Relationship between PVA and myocardial oxygen consumption can be derived from thermodynamics

The pressure-volume area (PVA) has been shown to be an excellent, linear index of myocardial oxygen consumption. The thermodynamic basis for this result, however, has not been elucidated. The present study was undertaken to determine what information could be gained from analyzing the cardiac pressure-volume (P-V) cycle as an approximation to some "ideal" thermodynamic cycle operating under the constraints imposed by cardiovascular anatomy and physiology. The myocardium was approximated as a linear, chemically driven elastance in accordance with the time-varying elastance model. Analysis provided descriptions of a Carnot cycle for myocardium and a suboptimal ideal cycle, including isovolumic phases. Further analysis of the ideal cycle indicated that the end-systolic P-V relationship (ESPVR) is an approximation to the adiabatic P-V trajectory that primarily determines total energy consumption. Analysis also indicated possible explanations of current results that seem to be at odds with the time-varying elastance model. These results suggest that thermodynamic cycle analysis may provide a useful analytic tool for investigation of the cardiac cycle.