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. 1979 Apr;63(4):695–703. doi: 10.1172/JCI109352

Role of Tachycardia as an Inotropic Stimulus in Man

Donald R Ricci 1,2, Arthur E Orlick 1,2, Edwin L Alderman 1,2, Neil B Ingels Jr 1,2, George T Daughters II 1,2, Catherine A Kusnick 1,2, Bruce A Reitz 1,2, Edward B Stinson 1,2
PMCID: PMC372004  PMID: 312295

Abstract

We examined the inotropic effect of tachycardia in nine postsurgical aortocoronary bypass graft patients (with intact cardiac innervation) and nine cardiac allograft recipients (with denervated hearts). The changes in stroke volume (SV) and velocity of circumferential fiber shortening (VCF) which accompany sudden increases and decreases in atrial pacing frequency were determined by computer-aided fluoroscopic analysis of the motion of surgically implanted midwall myocardial markers. Because the first beat after a change in rate retains the frequency characteristics of the preceding rate, we compared the first posttachycardia beat with control beats and late tachycardia beats with the first tachycardia beat; afterload and preload for each pair of beats were similar. For an increase in heart rate of 50 beats/min, SV and VCF rose 79 and 64% from the first tachycardia beat to late tachycardia beats, and SV and VCF rose 8 and 35% from control beats to the first posttachycardia beat in the innervated group. Responses in the denervated group were not significantly different from those in the innervated group. The degree of the inotropic response was positively correlated with the magnitude of the increase in heart rate (r = 0.91). The decay in augmented contractility after decreasing the rate back to control levels fits an exponential relationship with a mean t½ of 1.7 s. Thus, in conscious man, increases in heart rate represent a positive inotropic stimulus, independent of other factors influencing ventricular performance and unaffected by neural innervation, and should be considered when changes in cardiac function are interpreted during serial studies or after drug administration.

