title: Combined effect of the force-frequency and length-tension mechanisms on left ventricular function in patients with dilated cardiomyopathy.
abstract: BACKGROUND
  The myocardial length-tension and the force-frequency relations are important mechanisms that regulate the contractile strength of the heart.
  
  
  OBJECTIVE
  To evaluate in humans the effect on left ventricular function of the interaction between the myocardial length-tension and force-frequency relations.
  
  
  RESULTS
  Eight patients with dilated cardiomyopathy (DCM) and 6 control subjects underwent radionuclide monitoring of left ventricular function during atrial pacing, saline loading and atrial pacing at the end of saline loading. In controls, atrial pacing reduced left ventricular end-diastolic (P < 0.001) and end-systolic volumes (P < 0.001) with no change in ejection fraction whereas after volume expansion end-diastolic volume (P < 0.001) and ejection fraction (P < 0.001) increased. Atrial pacing after volume expansion increased ejection fraction (P < 0.05). In patients with DCM, ejection fraction was reduced during atrial pacing (P < 0.001) and volume expansion (P < 0.05) due to an increase in left ventricular end-systolic volume (P < 0.001). Pacing tachycardia after volume expansion further increased end-systolic volume and reduced ejection fraction with a significant 'pacing by load' interaction (P < 0.001). Peak filling rate increased at each step in controls while it remained unchanged in patients with DCM.
  
  
  CONCLUSIONS
  The heart rate increase during left ventricular distension improves ventricular function in normals and has detrimental effects in patients with DCM.
authors.affiliation: Department of Internal Medicine, Cardiology and Heart Surgery, Federico II University of Naples, 80131 Naples, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Petretta
authors.forename: Maria L E
authors.initials: ML
authors.lastname: Vicario
authors.forename: Letizia
authors.initials: L
authors.lastname: Spinelli
authors.forename: Adele
authors.initials: A
authors.lastname: Ferro
authors.forename: Alberto
authors.initials: A
authors.lastname: Cuocolo
authors.forename: Mario
authors.initials: M
authors.lastname: Condorelli
authors.forename: Domenico
authors.initials: D
authors.lastname: Bonaduce
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002306:Cardiac Volume; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging* / Q000628:therapy*; D016022:Case-Control Studies; D003971:Diastole / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011336:Probability; D015635:Radionuclide Ventriculography; D012016:Reference Values; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D013599:Systole / Q000502:physiology; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D017725:Ventricular Pressure