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Table 1 Force-frequency relationship from the experimental lab to clinical applications

From: Myocardial contractility in the echo lab: molecular, cellular and pathophysiological basis

Author Feldman Bhargava Hasenfusss Liu Inagaki Schuler Dehmer Lavie
Journal J Clin Invest Am J Cardiol Eur Heart J Circ Circ Am j Cardiol Am J Cardiol Chest
Year 1988 1988 1994 1993 1999 1982 1981 1989
Method cath lab cath lab cath lab cath lab cath lab nuc nuc nuc
FORCE SP/ESV dP/dt dP/dt Ees dP/dt SP/ESV SP/ESV SP/ESV
TREPPE Yes Yes Yes Yes Yes Base- peak Base-peak Base-peak
HR increase PM PM PM PM PM
EX
ISO
EX EX EX
PTS# Disease DC 7 DC 5 DC 9 HYP 10 HYP 17 AR 14 AR 17 MR 11
FFR Upsloping 3 - - - 7 7 11 7
   Flat-Biph - 2 - 10 10 7 2 2
   Neg 4 3 9 - - - 4 2
Control # 6 3 8 8 10 9 15 -
FFR Upsloping 6 3 8 8 10 9 15 -
   Flat-Biph - - - - - - - -
   Neg - - - - - - - -
  1. PM = atrial pacing; EX = exercise; ISO = isoproterenol ; DC = dilated cardiomyopathy; HYP = hypertensive cardiomyopathy; CHD = coronary artery disease; AR = aortic regurgitation; MR = mitral regurgitation; FFR = force-frequency relation
  2. Several attempts have been made to transfer the force-frequency relationship from the experimental lab to clinical applications. Such attempts have been based on invasive evaluation in cath lab (Feldman 1988, Bhargava 1988, Hasenfuss 1994, Liu 1993, Inagaki 1999), or noninvasive evaluation with radionuclide scintigraphy (Schuler 1982, Dehmer 1981, Lavie 1989). The extensively adopted maximum rate of pressure rise (max dP/dt) for force measurement is largely preload and afterload dependent. Since End-systolic elastance (Ees), is almost insensitive to changes in preload and afterload, Ees should be measured at each heart rate step increase, as done by Liu and coworkers.
  3. But measuring Ees for increasing heart rates is impractical: increasing heart rates obtained with atrial pacing has to be adjunct to the LV conductance catheter, the LV pressure catheter, the vena cava balloon, and the afterload changes. Proof of this is that only Liu adopted this method in humans.
  4. The scintigraphic approach is noninvasive, but requires exposure to ionizing radiations and – due to limited temporal resolution – allows the measurement of SP/ESV only at baseline at peak exercise. The pattern of the force-frequency relationship over a spectrum of different heart rates cannot be assessed.