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Selected References

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

  1. Anderson P. A., Rankin J. S., Arentzen C. E., Anderson R. W., Johnson E. A. Evaluation of the force-frequency relationship as a descriptor of the inotropic state of canine left ventricular myocardium. Circ Res. 1976 Dec;39(6):832–839. doi: 10.1161/01.res.39.6.832. [DOI] [PubMed] [Google Scholar]
  2. BRISTOW J. D., FERGUSON R. E., MINTZ F., RAPAPORT E. The influence of heart rate on left ventricular volume in dogs. J Clin Invest. 1963 May;42:649–655. doi: 10.1172/JCI104755. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Branzi A., Mailhot J., Alderman E. L., Harrison D. C. Ultrasound determination of left ventricular position for volume angiography. Chest. 1972 Jul;62(1):29–33. doi: 10.1378/chest.62.1.29. [DOI] [PubMed] [Google Scholar]
  4. Covell J. W., Ross J., Jr, Sonnenblick E. H., Braunwald E. Comparison of the force-velocity relation and the ventricular function curve as measures of the contractile state of the intact heart. Circ Res. 1966 Aug;19(2):364–372. doi: 10.1161/01.res.19.2.364. [DOI] [PubMed] [Google Scholar]
  5. Edmands R. E., Greenspan K., Fisch C. The role of inotropic variation in ventricular function during atrial fibrillation. J Clin Invest. 1970 Apr;49(4):738–746. doi: 10.1172/JCI106286. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Frommer P. L., Robinson B. F., Braunwald E. Paired electrical stimulation. A comparison of the effects on performance of the failing and nonfailing heart. Am J Cardiol. 1966 Nov;18(5):738–744. doi: 10.1016/0002-9149(66)90092-0. [DOI] [PubMed] [Google Scholar]
  7. GLICK G., SONNENBLICK E. H., BRAUNWALD E. MYOCARDIAL FORCE-VELOCITY RELATIONS STUDIED IN INTACT UNANESTHETIZED MAN. J Clin Invest. 1965 Jun;44:978–988. doi: 10.1172/JCI105215. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Gault J. H., Ross J., Jr, Braunwald E. Contractile state of the left ventricle in man: instantaneous tension-velocity-length relations in patients with and without disease of the left ventricular myocardium. Circ Res. 1968 Apr;22(4):451–463. doi: 10.1161/01.res.22.4.451. [DOI] [PubMed] [Google Scholar]
  9. Glick G., Williams J. F., Jr, Harrison D. C., Morrow A. G., Braunwald E. Cardiac dimensions in intact unanesthetized man. VI. Effects of changes in heart rate. J Appl Physiol. 1966 May;21(3):947–952. doi: 10.1152/jappl.1966.21.3.947. [DOI] [PubMed] [Google Scholar]
  10. Gould K. L., Kennedy J. W., Frimer M., Pollack G. H., Dodge H. T. Analysis of wall dynamics and directional components of left ventricular contraction in man. Am J Cardiol. 1976 Sep;38(3):322–331. doi: 10.1016/0002-9149(76)90174-0. [DOI] [PubMed] [Google Scholar]
  11. Graham T. P., Jr, Powell W. J., Jr, Clancy R. L., Gilmore J. P. Characterization of the frequency-force relationship in the dog atrium in situ. Circ Res. 1967 Mar;20(3):338–348. doi: 10.1161/01.res.20.3.338. [DOI] [PubMed] [Google Scholar]
  12. Hajdu S., Posner C. J. Absence of Bowditch phenomenon in the ventricular muscle of hamsters with hereditary cardiomyopathy. Am Heart J. 1971 Jun;81(6):781–789. doi: 10.1016/0002-8703(71)90082-2. [DOI] [PubMed] [Google Scholar]
  13. Higgins C. B., Vatner S. F., Franklin D., Braunwald E. Extent of regulation of the heart's contractile state in the conscious dog by alteration in the frequency of contraction. J Clin Invest. 1973 May;52(5):1187–1194. doi: 10.1172/JCI107285. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Ingels N. B., Jr, Daughters G. T., 2nd, Stinson E. B., Alderman E. L. Measurement of midwall myocardial dynamics in intact man by radiography of surgically implanted markers. Circulation. 1975 Nov;52(5):859–867. doi: 10.1161/01.cir.52.5.859. [DOI] [PubMed] [Google Scholar]
  15. KOCH-WESER J., BLINKS J. R. THE INFLUENCE OF THE INTERVAL BETWEEN BEATS ON MYOCARDIAL CONTRACTILITY. Pharmacol Rev. 1963 Sep;15:601–652. [PubMed] [Google Scholar]
  16. Karliner J. S., Gault J. H., Bouchard R. J., Holzer J. Factors influencing the ejection fraction and the mean rate of circumferential fibre shortening during atrial fibrillation in man. Cardiovasc Res. 1974 Jan;8(1):18–25. doi: 10.1093/cvr/8.1.18. [DOI] [PubMed] [Google Scholar]
  17. Karliner J. S., Gault J. H., Eckberg D., Mullins C. B., Ross J., Jr Mean velocity of fiber shortening. A simplified measure of left ventricular myocardial contractility. Circulation. 1971 Sep;44(3):323–333. doi: 10.1161/01.cir.44.3.323. [DOI] [PubMed] [Google Scholar]
  18. Langer G. A. Ion fluxes in cardiac excitation and contraction and their relation to myocardial contractility. Physiol Rev. 1968 Oct;48(4):708–757. doi: 10.1152/physrev.1968.48.4.708. [DOI] [PubMed] [Google Scholar]
  19. Leighton R. F., Zaron S. J., Robinson J. L., Weissler A. M. Effects of atrial pacing on left ventricular performance in patients with heart disease. Circulation. 1969 Nov;40(5):615–622. doi: 10.1161/01.cir.40.5.615. [DOI] [PubMed] [Google Scholar]
