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Changes in electrocardiographic morphology reflect instantaneous changes in left ventricular volume and output in cardiac surgery patients

Pinsky, MR and Gorcsan, J and Gasior, TA and Mandarino, WA and Deneault, LG and Hattler, BG and Kunig, H (1995) Changes in electrocardiographic morphology reflect instantaneous changes in left ventricular volume and output in cardiac surgery patients. The American Journal of Cardiology, 76 (10). 667 - 674. ISSN 0002-9149

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We examined the relation between changes in R-to-T wave amplitude ratios (R:T) and left ventricular (LV) performance as cardiac output was rapidly varied by inferior vena caval occlusion in 6 subjects prior to cardiopulmonary bypass. To assess the influence of contractility, paired studies before and after bypass were performed in 4 subjects. Stroke volume and cardiac output were assessed by aortic flow probe, and transesophageal echocardiographic LV area measures using the automated border-detection method were used to give LV stroke area, stroke force, maximal LV area, fractional area change, end-systolic elastance, and preload recruitable stroke force. Data were collected on computer and analyzed by linear regression. Significant changes in R:T and measured LV variables during the inferior vena caval occlusion were stroke volume (r = 0.81), LV stroke area (r = 0.77), LV stroke force (r = 0.81), maximal LV area (r = 0.78), and cardiac output (r = 0.80). However, R:T varied inconsistently in relation to fractional area change. After cardiopulmonary bypass, the linear relation between R:T with LV stroke force, LV stroke volume, and maximal LV area persisted, but at a lesser slope. Although absolute pre-inferior vena caval occlusion R:T did not correlate with end-systolic elastance or preload recruitable stroke force, the change in the slope of these linear relations correlated well with the change in end-systolic elastance after surgery (r = 0.92). Instantaneous changes in electrocardiographic morphology reflect changes in LV preload-dependent variables, whereas long-term changes in electrocardiographic morphology may also reflect changes in contractile state. © 1995.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Pinsky, MRpinsky@pitt.eduPINSKY0000-0001-6166-700X
Gorcsan, Jgorcsan@pitt.eduGORCSAN
Gasior, TA
Mandarino, WA
Deneault, LG
Hattler, BG
Kunig, H
Date: 1 October 1995
Date Type: Publication
Journal or Publication Title: The American Journal of Cardiology
Volume: 76
Number: 10
Page Range: 667 - 674
DOI or Unique Handle: 10.1016/s0002-9149(99)80194-5
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 0002-9149
PubMed ID: 7572622
Date Deposited: 05 Mar 2012 17:40
Last Modified: 30 Jan 2020 16:55


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