From 'Emax' to pressure-volume relations: A broader view

In this perspective, we have tried to review the status of the end systolic pressure volume relation and pressure-volume relations for the characterization of ventricular performance. Many of the current concerns regarding ESPVR primarily impact on attempts to reduce pressure-volume data to a single number, EEs, as an index of contractility. Rather than dwell on these issues, we believe the focus should be reorientated toward use of the entire pressure-volume description for its many strengths: (1) that it provides a characterization of pump preference that allows loading factors to be reasonably separated from ventricular properties, (2) that it identifies both diastolic and systolic properties in common terms and therefore helps clarify their interrelationship, and (3) that it provides a description of coupling between ventricle and vasculature, which enables predictions of stroke volume and stroke work response to various loading interventions.