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Research Article Free access | 10.1172/JCI109352

Role of Tachycardia as an Inotropic Stimulus in Man

Donald R. Ricci, Arthur E. Orlick, Edwin L. Alderman, Neil B. Ingels Jr., George T. Daughters II, Catherine A. Kusnick, Bruce A. Reitz, and Edward B. Stinson

Division of Cardiology and Department of Cardiovascular Surgery, Stanford University Medical Center, Stanford, California 94305

Palo Alto Medical Research Foundation, Palo Alto, California 94301

Find articles by Ricci, D. in: JCI | PubMed | Google Scholar

Division of Cardiology and Department of Cardiovascular Surgery, Stanford University Medical Center, Stanford, California 94305

Palo Alto Medical Research Foundation, Palo Alto, California 94301

Find articles by Orlick, A. in: JCI | PubMed | Google Scholar

Division of Cardiology and Department of Cardiovascular Surgery, Stanford University Medical Center, Stanford, California 94305

Palo Alto Medical Research Foundation, Palo Alto, California 94301

Find articles by Alderman, E. in: JCI | PubMed | Google Scholar

Division of Cardiology and Department of Cardiovascular Surgery, Stanford University Medical Center, Stanford, California 94305

Palo Alto Medical Research Foundation, Palo Alto, California 94301

Find articles by Ingels, N. in: JCI | PubMed | Google Scholar

Division of Cardiology and Department of Cardiovascular Surgery, Stanford University Medical Center, Stanford, California 94305

Palo Alto Medical Research Foundation, Palo Alto, California 94301

Find articles by Daughters, G. in: JCI | PubMed | Google Scholar

Division of Cardiology and Department of Cardiovascular Surgery, Stanford University Medical Center, Stanford, California 94305

Palo Alto Medical Research Foundation, Palo Alto, California 94301

Find articles by Kusnick, C. in: JCI | PubMed | Google Scholar

Division of Cardiology and Department of Cardiovascular Surgery, Stanford University Medical Center, Stanford, California 94305

Palo Alto Medical Research Foundation, Palo Alto, California 94301

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Division of Cardiology and Department of Cardiovascular Surgery, Stanford University Medical Center, Stanford, California 94305

Palo Alto Medical Research Foundation, Palo Alto, California 94301

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Published April 1, 1979 - More info

Published in Volume 63, Issue 4 on April 1, 1979
J Clin Invest. 1979;63(4):695–703. https://doi.org/10.1172/JCI109352.
© 1979 The American Society for Clinical Investigation
Published April 1, 1979 - Version history
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Abstract

We examined the inotropic effect of tachycardia in nine postsurgical aortocoronary bypass graft patients (with intact cardiac innervation) and nine cardiac allograft recipients (with denervated hearts). The changes in stroke volume (SV) and velocity of circumferential fiber shortening (VCF) which accompany sudden increases and decreases in atrial pacing frequency were determined by computer-aided fluoroscopic analysis of the motion of surgically implanted midwall myocardial markers. Because the first beat after a change in rate retains the frequency characteristics of the preceding rate, we compared the first posttachycardia beat with control beats and late tachycardia beats with the first tachycardia beat; afterload and preload for each pair of beats were similar. For an increase in heart rate of 50 beats/min, SV and VCF rose 79 and 64% from the first tachycardia beat to late tachycardia beats, and SV and VCF rose 8 and 35% from control beats to the first posttachycardia beat in the innervated group. Responses in the denervated group were not significantly different from those in the innervated group. The degree of the inotropic response was positively correlated with the magnitude of the increase in heart rate (r = 0.91). The decay in augmented contractility after decreasing the rate back to control levels fits an exponential relationship with a mean t½ of 1.7 s. Thus, in conscious man, increases in heart rate represent a positive inotropic stimulus, independent of other factors influencing ventricular performance and unaffected by neural innervation, and should be considered when changes in cardiac function are interpreted during serial studies or after drug administration.

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