Cardiovascular physiology by Hans-Joachim Priebe; Karl Skarvan

By Hans-Joachim Priebe; Karl Skarvan

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Protein metabolism of the heart. J Mol Cell Cardiol 1984;16:3–32. 69 Lesch M, Taegtmeyer H, Peterson MB, Vernick R. Studies on the mechanism of the inhibition of myocardial protein synthesis during oxygen deprivation. Am J Physiol 1976;230:120–6. 70 Taegtmeyer H, Lesch M. Altered protein and amino acid metabolism in myocardial hypoxia and ischemia. Amsterdam: Elsevier/North Holland, 1980:347–60. 71 Morgan HE, Rannels DE, McKee EE. Protein metabolism of the heart. In: Berne, R, ed, Handbook of physiology: the cardiovascular system: the heart.

Preload As already stated, preload is the force that stretches the resting myocardium and determines the resting length of its contractile fibres. In the intact ventricle, the fibre length cannot be measured. 1 4 6 9 The measurement of end diastolic volume in patients undergoing surgery is difficult. Most data on left ventricular volume are based on contrast ventriculography, which requires radiography equipment, left heart catheterisation, and injection of contrast medium; it cannot be used for serial measurements.

18 Future research will have to use a multivariate approach to this complex and salient issue. Currently, the preferred way of assessing myocardial contractility in human studies is the determination of time varying elastance or of preload recruitable stroke work. 7). It represents the slope of the P/V relationship and increases towards the end of systole to a maximum: therefore, maximal elastance (Emax) or end systolic elastance (Ees) is an index of myocardial contractility. In isolated ejecting ventricles, Emax and Ees are almost identical over a wide range of varying preloads.

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