End-systolic elastance

Ees (ESPVR slope) · Simplified: Ees ≈ ESP / ESV (V₀ = 0); better: single-beat method of Chen using EF, pre-ejection and total systolic times

Normal range & thresholds

Healthy adults ≈2 mmHg/mL; higher with age, hypertension and HFpEF (ventricular stiffening), lower in HFrEF ^[110,161].

Pathophysiology

The slope of the end-systolic pressure–volume relationship is the most load-independent index of contractility available — Suga and Sagawa’s time-varying elastance ^[111,123]. Echo approximates it either from one point with V₀ assumed zero (overestimates contractility in dilated hearts) or with Chen’s single-beat method, validated invasively ^[110].

Raised by

• Inotropes, exercise; concentric hypertrophy; HFpEF; ageing

Lowered by

• HFrEF, myocarditis, ischaemia, cardiotoxicity; β-blockade (acutely)

Technique & pitfalls

• Single-point Ees = ESP/ESV only if V₀ ≈ 0 — misleading in large ventricles.
• Chen single-beat: requires EF, systolic and diastolic cuff pressure and timing of pre-ejection and total systolic periods ^[110].

Pseudo-change & artefact

• The V₀ assumption; errors in ESV (foreshortening) and pressure.

Treatment thresholds

No guideline threshold. Used to explain mechanism (contractility vs load) and in coupling (card 50).

Next step

• Interpret with Ea (card 48) and myocardial work (card 55), which also corrects deformation for load.

Drugs

Raised by inotropes and digoxin; lowered by β-blockers and negative inotropes acutely; improves chronically with GDMT reverse remodelling.

Reversibility

Improves with recovery of contractile tissue; unchanged by scar.