less than 001) lower than mean stroke volume calculated by the dye dilution technique. There was no significant difference between the mean change in stroke volume determined by the two techniques during serial measurements. The reproducibility of individual impedance-determined stroke volumes (6.1 ml) did not differ significantly from individual values obtained by dye dilution (9.3 ml). Maximum mean impedance-determined stroke volume was recorded in the left lateral position (83.8 +/- 4.0 ml). Mean stroke volume was significantly (p less than 0.01) reduced in the supine position (17.9%). A smaller (14.4%) reduction was registered in the right lateral position. These changes in stroke volume according to body position were equally evident by both methods. Impedance cardiography is a safe, reliable, non-invasive technique for the measurement of changes in stroke volume during late pregnancy. The ability of impedance cardiography to determine changes in stroke volume was unaffected by changes in body position.

Adult↗

PubMed1986

Regulation of stroke volume during submaximal and maximal upright exercise in normal man.

To characterize the hemodynamic factors that regulate stroke volume during upright exercise in normal man, 24 asymptomatic male volunteers were evaluated by simultaneous right heart catheterization, radionuclide angiography, and expired gas analysis during staged upright bicycle exercise to exhaustion. From rest to peak exercise, oxygen consumption increased from 0.33 to 2.55 liters/min (7.7-fold), cardiac index increased from 3.0 to 9.7 liters/min per m2 (3.2-fold), and arteriovenous oxygen difference increased from 5.8 to 14.1 vol% (2.5-fold). The increase in cardiac index resulted from an increase in heart rate from 73 to 167 beats/min (2.5-fold), and an increase in left ventricular stroke volume index from 41 to 58 ml/m2 (1.4-fold). During low levels of exercise, there was a linear increase in cardiac index due to an increase in both heart rate and stroke volume index; stroke volume index increased as a result of an increase in left ventricular filling pressure and end-diastolic volume index and, to a much smaller extent, a decrease in end-systolic volume index. During high levels of exercise, further increases in cardiac index resulted entirely from an increase in heart rate, since stroke volume index increased no further. Left ventricular end-diastolic volume index decreased despite a linear increase in pulmonary artery wedge pressure; stroke volume index was maintained by a further decrease in end-systolic volume index. The degree to which stroke volume index increased during exercise in individuals correlated with the change in end-diastolic volume index (r = 0.66) but not with the change in end-systolic volume index (r = 0.07). Thus, the mechanism by which left ventricular stroke volume increases during upright exercise in man is dependent upon the changing relationship between heart rate, left ventricular filling, and left ventricular contractility. At low levels of exertion, an increase in left ventricular filling pressure and end-diastolic volume are important determinants of the stroke volume response through the Starling mechanism. At high levels of exertion, the exercise tachycardia is accompanied by a decrease in end-diastolic volume despite a progressive increase in filling pressure, so that stroke volume must be maintained by a decrease in end-systolic volume.

Adult↗

PubMed2003

Stroke volume variations.

During the cyclic changes in intrathoracic pressure, changes in stroke volume characterize the state at which both ventricles are preload dependant. Determining stoke volume variations may thus help to predict fluid responsiveness in mechanically ventilated patients. Selected review of the articles having investigated the stroke volume variations in critically ill patients. Stroke volume variations can effectively predict preload dependency in mechanically ventilated patients. Stroke volume can either be measured directly or estimated using the analysis of the arterial pressure waveform. Alternatively, pulse pressure variations can be calculated. However, these index are sensitive to tidal volume. During mechanical ventilation with low tidal volumes, the ventilatory-induced changes in preload may be too small to generate changes in stroke volume, even in preload dependant patients. Stroke volume variations can be useful to detect fluid responsiveness in mechanically ventilated patients.

Heart↗

PubMed1976

Acute alterations in stroke volume during exercise at 3,100 m altitude.

