Several studies have recently reported that the relationship between myocardial oxygen consumption per beat (Vo2) and left ventricular (LV) systolic pressure-volume area (PVA), which represents total mechanical energy generated by contraction, is linear and independent of loading conditions in excised, supported, and intact hearts. We assessed the Vo2-PVA relationship in nine patients with heart disease. LV volume and pressure were measured simultaneously by conductance catheter and tip-micromanometer. Vo2 was calculated from the difference between arterial and coronary sinus oxygen content, and coronary sinus blood flow measured by the thermodilution method. We obtained the linear relationship between Vo2 and PVA by dextran infusions (median r = 0.917). The slope of the Vo2-PVA relationship was (1.82 +/- 0.66) x 10(-5) mlO2 mmHg-1 ml-1 and the contractile efficiency, the reciprocal of the slope of the Vo2-PVA relationship, was 40 +/- 13%. The Vo2 intercept, which reflects Vo2 for non-mechanical work, was 0.0284 +/- 0.0286 ml O2 beat-1. These results suggest that PVA is a good predictor of myocardial oxygen consumption and a powerful tool to evaluate the coupling of LV mechanical performance to energy use in human hearts.