The pressure-volume relationship of the heart: past, present and future

The pressure-volume relationship of the heart was first reported more than a century ago. It was not widely accepted, however, until the mid-1970s. The pressure-volume diagram became a central theme of cardiac mechanics once it was shown to be a good representation of ventricular mechanics. Early in 1980s, the introduction of the ventricular interaction with afterload using effective arterial elastance made it possible to translate ventricular mechanical properties represented by the pressure-volume relationship to the pumping ability of the heart. Furthermore incorporating the framework of ventricular arterial interaction into the classic Guyton's circulatory equilibrium early in 2000s enabled us to express quantitatively how mechanical properties of the ventricles and vascular systems determine the circulatory equilibrium. Successful quantitative descriptions of circulatory equilibrium using the pressure-volume concept would promote basic cardiovascular physiology and accelerate its clinical applications.