From the Departments of Physiology (K.D., J.A.M., S.R.H.), Internal
Medicine (K.B.M.), and Surgery (V.J.), Temple University School of Medicine,
Philadelphia, Pa.
Correspondence to Kenneth B. Margulies, MD, Assistant Professor of Medicine and Physiology, Room 318, OMS Bldg, Temple University School of Medicine, 3400 N Broad St, Philadelphia, PA 19140. E-mail margul{at}astro.ocis.temple.edu
Background—The failing
myocardium is characterized by decreased force
production, slowed relaxation, and depressed responses to
ß-adrenergic stimulation. In some heart failure patients, heart
function is so poor that a left ventricular assist device
(LVAD) is inserted as a bridge to transplantation. In the present
research, we investigated whether circulatory support with an LVAD
influenced the functional properties of myocytes from the failing
heart.
Methods and Results—Myocytes were isolated from human explanted
failing hearts (HF-myocytes) and failing hearts with antecedent LVAD
support (HF-LVAD-myocytes). Studies of myocyte function indicated that
the magnitude of contraction was greater (9.6±0.7% versus 6.9±0.5%
shortening), the time to peak contraction was significantly abbreviated
(0.37±0.01 versus 0.75±0.04 seconds), and the time to 50% relaxation
was reduced (0.55±0.02 versus 1.45±0.11 seconds) in the
HF-LVAD-myocytes compared with the HF-myocytes
(P<0.05). The HF-LVAD-myocytes had larger contractions
than the HF-myocytes at all frequencies of stimulation tested. The
negative force-frequency relationship of the HF-myocytes was improved
in HF-LVAD-myocytes but was not reversed. Responses to ß-adrenergic
stimulation (by isoproterenol) were greater in HF-LVAD-myocytes versus
HF-myocytes.
Conclusions—The results of the study strongly support the idea
that circulatory support with an LVAD improves myocyte contractile
properties and increases ß-adrenergic responsiveness.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Myocyte Recovery After Mechanical Circulatory Support in Humans With End-Stage Heart Failure
Key Words: heart-assist device • myocytes • cardiomyopathy • calcium
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