Ventriculoarterial coupling shifts from maximizing mechanical efficiency in normal hearts to maximizing stroke work in moderate dysfunction, and fails to maximize either in severe dysfunction.
To investigate coupling between the heart and arterial system in normal subjects and cardiac patients, we determined both the slope of the left ventricular end-systolic pressure-volume relation (ventricular elastance) and the slope of the arterial end-systolic pressure-stroke volume relation (effective arterial elastance) in three groups of subjects: group A, 12 subjects with ejection fraction of 60% or more; group B, seven patients with ejection fraction of 40-59%; and group C, nine patients with ejection fraction of less than 40%. We also determined the left ventricular stroke work, end-systolic potential energy, and the ventricular work efficiency defined as stroke work per pressure-volume area (stroke work + potential energy). In group A, ventricular elastance was nearly twice as large as arterial elastance. This is a condition for a maximal mechanical efficiency. In group B, ventricular elastance was almost equal to arterial elastance. This is a condition for maximal stroke work from a given end-diastolic volume. In group C, ventricular elastance was less than one half of arterial elastance, which resulted in increased potential energy and decreased work efficiency. Thus, the present study suggests that ventriculoarterial coupling is normally set toward higher left ventricular work efficiency, whereas in patients with moderate cardiac dysfunction, ventricular and arterial properties are so matched as to maximize stroke work at the expense of the work efficiency. Neither the stroke work nor the work efficiency is near maximum for patients with severe cardiac dysfunction.
Asanoi et al. (1989) studied this question.