Figure 1 Ventricular end-diastolic pressure–volume relationship curves

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Presentation transcript:

Figure 1 Ventricular end-diastolic pressure–volume relationship curves Figure 1 | Ventricular end-diastolic pressure–volume relationship curves. a | End-diastolic pressure–volume relationship (EDPVR) in rat models of myocardial infarction (MI) and subsequent ventricular remodelling. Shaded area shows the range of normal EDPVR; each curve represents the EDPVR measured at the specified day after MI, delineating the time course of heart remodelling3. b | First ex vivo measurements of EDPVRs in human failing hearts obtained at the time of heart transplantation. Each curve represents data from a different heart: the left-most curve (with small end-diastolic volumes) is from a patient with restrictive cardiomyopathy; the other curves are from patients with dilated and ischaemic cardiomyopathies, and reflect hearts with various degrees of enlargement (that is, remodelling)4. c | Comparison of changes in left ventricular (LV) end-diastolic volume and pressure owing to acute unloading (LV end-diastolic pressure–volume values move along a fixed EDPVR from the red to the green point) with changes during reverse remodelling, as occurs during chronic ventricular unloading (LV end-diastolic pressure and volume decrease, but the EDPVR also shifts, moving from the red to the blue point). Therefore, differentiating reverse remodelling from pressure and volume reductions owing to LV unloading generally requires an assessment of EDPVR shifts7. d | EDPVRs of ex vivo hearts obtained at heart transplantation from four patients with end-stage idiopathic cardiomyopathy without LV assist device (LVAD) support (CHF), three patients with heart failure after prolonged LVAD support (LVAD), and three individuals with nonfailing hearts (Normal). EDPVRs of nonsupported hearts are right-shifted to larger volumes, indicative of remodelling, whereas EDPVRs of LVAD-supported hearts are similar to those of the normal hearts even though at the time of LVAD implantation, the hearts were dilated to a similar degree as the nonsupported hearts. The term 'reverse remodelling' was introduced based on these findings. Data for the graph was obtained from Ref. 7. Panel a is reproduced from Pfeffer, J. M. et al. Progressive ventricular remodeling in rat with myocardial infarction. Am. J. Physiol. 260, H1406–H1414 (1991), with permission from the American Physiological Society. Panel b is reproduced from Burkhoff, D. et al. In vitro studies of isolated supported human hearts. Heart Vessels 4, 185–196 (1988), with permission from Springer Nature. Panel a is reproduced from Pfeffer, J. M. et al. Progressive ventricular remodeling in rat with myocardial infarction. Am. J. Physiol. 260, H1406–H1414 (1991), with permission from the American Physiological Society. Panel b is reproduced from Burkhoff, D. et al. In vitro studies of isolated supported human hearts. Heart Vessels 4, 185–196 (1988), with permission from Springer Nature Kim, G. H. et al. (2017) Reverse remodelling and myocardial recovery in heart failure Nat. Rev. Cardiol. doi:10.1038/nrcardio.2017.139