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Frank-Starling principle.

Frank-Starling principle.
Frank-Starling principle.

Normally (top curve), as preload increases, cardiac performance also increases. However at a certain point, performance plateaus, then declines. In heart failure (HF) due to systolic dysfunction (bottom curve), the overall curve shifts downward, reflecting reduced cardiac performance at a given preload, and, as preload increases, there is less of an increase in cardiac performance. With treatment (middle curve), performance is improved, although not normalized.

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