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Review
. 2013 Apr;6(2):239-52.
doi: 10.1007/s12265-012-9424-1. Epub 2012 Nov 21.

Right and left ventricular diastolic pressure-volume relations: a comprehensive review

Ares Pasipoularides  1
Affiliations
Review

Right and left ventricular diastolic pressure-volume relations: a comprehensive review

Ares Pasipoularides. J Cardiovasc Transl Res. 2013 Apr.

Abstract

Ventricular compliance alterations can affect cardiac performance and adaptations. Moreover, diastolic mechanics are important in assessing both diastolic and systolic function, since any filling impairment can compromise systolic function. A sigmoidal passive filling pressure-volume relationship, developed using chronically instrumented, awake-animal disease models, is clinically adaptable to evaluating diastolic dynamics using subject-specific micromanometric and volumetric data from the entire filling period of any heartbeat(s). This innovative relationship is the global, integrated expression of chamber geometry, wall thickness, and passive myocardial wall properties. Chamber and myocardial compliance curves of both ventricles can be computed by the sigmoidal methodology over the entire filling period and plotted over appropriate filling pressure ranges. Important characteristics of the compliance curves can be examined and compared between the right and the left ventricle and for different physiological and pathological conditions. The sigmoidal paradigm is more accurate and, therefore, a better alternative to the conventional exponential pressure-volume approximation.

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Figures

Fig. 1
Fig. 1
a The shape of the sigmoidal curve at lower chamber volumes and pressures corresponds to the shape of an increasing but concave to the volume axis exponential function and at higher operating volumes and pressures to the shape of an increasing but convex to the volume axis exponential function (left panels). Concave means that the increase in distending pressure required by a one-unit increase in chamber volume becomes progressively smaller with increasing volumes. Convex means that the increase in distending pressure required by a one-unit increase in chamber volume becomes progressively larger. This sequential juxtaposition emphasizes different dynamic mechanisms applying over the successive operating volume ranges. The sigmoidal curve-fit function (right panel) encompasses the entire Pf–V range. b Representative ensemble of sigmoidal diastolic Pf–V trajectories
Fig. 2
Fig. 2
Representative RV and LV Pf–V relationships. The lower panel shows a distinctly sigmoidal LV Pf–V relationship. The top panel shows an RV Pf–V relationship that could also be fitted with an exponential model; its shape, however, can also be viewed as corresponding to the upper, convex to the abscissa, portion of an overall sigmoidal curve (See Fig. 1). Such curves belong to the ensemble of sigmoidal diastolic Pf–V trajectories in Fig. 1 b
Fig. 3
Fig. 3
Top: Experimental RV disease modalities induce significant changes in parameters B, C, and K1 of the sigmoidal model. Bottom: the impact of individual parameter changes on the overall shape of the sigmoidal curve. Left: an increase in B results in a submersion of the lower portion of the curve; the portion of the sigmoidal curve remaining above the abscissa may then resemble an exponential. Middle: an increase in C results in a rise with leftward rotation of the middle portion of the curve without altering the position of the asymptotes; the slope dPf/dV undergoes changes along the curve, implying alterations in compliance. Right: an increase in K1 results in a horizontal, rightward displacement of the entire curve to higher operating volumes [Adapted from Pasipoularides et al. [37], with permission of the American Physiological Society]
Fig. 4
Fig. 4
RV and LV diastolic pressure–volume relations: more than meets the eye! A rise in parameter B of a sigmoidal curve can displace it downward as is shown, from a to b; the portion of the overall sigmoidal Pf–V relation that emerges above the abscissa and is actually manifested may then appear to be quasi-exponential
Fig. 5
Fig. 5
Bottom: there is an extraordinarily closer agreement between the Pf–V data points' scattergram and the least-squares fitted curve when the sigmoidal model is used, than with the exponential. The residual sum of squares (SSRes) for the former is smaller by one order of magnitude than for the latter. Top: the residuals of the exponential, but not of the sigmoidal, curve-fit are characterized by a strong correlation of sequential observations; note the different scales of the ordinates in the residual plots. This correlation indicates that a systematic effect is neglected by the exponential curve fit but not by the sigmoidal [Reproduced from Pasipoularides et al. [37], with permission of the American Physiological Society]
Fig. 6
Fig. 6
Left panels: myocardial (panel a) and chamber (panel b) normal compliance curves of chronically instrumented pigs plotted against the ventricular passive filling pressure for both the right (dotted line) and the left (solid line, shaded) ventricle. Right panels: characteristic shapes of RV Pf–V relationships (panel c) and corresponding global curves of RV myocardial compliance (panel d) under hypovolemic conditions, and during surgically created subacute (2–5 wk) states of pressure overload, volume overload and RV free wall ischemia in chronically instrumented dogs; arrows identify the end-diastolic data points.
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