Limitations of R-average as an index of left ventricular isovolumic relaxation.
Freeman et al. (1993) have recently introduced a new index measuring isovolumic relaxation in the in situ left ventricle. This index, called the R-average, shows less variability than the traditionally used monoexponential time constant (tau), and could therefore represent an alternative measure of isovolumic relaxation during different physiological or pathophysiological interventions. However, the R-average represents the average pressure fall during isovolumic relaxation (isovolumic pressure fall divided by the isovolumic time period), and is therefore highly influenced by the end-systolic pressure level. The present study was done in order to assess whether small increments in loading conditions would alter the R-average without changes in the isovolumic relaxation period or the monoexponential pressure decay tau. We used a right heart bypass porcine model, and end-systolic pressure was altered between 92 and 140 mmHg by pre-loading (servo-pump) or after-loading (phenylephrine) in spontaneously beating and paced hearts. During loading, we found a significant increase in the R-average and a close correlation (r = 0.72 - 0.99) between R-average and en-systolic pressure. However, no alterations were found in the duration of the isovolumic relaxation time period or monoexponential pressure decay (tau) during these loading conditions. In our view, the R-average indicates the systolic loading level for the ventricle, but does not necessarily reflect alterations in the process of active relaxation.
Myrmel
T
T
Division of Cardiothoracic Surgery, New England Deaconess Hospital, Boston, MA 02215, USA.
Krukenkamp
I B
IB
Caldarone
C A
CA
Burns
P A
PA
Gaudette
G
G
Levitsky
S
S
D000818:Animals; D001794:Blood Pressure / Q000502:physiology*; D005260:Female; D006439:Hemodynamics; D008297:Male; D009126:Muscle Relaxation / Q000502:physiology*; D013223:Statistics as Topic; D013552:Swine; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*