  20. Mahler F., Ross J., Jr, O'Rourke R. A., Covell J. W. Effects of changes in preload, afterload and inotropic state on ejection and isovolumic phase measures of contractility in the conscious dog. Am J Cardiol. 1975 May;35(5):626–634. doi: 10.1016/0002-9149(75)90048-x. [DOI] [PubMed] [Google Scholar]
  21. Mahler F., Yoran C., Ross J., Jr Intropic effect of tachycardia and poststimulation potentiation in the conscious dog. Am J Physiol. 1974 Sep;227(3):569–575. doi: 10.1152/ajplegacy.1974.227.3.569. [DOI] [PubMed] [Google Scholar]
  22. Morton M. J., McAnulty J. H., Rahimtoola S. H. "Ventricular function curve" from a single diagnostic left ventriculogram: technique, results and value. Am J Cardiol. 1978 Apr;41(4):710–717. doi: 10.1016/0002-9149(78)90822-6. [DOI] [PubMed] [Google Scholar]
  23. NIEDERGERKE R. The rate of action of calcium ions on the contraction of the heart. J Physiol. 1957 Oct 30;138(3):506–515. doi: 10.1113/jphysiol.1957.sp005867. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. NIEDERGERKE R. The staircase phenomenon and the action of calcium on the heart. J Physiol. 1956 Dec 28;134(3):569–583. doi: 10.1113/jphysiol.1956.sp005666. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Noble M. I., Wyler J., Milne E. N., Trenchard D., Guz A. Effect of changes in heart rat on left ventricular performance in conscious dogs. Circ Res. 1969 Feb;24(2):285–295. doi: 10.1161/01.res.24.2.285. [DOI] [PubMed] [Google Scholar]
  26. Powers E. R., Foster J. R., Powell W. J., Jr Interaction of interval-force relationship with aortic pressure and stroke volume. Am J Physiol. 1976 Apr;230(4):893–900. doi: 10.1152/ajplegacy.1976.230.4.893. [DOI] [PubMed] [Google Scholar]
  27. Quinones M. A., Gaasch W. H., Alexander J. K. Influence of acute changes in preload, afterload, contractile state and heart rate on ejection and isovolumic indices of myocardial contractility in man. Circulation. 1976 Feb;53(2):293–302. doi: 10.1161/01.cir.53.2.293. [DOI] [PubMed] [Google Scholar]
  28. ROSIN H., FARAH A. Post-stimulation potentiation of contractility in the isolated auricle of the rabbit. Am J Physiol. 1955 Jan;180(1):75–82. doi: 10.1152/ajplegacy.1954.180.1.75. [DOI] [PubMed] [Google Scholar]
  29. RUSHMER R. F. Constancy of stroke volume in ventricular responses to exertion. Am J Physiol. 1959 Apr;196(4):745–750. doi: 10.1152/ajplegacy.1959.196.4.745. [DOI] [PubMed] [Google Scholar]
  30. Rider A. K., Copeland J. G., Hunt S. A., Mason J., Specter M. J., Winkle R. A., Bieber C. P., Billingham M. E., Dong E., Jr, Griepp R. B. The status of cardiac transplantation, 1975. Circulation. 1975 Oct;52(4):531–539. doi: 10.1161/01.cir.52.4.531. [DOI] [PubMed] [Google Scholar]
  31. SARNOFF S. J., MITCHELL J. H., GILMORE J. P., REMENSNYDER J. P. Homeometric autoregulation in the heart. Circ Res. 1960 Sep;8:1077–1091. doi: 10.1161/01.res.8.5.1077. [DOI] [PubMed] [Google Scholar]
  32. SONNENBLICK E. H. Force-velocity relations in mammalian heart muscle. Am J Physiol. 1962 May;202:931–939. doi: 10.1152/ajplegacy.1962.202.5.931. [DOI] [PubMed] [Google Scholar]
  33. Sandler H., Dodge H. T. The use of single plane angiocardiograms for the calculation of left ventricular volume in man. Am Heart J. 1968 Mar;75(3):325–334. doi: 10.1016/0002-8703(68)90089-6. [DOI] [PubMed] [Google Scholar]
  34. Sasayama S., Franklin D., Ross J., Jr Hyperfunction with normal inotropic state of the hypertrophied left ventricle. Am J Physiol. 1977 Apr;232(4):H418–H425. doi: 10.1152/ajpheart.1977.232.4.H418. [DOI] [PubMed] [Google Scholar]
  35. Sonnenblick E. H., Braunwald E., Williams J. F., Jr, Glick G. Effects of exercise on myocardial force-velocity relations in intact unanesthetized man: relative roles of changes in heart rate, sympathetic activity, and ventricular dimensions. J Clin Invest. 1965 Dec;44(12):2051–2062. doi: 10.1172/JCI105312. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Sonnenblick E. H., Morrow A. G., Williams J. F., Jr Effects of heart rate on the dynamics of force development in the intact human ventricle. Circulation. 1966 Jun;33(6):945–951. doi: 10.1161/01.cir.33.6.945. [DOI] [PubMed] [Google Scholar]
  37. Stinson E. B., Caves P. K., Griepp R. B., Oyer P. E., Rider A. K., Shumway N. E. Hemodynamic observations in the early period after human heart transplantation. J Thorac Cardiovasc Surg. 1975 Feb;69(2):264–270. [PubMed] [Google Scholar]
  38. Tsakiris A. G., Donald D. E., Sturm R. E., Wood E. H. Volume, ejection fraction, and internal dimensions of left ventricle determined by biplane videometry. Fed Proc. 1969 Jul-Aug;28(4):1358–1367. [PubMed] [Google Scholar]
  39. Tsien R. W., Giles W., Greengard P. Cyclic AMP mediates the effects of adrenaline on cardiac purkinje fibres. Nat New Biol. 1972 Dec 6;240(101):181–183. doi: 10.1038/newbio240181a0. [DOI] [PubMed] [Google Scholar]
  40. WEISSLER A. M., HARRIS L. C., WHITE G. D. LEFT VENTRICULAR EJECTION TIME INDEX IN MAN. J Appl Physiol. 1963 Sep;18:919–923. doi: 10.1152/jappl.1963.18.5.919. [DOI] [PubMed] [Google Scholar]

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