Integration of multiple perspectives to understand the left ventricular pressure–volume relationship

Figures

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  Fig. 1. P–V loop diagram with beneath and beyond phenomena. Beneath the loop: the P–V loop is a multiscale, time-dependent integrator of myocardial biology, wherein cross-bridge kinetics, Ca²⁺ handling, titin/ECM mechanics, and energetic constraints converge to define systo–diastolic performance. Remodeling via mechanotransduction renders each loop a transient snapshot of an evolving myocardial state. Beyond the loop: Global P–V metrics provide an incomplete rendering of cardiac performance, as regional heterogeneity, dyssynchrony, intraventricular flow physics, multi-chamber coupling, and arterial wave phenomena can substantially alter efficiency and instantaneous loading while leaving conventional loop descriptors largely unchanged. ED End-diastole, ED End-diastole, EDV End-diastolic volume, ES End-systole, ESV End-systolic volume, IVC Isovolumic contraction, IVR Isovolumic relaxation. Other abbreviations as in the text.

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  Fig. 2. From regional myocardial mechanics to global P–V loop. A Regional heterogeneity in pressure loading and electromechanical timing produces segment-specific pressure–volume loop morphologies, which are ultimately integrated into the global P-V loop. B While this global descriptor summarizes overall chamber performance, it conceals the underlying multiscale and directional mechanics governing ventricular function. ED End-diastole, ES End-systole, IVC Isovolumic contraction, IVR Isovolumic relaxation. Other abbreviations as in the text.

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  Fig. 3. Multiscale determinants of ventricular mechanics. A Intraventricular pressure gradients drive blood acceleration, diastolic filling, and systolic ejection, shaping intraventricular flow organization and vortex dynamics in concert with ventricular geometry and valvular function. B Spatially and temporally integrated pressure gradients give rise to hemodynamic forces, representing the vectorial exchange of momentum between blood and myocardium. AoV Aortic valve, MV Mitral valve, P Pressure. Other abbreviations as in the text.

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  Fig. 4. Integration of complementary methodologies with P–V loop analysis for comprehensive cardiovascular assessment. PIV Particle image velocitometry. Other abbreviations as in the text.