(Circulation. 1997;96:2978-2986.)
© 1997 American Heart Association, Inc.
Articles |
Left Ventricular Pressure-Volume Relationships Before and After Cardiomyoplasty in Patients With Heart Failure
From the Departments of Anesthesiology and Cardiology, Cardiovascular Research Institute, University Hospital Maastricht, The Netherlands (J.J.S., F.H. v.d. V., S.A.A.P.H., H.-G.K., H.J.J.W.); Department of Cardiology, University Hospital Leiden, The Netherlands (E.T. v.d. V, J.B.); Departments of Cardiac Surgery and Cardiology, Lyon, France (F.D., O.J., G.F.); Department of Cardiac Surgery, Ospedale Civile, Brescia, Italy (O.A., R.L., M.V.); and Department of Pulmonary Diseases, Erasmus University Rotterdam, The Netherlands (J.R.C.J.)
Correspondence to J.J. Schreuder, MD, PhD, Department of Anesthesiology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail JSCHR{at}SANE.AZM.NL
Background The aim of this study was to elucidate whether beneficial effects of cardiomyoplasty (CMP) in patients with dilated cardiomyopathy are the result of a decrease in existing ventricular dilatation or a prevention of further dilatation.
Methods and Results Combined
micromanometer-conductance catheters were used to
evaluate left ventricular pressure-volume relationships in
six patients with dilated cardiomyopathy before and
at 6 and 12 months after CMP. Acute changes in preload and afterload
were induced by a standardized leg-tilting intervention and a bolus
infusion of nitroglycerin. After CMP,
end-diastolic volume (EDV) decreased from 138±10 to
103±18 mL/m2 (P<.01) at 6 months and to
83±17 mL/m2 (P<.01) at 12 months.
End-diastolic pressure (EDP) decreased from 20.2±6.4 to
13.9±7.7 mm Hg (P<.01) at 6 months after CMP.
Peak ejection rate and ejection fraction increased at 6 months after
CMP from 594±214 to 799±214 mL/s (P<.05) and from
26.6±4.7% to 40.1±8.3% (P<.05), respectively. Peak
-dP/dt decreased at 12 months after CMP from -842±142 to
-712±168 mm Hg/s (P<.05). Leg-tilting before
CMP increased EDP from 20.2±6.4 to 25.6±5.2 mm Hg
(P<.01), end-systolic pressure (ESP) from
118±17 to 122±17 mm Hg (P<.05), and 
from
50.8±2.8 to 53.8±2.3 ms (P<.05). Six months after
CMP, leg-tilting also increased EDV from 103±18 to 110±22
mL/m2 (P<.05) and ESV from 62±14 to 66±14
mL/m2 (P<.05). Before CMP,
nitroglycerin decreased EDP from 20.2±6.4 to
10.4±3.8 mm Hg (P<.01), ESP from 118±17 to
96±11 mm Hg (P<.05), ESV from 100±11 to 89±7
mL/m2 (P<.05), and from 50.8±2.8 to
44.5±3.7 ms (P<.05). Six months after CMP,
nitroglycerin decreased EDP, ESP, and to similar
values.
Conclusions Our findings show that up to 1 year after CMP, marked decreases in left ventricular volume are present. Our measurements suggest that CMP actively reduced the dilated ventricle but did not prevent a higher EDV on an increased venous return. The latissimus dorsi muscle wrap contraction results in better synchronization of contraction and more rapid emptying of the left ventricle.
Key Words: cardiomyoplasty • cardiomyopathy • ventricles
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