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Updated: Dec 21, 2025

Continuous Venous-Arterial Doppler Ultrasound During a Preload Challenge
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Re-visiting the Frank-Starling nexus.

June-Chiew Han1, Denis Loiselle2, Andrew Taberner3

  • 1Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand.

Progress in Biophysics and Molecular Biology
|May 15, 2020
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Otto Frank discovered two heart pressure-volume relations, but Starling

Keywords:
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Area of Science:

  • Cardiology
  • Physiology
  • Medical History

Background:

  • Otto Frank identified two distinct cardiac pressure-volume relations in frog heart preparations over a century ago.
  • Frank's findings on contraction-mode-dependent pressure-volume relationships were not addressed by Starling.
  • Starling's work, referencing Frank's, led to the widely known 'Starling's Law of the Heart'.

Observation:

  • Frank identified two pressure-volume curves: one for isovolumic twitches and another for afterloaded twitches.
  • Starling referenced Frank's work but did not appear to replicate or acknowledge Frank's finding of multiple pressure-volume relations.
  • Starling's conclusion emphasized fiber length as the determinant of contraction energy, becoming widely known as 'Starling's Law of the Heart.'

Findings:

  • This review addresses the discrepancy between Frank's and Starling's findings regarding cardiac pressure-volume relationships.
  • It questions why Starling presented a single relation, why the combined 'Frank-Starling' nomenclature is used, and why Frank's contributions were overlooked for decades.

Implications:

  • Re-evaluating the historical development of cardiac physiology principles.
  • Clarifying the contributions of Otto Frank and George Starling to understanding cardiac mechanics.
  • Potentially revising the historical narrative of the Frank-Starling relationship and its underlying physiological basis.