Following 3 weeks exposure to an altitude of 3,100 m, the cardiac output response to upright submaximal exercise was examined in 3 healthy subjects breathing ambient air and breathing 60% oxygen. The procedure allowed acute alteration of the 2 conditions within a single testing period of 30 min, 60% oxygen breathing either preceding or following breathing ambient air. Cardiac output was also measured in two of the subjects during maximal exercise under these two conditions. Administration of the high oxygen inspirate during exercise had little effect on the level of cardiac output but resulted in an immediate bradycardia and a dramatic increase of approximately 16% in stroke volume. Stroke volumes during maximal exercise were also increased by approximately 10% by the administration of high oxygen. It is suggested that the condition of decreases exercise stroke volume which develops with chronic exposure to altitude may be largely the result of diminished myocardial contractility stemming from a condition of myocardial hypoxia.

Altitude↗

PubMed2003

Stroke volume response to incremental submaximal exercise in aerobically trained, active, and sedentary men.

Stroke volume response of trained cyclists (n = 10; Trained), active but untrained men (n = 10; Active), and sedentary men (n = 10; Sedentary) was determined by impedance cardiography during cycle ergometer exercise. For the Trained, at a heart rate of 90 beats. min(-1), stroke volume increased by 27% compared to baseline levels, whereas stroke volume of Active and Sedentary groups did not significantly increase. Throughout exercise indices of ventricular emptying and filling of Trained were significantly greater than that of the other two groups whereas ventricular rates of the Active were significantly greater than those of the Sedentary. Throughout exercise cardiac contractility of the Trained was significantly greater than the other two groups. Results indicate that despite similar resting heart rate, stroke volume, and body mass, Trained compared to Active men significantly enhanced stroke volume, ventricular filling, and cardiac contractility during incremental ergometry exercise. Active compared to Sedentary men, however, displayed significantly larger stroke volume and ventricular filling rates during ergometry. We conclude that impedance cardiography indices of ventricular performance of aerobically trained men were superior to those of active, untrained men possessing similar resting stroke volume and heart rate. Furthermore, the ventricular performance of the active men possessing large resting stroke volume was superior to that of sedentary men.

Adolescent↗

PubMed2003

Pericardium modulates left and right ventricular stroke volumes to compensate for sudden changes in atrial volume.

The pericardium may modulate acute compensatory changes in stroke volumes seen with sudden changes in cardiac volume, but such a mechanism has never been clearly demonstrated. In eight open-chest dogs, we measured left and right ventricular pressures, diameters, stroke volumes, and pericardial pressures during rapid (approximately 300 ms) systolic infusions or withdrawals of approximately 25 ml blood into and out of the left atrium and right atrium. Control beats, the infusion/withdrawal beat, and 4-10 subsequent beats were studied. With infusions, ipsilateral ventricular end-diastolic transmural pressure, diameter, and stroke volume increased. With the pericardium closed, there was a compensatory decrease in contralateral transmural pressure, diameter, and stroke volume, mediated by opposite changes in transmural end-diastolic pressures. The sum of the ipsilateral increase and contralateral decrease in stroke volume approximated the infused volume. Corresponding changes were seen with blood withdrawals. This direct ventricular interaction was diminished when pericardial pressure was <5 mmHg and absent when the pericardium was opened. Pericardial constraint appears essential for immediate biventricular compensatory responses to acute atrial volume changes.

Animals↗

PubMed2002

Stroke volumes generated by precordial compression during cardiac resuscitation.

OBJECTIVES: To quantitate stroke volumes generated by precordial compression during cardiopulmonary resuscitation and to determine their relationship to coronary perfusion pressure and the success of resuscitation. DESIGN: Prospective, observational animal study. SETTING: Medical research laboratory in a university-affiliated research and educational foundation. SUBJECTS: Domestic pigs. INTERVENTIONS: Ventricular fibrillation was electrically induced in 25 anesthetized male domestic pigs. After an interval of 7 mins, electrical defibrillation was attempted. Failing to reverse ventricular fibrillation in each instance, precordial compression was begun coincident with mechanical ventilation. MEASUREMENTS AND MAIN RESULTS: Stroke volumes were computed from differences between diastolic and systolic areas of the left ventricle by utilizing transesophageal echocardiography. Both stroke volumes and coronary perfusion pressure were consistently greater in successfully resuscitated animals. Progressive decreases in stroke volumes during precordial compression were predictive of unsuccessful resuscitation. A linear correlation between stroke volume and coronary perfusion pressure (r =.70) was documented. CONCLUSION: These observations support the concept that stroke volumes generated by precordial compression are quantitatively related to the coronary perfusion pressure and to the success of cardiopulmonary resuscitation.

