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(Circulation. 1997;96:3665-3671.)
© 1997 American Heart Association, Inc.

Articles

Stabilization of Chronic Remodeling by Asynchronous Cardiomyoplasty in Dilated Cardiomyopathy

Effects of a Conditioned Muscle Wrap

Himanshu J. Patel, MD; David J. Polidori, MD; James J. Pilla, PhD; Theodore Plappert, CVT; David Kass, MD; Martin St John Sutton, FRCP; Edward B. Lankford, MD, PhD; ; Michael A. Acker, MD

From the Divisions of Cardiothoracic Surgery (H.J.P., D.J.P., J.J.P., M.A.A.) and Cardiology (T.P., M.S.S., E.B.L.), Departments of Surgery and Medicine, University of Pennsylvania School of Medicine, Philadelphia, and the Department of Medicine (D.K.), The Johns Hopkins School of Medicine, Baltimore, Md.

Correspondence to Michael A. Acker, MD, Division of Cardiothoracic Surgery, Silverstein 4, Hospital of the University of Pennsylvania, 34th and Spruce Streets, Philadelphia, PA 19104.

Background Dynamic cardiomyoplasty is a promising new therapy for dilated cardiomyopathy. The girdling effects of a conditioned muscle wrap alone have recently been postulated to partly explain its mechanism. We investigated this effect in a canine model of chronic dilated cardiomyopathy.

Methods and Results Twenty dogs underwent rapid ventricular pacing (RVP) for 4 weeks to create a model of dilated cardiomyopathy. Seven dogs were then randomly selected to undergo subsequent cardiomyoplasty, and all dogs had 6 weeks of additional RVP. The cardiomyoplasty group also received 6 weeks of concurrent skeletal muscle stimulation consisting of single twitches delivered asynchronously at 2 Hz to transform the wrap without active assistance. All dogs were studied by pressure-volume analysis and echocardiography at baseline and after 4 and 10 weeks of pacing. Systolic indices, including ejection fraction (EF), end-systolic elastance (Ees), and preload-recruitable stroke work (PRSW) were all increased at 10 weeks in the wrap versus controls (EF, 34.0 versus 27.1, P=.008; Ees, 1.65 versus 1.26, P=.09; PRSW, 35.9 versus 25.5, P=.001). Ventricular volumes, diastolic relaxation, and left ventricular end-diastolic pressures stabilized in the cardiomyoplasty group but continued to deteriorate in controls. Both the end-systolic and end-diastolic pressure-volume relationships shifted farther rightward in controls but remained stable in the cardiomyoplasty group.

Conclusions In addition to potential benefits from active systolic assistance, benefits from dynamic cardiomyoplasty appear to be partially accounted for by the presence of a conditioned muscle wrap alone. This conditioned wrap stabilizes the remodeling process of heart failure, arresting progressive deterioration of systolic and diastolic function.

Key Words: cardiomyopathy • electrical stimulation • heart failure • mechanics • remodeling • surgery