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Accounting for the Gregg effect in tetanised coronary arterial pressure-flow relationships
J Z Livingston1, H R Halperin, F C Yin
1Johns Hopkins University School of Medicine, Baltimore, MD 21205.
Objective:
Myocardial contraction shifts the diastolic coronary pressure-flow relationship to lower flows at any given pressure, the amount of shift being determined primarily by the contractile level. A portion of this shift may be attributable to the Gregg effect. The purpose of this study was to quantify the influence of the Gregg effect and thereby demonstrate the pure effect of activation at a constant contractile level on the pressure-flow relationships.
Methods:
It was first shown in beating canine interventricular septa that transverse stiffness induced by small high frequency indentations transverse to the plane of the tissue was an index of contractility. At constant perfusion pressure and preload, there was an inverse relationship between peak transverse stiffness and contractile level (induced by graded doses of 2,3-butanedione monoxime) for both isotonic and auxotonic contractions. A Gregg effect was next verified by showing a linear dependence between transverse stiffness and perfusion pressure during ryanodine induced tetanizations. Finally, the relationship between changes in flow and transverse stiffness was determined from diastole to tetany at two contractile levels. These relationships suffice to quantify the Gregg effect.
Results:
Correcting for the Gregg effect from the transverse stiffness measurements obtained concomitantly with previously reported pressure-flow data in six specimens showed the following: using a linear fit to the pressure-flow data, the mean slope of the diastolic pressure-flow relationships decreased from 0.88 to 0.81 and 0.74 ml.min-1 x mmHg-1 during tetanisation at normal and reduced contractile levels, respectively. Correcting for the Gregg effect decreased the tetanised slopes to intermediate values of 0.85 and 0.79 ml.min-1 x mmHg-1, respectively.
Conclusions:
A small but clearly discernible portion of the shift in tetanised pressure-flow relationships is attributable to the Gregg effect. Similar conclusions pertained when quadratic regressions were fitted to the pressure-flow data.