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Related Concept Videos

Cardiac Output II: Effect of Stroke Volume on Cardiac Output01:22

Cardiac Output II: Effect of Stroke Volume on Cardiac Output

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Cardiac output (CO), the amount of blood the heart pumps per minute, is a parameter in cardiovascular physiology determined by stroke volume and heart rate. Stroke volume, the amount of blood pushed from one of the ventricles per heartbeat, is influenced by preload, afterload, and contractility.
Preload
Preload refers to the initial elongation of the cardiac myocytes before contraction and is related to the volume of blood filling the heart at the end of diastole, or end-diastolic volume. The...
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Cardiac Output and Stroke Volume01:11

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Cardiac output (CO) is an integral aspect of human physiology, reflecting the heart's efficiency and responsiveness to the body's needs. It represents the volume of blood that the left or right ventricle ejects into the aorta or pulmonary trunk each minute. The CO is calculated by multiplying the heart rate (HR)—the number of heartbeats per minute—by the stroke volume (SV)—the amount of blood pumped out with each heartbeat.
In an average resting adult male, the typical cardiac...
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Cardiac Output I:Effect of Heart Rate on Cardiac Output01:19

Cardiac Output I:Effect of Heart Rate on Cardiac Output

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Cardiac Output
Cardiac output (CO) refers to the total amount of blood ejected by one of the ventricles in liters per minute (L/min). In a resting adult, CO ranges from 5 to 6 L/min, adjusting according to the body's metabolic requirements.
Effect of Heart Rate on Cardiac Output
Cardiac output adapts to metabolic demands during stress, physical activity, or illness. The autonomic nervous system regulates heart rate via the sinoatrial node. The parasympathetic nervous system decreases heart...
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Regulation of Stroke Volume01:27

Regulation of Stroke Volume

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The regulation of stroke volume, which is the amount of blood the heart pumps out during each heartbeat, is critical for maintaining a healthy circulatory system. Stroke volume is influenced by three main factors: preload, contractility, and afterload.
Preload refers to the degree of stretch on the heart before it contracts. It's analogous to the stretching of a rubber band; the more it's stretched, the more forcefully it snaps back. This concept is encapsulated in the Frank-Starling law of the...
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Cardiomyopathy II: Dilated Cardiomyopathy01:30

Cardiomyopathy II: Dilated Cardiomyopathy

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Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
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Imbalances in Cardiac Output01:26

Imbalances in Cardiac Output

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The heart's primary function is to pump blood throughout the body, maintaining a balance between blood sent out (cardiac output) and blood returning (venous return). If this balance is disrupted, it can result in congestive heart failure (CHF), a severe condition where the heart becomes an inefficient pump, leading to inadequate blood circulation.
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Related Experiment Video

Updated: Jan 19, 2026

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
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Hemodynamic Optimization in Cardiac Resynchronization Therapy: Should We Aim for dP/dtmax or Stroke Work?

Alwin Zweerink1, Odette A E Salden2, Wouter M van Everdingen2

  • 1Department of Cardiology, and Amsterdam Cardiovascular Sciences (ACS), Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands.

JACC. Clinical Electrophysiology
|September 21, 2019
PubMed
Summary

Stroke work (SW)-guided optimization during cardiac resynchronization therapy (CRT) significantly improves patient outcomes. Acute SW changes predict long-term CRT response better than dP/dtmax, enhancing ventricular-arterial coupling.

Keywords:
cardiac resynchronization therapy (CRT)dP/dt(max)hemodynamic optimizationpressure−volume loopsquadripolar LV leadsstroke work

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Area of Science:

  • Cardiology
  • Cardiac Electrophysiology
  • Heart Failure Management

Background:

  • Cardiac resynchronization therapy (CRT) aims to improve cardiac function in heart failure patients.
  • Hemodynamic optimization is crucial for maximizing CRT benefits.
  • Maximal left ventricular pressure rise (dP/dtmax) and stroke work (SW) are key hemodynamic parameters.

Purpose of the Study:

  • To evaluate the acute effects of dP/dtmax-guided versus SW-guided CRT optimization.
  • To assess the relationship between acute hemodynamic changes and long-term CRT response.

Main Methods:

  • Forty-one patients received CRT with invasive pressure-volume loop measurements.
  • 16 left ventricular (LV) pacing configurations were tested with varying atrioventricular (AV) delays.
  • Conventional CRT involved distal electrode pacing with a 120 ms AV delay.

Main Results:

  • Both dP/dtmax and SW optimization significantly increased their respective parameters compared to conventional CRT.
  • SW optimization enhanced ventricular-arterial (VA) coupling (45% vs. 32%), while dP/dtmax favored LV contractility (8% vs. 5%).
  • Acute changes in SW were predictive of long-term CRT response (AUC=0.78), unlike dP/dtmax changes (AUC=0.65).

Conclusions:

  • PV-guided hemodynamic optimization in CRT significantly improves SW through enhanced VA coupling.
  • dP/dtmax optimization primarily enhances LV contractility.
  • Acute SW changes are a stronger predictor of long-term CRT response than dP/dtmax changes.