(Circulation. 1995;92:1011-1019.)
© 1995 American Heart Association, Inc.
Articles |
Bioenergetic Consequences of Left Ventricular Remodeling
From the Cardiovascular Division, Department of Medicine, and the Center for Magnetic Resonance Research, University of Minnesota Medical School, Minneapolis.
Correspondence to Jianyi Zhang, MD, PhD, Cardiovascular Division, University of Minnesota Medical School, Box 508 UMHC, Minneapolis, MN 55455.
Background Left ventricular (LV) remodeling is associated with LV dysfunction and decrease of coronary flow reserve. The underlying mechanisms responsible for these alterations are unclear. Changes in myocardial high-energy phosphate levels may be associated with these alterations.
Methods and Results Twelve dogs with LV remodeling secondary to
discrete necrosis produced by transmyocardial DC shock were compared
with 8 normal dogs. LV mass and end-diastolic volume were
measured by magnetic resonance imaging 7 days before and 12.9±1.3
months after DC shock. Transmurally localized 31P nuclear
magnetic resonance spectra from five layers across the LV wall were
obtained simultaneously with transmural blood flow measurements
(microspheres) under basal conditions and during pacing at 200 and 240
beats per minute. LV mass and end-diastolic volume were
significantly increased after DC shock (33% and 26%, respectively,
each P<.01). Under basal conditions, the subendocardial
creatine phosphate (CP)/ATP ratio was significantly lower in remodeled
LV compared with the control group (1.71±0.09 versus 2.04±0.09,
P<.05). The subendocardial CP/ATP ratio was inversely
correlated with both the increase in LV mass and LV
end-diastolic volume (r=-.77 and
r=-.70, P<.01 and P<.05,
respectively). In remodeled myocardium, pacing induced a significant
increase in LV end-diastolic pressure (from 8±1 to 20±3
mm Hg, P<.05), which was accompanied by a significant
decrease of subendocardial/subepicardial (Endo/Epi) blood flow ratio
(from 1.01±0.10 to 0.63±0.11, P<.05) and a
significant
decrease in subendocardial CP/ATP ratio (from 1.78±0.07 to
1.61±0.10,
P<.05) and increase of 
Pi/ATP ratio
(from 0 to 0.24±0.05, P<.01). The decrease in
subendocardial CP/ATP ratio was correlated with the decrease in
Endo/Epi blood flow ratio (r=.79, P<.05).
Conclusions These results demonstrate that alterations in myocardial high-energy phosphate levels are correlated with the extent of LV remodeling. In remodeled hearts, pacing-induced tachycardia produces further changes of myocardial high-energy phosphate levels in the subendocardium that appear to be related to ventricular dysfunction and redistribution of blood flow away from the subendocardium.
Key Words: ventricles • hypertrophy • phosphates • myocardium • ischemia • spectroscopy
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