Evaluation of left ventricular performance: an insolvable problem in human beings? The Graal quest

Excerpt

What is needed to assess ventricular function with special reference to contractility indices from a physiological point of view? First, we have to measure pressures, and for a physiological interpretation of the data, pressures should be recorded with intravascular micromanometers. Second, we need to measure left ventricular volumes and to relate each pressure to the corresponding volume to calculate indices of left ventricular function. Third, as most of the contractility indices are frequency-, preload-, and afterload-dependent, we have to interpret the data taking into account these factors which are also very difficult to assess. All these concerns have been extensively discussed in recent decades and the use of very sophisticated invasive methods such as intracardiac micromanometers and impedance catheters have not totally solved the problems [1, 2, 3, 4]. Thus, when non-invasive methods, such as echocardiography and peripheral arterial pressure, are used the problem seems to be almost insolvable. …