Skip to main content
NCBI home page
The Journal of Clinical Investigation logoLink to The Journal of Clinical Investigation
. 1971 Dec;50(12):2653–2659. doi: 10.1172/JCI106766

Pressure-flow studies in man: effect of atrial systole on ventricular function in mitral stenosis

M Eugene Kendall 1,2, Abe Walston II 1,2, Frederick R Cobb 1,2, Joseph C Greenfield Jr 1,2
PMCID: PMC292215  PMID: 5129316

Abstract

The effect of atrial contraction on left ventricular function in six patients with varying degrees of mitral stenosis was determined by utilizing the pressure gradient technique to measure instantaneous aortic blood flow and pressure. Aortic flow was measured as ventricular rate was controlled by right ventricular pacing to create A-V (atrioventricular) dissociation at varying rates (90-150 beats/min). At each heart rate, beats with preceding P waves, effective atrial systole, were grouped according to the duration of the P-R interval. Beats without P waves served as controls. There was always a significant increase in stroke volume, created by effective atrial systole, but the P-R interval at which it took place was different for each patient. There was no difference in the stroke volume for beats preceded by P waves having a P-R interval within the range of 0.05-0.20 sec. These beats were grouped for each patient, subjected to regression analysis, and compared to control beats. The absolute and percent change created by effective atrial systole was inversely proportional to the severity of the disease as determined by mitral valve orifice size.

Effective atrial systole plays less of a role in augmenting left ventricular function in patients with mitral stenosis than in patients with normal valves.

Full text

PDF
2653

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Braunwald E., Rockoff S. D., Oldham H. N., Jr, Ross J., Jr Effective closure of the mitral valve without atrial systole. Circulation. 1966 Mar;33(3):404–409. doi: 10.1161/01.cir.33.3.404. [DOI] [PubMed] [Google Scholar]
  2. Carleton R. A., Graettinger J. S. The hemodynamic role of the atria with and without mitral stenosis. Am J Med. 1967 Apr;42(4):532–538. doi: 10.1016/0002-9343(67)90052-6. [DOI] [PubMed] [Google Scholar]
  3. Feigenbaum H., Campbell R. W., Wunsch C. M., Steinmetz E. F. Evaluation of the left ventricle in patients with mitral stenosis. Circulation. 1966 Sep;34(3):462–472. doi: 10.1161/01.cir.34.3.462. [DOI] [PubMed] [Google Scholar]
  4. GRANT R. P. Architectonics of the heart. Am Heart J. 1953 Sep;46(3):405–431. doi: 10.1016/0002-8703(53)90331-7. [DOI] [PubMed] [Google Scholar]
  5. Greenfield J. C., Jr, Fry D. L. Relationship between instantaneous aortic flow and the pressure gradient. Circ Res. 1965 Oct;17(4):340–348. doi: 10.1161/01.res.17.4.340. [DOI] [PubMed] [Google Scholar]
  6. HARVEY R. M., FERRER I., SAMET P., BADER R. A., BADER M. E., COURNAND A., RICHARDS D. W. Mechanical and myocardial factors in rheumatic heart disease with mitral stenosis. Circulation. 1955 Apr;11(4):531–551. doi: 10.1161/01.cir.11.4.531. [DOI] [PubMed] [Google Scholar]
  7. HERNANDEZ R. R., GREENFIELD J. C., Jr, MCCALL B. W. PRESSURE-FLOW STUDIES IN HYPERTROPHIC SUBAORTIC STENOSIS. J Clin Invest. 1964 Mar;43:401–407. doi: 10.1172/JCI104924. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Harley A., Starmer C. F., Greenfield J. C., Jr Pressure-flow studies in man. An evaluation of the duration of the phases of systole. J Clin Invest. 1969 May;48(5):895–905. doi: 10.1172/JCI106048. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Heidenreich F. P., Shaver J. A., Thompson M. E., Leonard J. J. Left atrial booster function in valvular heart disease. J Clin Invest. 1970 Sep;49(9):1605–1618. doi: 10.1172/JCI106378. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Heidenreich F. P., Thompson M. E., Shaver J. A., Leonard J. J. Left atrial transport in mitral stenosis. Circulation. 1969 Oct;40(4):545–554. doi: 10.1161/01.cir.40.4.545. [DOI] [PubMed] [Google Scholar]
  11. Kasalický J., Hurych J., Widimský J., Dejdar R., Metys R., Stanek V. Left heart haemodynamics at rest and during exercise in patients with mitral stenosis. Br Heart J. 1968 Mar;30(2):188–195. doi: 10.1136/hrt.30.2.188. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. LINDEN R. J., MITCHELL J. H. Relatonship between left ventricular diastolic pressure and myocardial segment length and observations on the contribution of atrial systole. Circ Res. 1960 Sep;8:1092–1099. doi: 10.1161/01.res.8.5.1092. [DOI] [PubMed] [Google Scholar]
  13. MITCHELL J. H., GUPTA D. N., PAYNE R. M. INFLUENCE OF ATRIAL SYSTOLE ON EFFECTIVE VENTRICULAR STROKE VOLUME. Circ Res. 1965 Jul;17:11–18. doi: 10.1161/01.res.17.1.11. [DOI] [PubMed] [Google Scholar]
  14. Ruskin J., McHale P. A., Harley A., Greenfield J. C., Jr Pressure-flow studies in man: effect of atrial systole on left ventricular function. J Clin Invest. 1970 Mar;49(3):472–478. doi: 10.1172/JCI106256. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. SKINNER N. S., Jr, MITCHELL J. H., WALLACE A. G., SARNOFF S. J. HEMODYNAMIC EFFECTS OF ALTERING THE TIMING OF ATRIAL SYSTOLE. Am J Physiol. 1963 Sep;205:499–503. doi: 10.1152/ajplegacy.1963.205.3.499. [DOI] [PubMed] [Google Scholar]
  16. Williams J. C., O'Donovan T. P., Cronin L., Wood E. H. Influence of sequence of atrial and ventricular systoles on closure of mitral valve. J Appl Physiol. 1967 Apr;22(4):786–792. doi: 10.1152/jappl.1967.22.4.786. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Clinical Investigation are provided here courtesy of American Society for Clinical Investigation

RESOURCES