Analysis of Variance↗

PubMed1990

Comparative accuracy of Doppler echocardiographic methods for clinical stroke volume determination.

Numerous Doppler echocardiographic methods to measure stroke volume have been proposed in experimental or clinical studies, but their relative accuracy in patients compared with an invasive reference standard remains uncertain. Accordingly, we compared Doppler with thermodilution stroke volume measurement in 18 hospitalized patients, 16 with an acute manifestation of coronary artery disease and two with chronic cardiomyopathies. Doppler time-velocity integrals were measured by darkest line (modal velocity) and the leading edge (maximal velocity) techniques at the aortic annular plane, the mitral orifice, and the mitral annular plane. Two-dimensional echocardiography was used to measure cross-sectional areas (M-mode-corrected at the mitral orifice). The combination of aortic annular cross-sectional area and the leading edge technique of measuring the time-velocity integral of blood flow at this site provided the most accurate measure of stroke volume (r = 0.87, p less than 0.0001, standard error of estimate = 11 cm3; mean difference from thermodilution = 2.8 ml +/- 8.9 ml, p = NS). It also resulted in the most accurate measurement of cardiac output (r = 0.88, p less than 0.0003; mean difference from thermodilution = 0.11 L/min +/- 0.69 L/min, p = NS). Other methods yielded values that correlated less closely and deviated systematically from thermodilution measurements. We therefore conclude that of the six common methods evaluated, the aortic annular leading edge method measures stroke volume with the best accuracy and is most suitable for clinical application.

Adult↗

PubMed1989

[Reproducibility of the Doppler spectrum of the left ventricular stroke volume].

The left ventricular stroke volume was determined in 15 healthy male volunteers of the same age (21-23 yrs). The systolic function was characterized by six, the diastolic function by five parameters. The diameter and the cross-sectional areas of the outflow tract were determined. Intraobserver, interobserver and day-to-day variability of these parameters were investigated. The reproducibility was tested by 4 statistical methods. The significance of the differences between the mean values was determined, as well as the percentual difference of the mean values and of the variation coefficients. Linear regression analysis was done and the correlation coefficient was determined for each parameter. The variation coefficient could be regarded as the best statistical method for characterizing the reproducibility. Thus the simplest, directly measured Doppler parameters gave the best reproducibility. The reproducibility of the complex, calculated parameters was poorer. Comparing the intra- and interobserver reproducibility error, the former one was less.

Adult↗

PubMed1975

Measurement of stroke volume from pulmonary artery pressure record in man.

Stroke volume was determined from the pulmonary artery pressure record by application of the pulse contour method. Pulmonary artery pressure records were obtained in 17 patients using a high fidelity catheter-tip pressure transducer and simultaneous measurements of cardiac output were obtained from indicator dilution curves. The formula used was SV = KP sa (i plus T s/Td) where Psa is the planimetered area beneath the systolic portion of the pulmonary artery pressure curve. Ts and Td are the durations of systole and diastole, and K is a constant. Stroke volume was altered by isometric handgrip exercise and/or pharmacological agents in 15 patients. Serial measurementswere made in 2 patients in acute pulmonary oedema after myocardial infarction. Comparison of a wide range of values of stroke volume by the pulse contour method with those obtained from dye dilution curves showed a good correlation (r plus 0.97, P smaller than 0.001) regression line y = 1.01 times - 0.47. Measurement of stroke volume from the pulmonary artery pressure contour is a technique of potential value in serial haemodynamic monitoring.

Blood Pressure↗