What is end-systolic pressure and why is it clinically important?

• A. End-systolic pressure is LV pressure at end of diastole; relates to preload.
• B. End-systolic pressure is LV pressure at the end of systole; relates to afterload and contractility; used to define ESPVR.
• C. End-systolic pressure is LV pressure at peak systole; defines LV volume.
• D. End-systolic pressure is the aortic diastolic pressure.

Answer: (B)

End-systolic pressure is the pressure inside the left ventricle at the moment systolic ejection ends. This timing is key because it reflects the load the ventricle has just overcome (afterload) and the heart’s ability to contract. Clinically, it lets us define the end-systolic pressure-volume relationship (ESPVR), a line that links end-systolic pressure to end-systolic volume across different loading conditions. The slope of this line, end-systolic elastance, is a useful index of contractility that remains relatively independent of preload and afterload, helping us assess true changes in ventricular function or responses to therapy. It’s not the pressure at the end of diastole (that would be end-diastolic pressure), nor the pressure at peak systole, nor the aortic diastolic pressure.