Biphasic changes in left ventricular function during hyperdynamic endotoxemia

Cardiac contractility was studied in a clinically relevant conscious swine model simulating human hemodynamics during endotoxemia. The slope of the end-systolic pressure-volume relationship [end-systolic elastance (E(ES))] was used as a load-independent contractility index. Chronic instrumentation in 10 pigs included two pairs of endocardial ultrasonic crystals for measuring internal major and minor axial dimensions of the left ventricle, a micromanometer for left ventricular pressure measurement, and a thermodilution pulmonary artery catheter. After a 10-day recovery period, control measurements of cardiac hemodynamic function were obtained. The following week, Escherichia coli endotoxin (10 μg · kg^-1 · h^-1) was administered intravenously for 24 h. E(ES) increased 1 h after endotoxin infusion and decreased beyond 7 h. The later hemodynamic changes resembled human cardiovascular performance during endotoxemia more closely than the changes during the acute phase. E(ES) decreased in the later phase. A similar biphasic response of E(ES) has been reported during a tumor necrosis factor- α (TNF) challenge. Even though plasma TNF was highest at I h and declined thereafter in this study, no consistent relationship between TNF and E(ES) was identified, and TNF levels did not correlate directly with the changes in E(ES).