Figure 1

Frank-Starling relationship. Once the ventricle is functioning on the steep part of the Frank-Starling curve, there is a preload reserve. Volume expansion (VE) induces a significant increase in stroke volume. The pulse pressure (PPV) and stroke volume (SVV) variations are marked and the passive leg raising (PLR) and end-expiratory occlusion (EEO) tests are positive. By contrast, once the ventricle is operating near the flat part of the curve, there is no preload reserve and fluid infusion has little effect on the stroke volume. There is a family of Frank-Starling curves depending upon the ventricular contractility.