(Circulation. 1996;94:2260-2267.)
© 1996 American Heart Association, Inc.
Articles |
Regional Deficits of Myocardial Blood Flow and Function in Left Ventricular Pacing–Induced Heart Failure
the Veterans Affairs Medical Center, San Diego, Calif.
Correspondence to H. Kirk Hammond, MD, VAMC San Diego (111-A), 3350 La Jolla Village Dr, San Diego, CA 92161. E-mail khammond@ucsd.edu.
Background Pacing-induced congestive heart failure has become a preferred model for the study of the pathogenesis of dilated cardiomyopathy. However, little is known regarding regional myocardial blood flow and function during the development of heart failure in this model.
Methods and Results To determine whether regional differences in myocardial blood flow are associated with regional dysfunction in ventricular pacing–induced heart failure, regional myocardial blood flow (radioactive microspheres) and regional wall thickening (transthoracic echocardiography) were measured in pigs studied at weekly intervals during the progression of heart failure induced by rapid pacing from the lateral wall of the left ventricle (220±9 bpm for 26±4 days). Echocardiography and hemodynamic measurements with the pacemaker off showed progressive, severe global left ventricular dysfunction. During pacing over the 3- to 4-week period, a progressive decrease in systolic wall thickening in the lateral wall occurred compared with the interventricular septum (IVS; P=.001); at 21 to 28 days, the difference was 50% (lateral wall, 14±6%; IVS, 28±6%; P=.0001). A difference in subendocardial blood flow per beat between the left ventricular lateral wall (the site of stimulation) and the IVS was found immediately on the initiation of pacing (IVS, 0.009±0.002 mL · min-1 · g-1 · beat-1; lateral wall, 0.005±0.001 mL · min-1 · g-1 · beat-1; P=.001), a difference that was sustained during pacing throughout the study. Subendocardial blood flow per beat was normal in both regions with the pacemaker off throughout the study.
Conclusions These data indicate that regional myocardial ischemia is associated with the development of contractile dysfunction of the paced wall during prolonged rapid left ventricular pacing and that regional stunning contributes to persistent global left ventricular dysfunction when pacing is discontinued.
Key Words: cardiomyopathy • stress • stunning, myocardial • blood flow • ischemia
This article has been cited by other articles:
 |
|
 |
|
  F. Zanon, E. Bacchiega, L. Rampin, S. Aggio, E. Baracca, G. Pastore, T. Marotta, G. Corbucci, L. Roncon, D. Rubello, et al. Direct His bundle pacing preserves coronary perfusion compared with right ventricular apical pacing: a prospective, cross-over mid-term study Europace, May 1, 2008; 10(5): 580 - 587. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Lionetti, L. Guiducci, A. Simioniuc, G. D. Aquaro, C. Simi, D. De Marchi, S. Burchielli, L. Pratali, M. Piacenti, M. Lombardi, et al. Mismatch between uniform increase in cardiac glucose uptake and regional contractile dysfunction in pacing-induced heart failure Am J Physiol Heart Circ Physiol, November 1, 2007; 293(5): H2747 - H2756. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. S. Kassab, M. Kostelec, G. D. Buckberg, J. Covell, A. Sadeghi, and J. I.E. Hoffman Myocardial protection in the failing heart: II. Effect of pulsatile cardioplegic perfusion under simulated left ventricular restoration J. Thorac. Cardiovasc. Surg., October 1, 2006; 132(4): 884 - 890. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. C. Stanley, F. A. Recchia, and G. D. Lopaschuk Myocardial Substrate Metabolism in the Normal and Failing Heart Physiol Rev, July 1, 2005; 85(3): 1093 - 1129. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. C. Lai, D. M. Roth, M. H. Gao, T. Tang, N. Dalton, Y. Y. Lai, M. Spellman, P. Clopton, and H. K. Hammond Intracoronary Adenovirus Encoding Adenylyl Cyclase VI Increases Left Ventricular Function in Heart Failure Circulation, July 20, 2004; 110(3): 330 - 336. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. D. Buckberg Congestive heart failure: Treat the disease, not the symptom--return to normalcy J. Thorac. Cardiovasc. Surg., March 1, 2003; 125(90030): S41 - 49. [Full Text] [PDF]
|
|
|
|
 |
|
 O. M. Muhling, Y. Wang, P. Panse, M. Jerosch-Herold, M. M. Cayton, L.S. Wann, M. M. Mirhoseini, and N. M. Wilke Transmyocardial laser revascularization preserves regional myocardial perfusion: an MRI first pass perfusion study Cardiovasc Res, January 1, 2003; 57(1): 63 - 70. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. D. Tune, K. N. Richmond, M. W. Gorman, and E. O. Feigl Control of Coronary Blood Flow during Exercise Experimental Biology and Medicine, April 1, 2002; 227(4): 238 - 250. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. B Haitsma, D. Bac, N. Raja, F. Boomsma, P. D Verdouw, and D. J Duncker Minimal impairment of myocardial blood flow responses to exercise in the remodeled left ventricle early after myocardial infarction, despite significant hemodynamic and neurohumoral alterations Cardiovasc Res, December 1, 2001; 52(3): 417 - 428. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. D. Buckberg Congestive heart failure: Treat the disease, not the symptom--Return to normalcy J. Thorac. Cardiovasc. Surg., April 1, 2001; 121(4): 628 - 637. [Full Text] [PDF]
|
|
|
|
|
|
H.K. Hammond and M.D. McKirnan Angiogenic gene therapy for heart disease: a review of animal studies and clinical trials Cardiovasc Res, February 16, 2001; 49(3): 561 - 567. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. L. Cmolik, D. R. Thompson, J. T. Sherwood, A. S. Geha, and D. T. George Increased coronary artery blood flow with aortomyoplasty in chronic heart failure Ann. Thorac. Surg., January 1, 2001; 71(1): 284 - 289. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. W. Prinzen, W. C. Hunter, B. T. Wyman, and E. R. McVeigh Mapping of regional myocardial strain and work during ventricular pacing: experimental study using magnetic resonance imaging tagging J. Am. Coll. Cardiol., May 1, 1999; 33(6): 1735 - 1742. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. H. Traverse, P. Melchert, G. L. Pierpont, B. Jones, M. Crampton, and R. J. Bache Regulation of Myocardial Blood Flow by Oxygen Consumption Is Maintained in the Failing Heart During Exercise Circ. Res., March 5, 1999; 84(4): 401 - 408. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Anzai, N. C. Lai, M. Gao, and H. K. Hammond Dissociation between regional dysfunction and beta -adrenergic receptor signaling in heart failure Am J Physiol Heart Circ Physiol, October 1, 1998; 275(4): H1267 - H1273. [Abstract] [Full Text] [PDF]
|
|