Left ventricular pressure-volume relationships before and after cardiomyoplasty in patients with heart failure

• Published in: Circulation (New York, N.Y.) Vol. 96; no. 9; pp. 2978 - 2986
• Main Authors: SCHREUDER, J. J, VAN DER VEEN, F. H, VOLTERRANI, M, KAULBACH, H.-G, BAAN, J, WELLENS, H. J. J, VAN DER VELDE, E. T, DELAHAYE, F, ALFIERI, O, JEGADEN, O, LORUSSO, R, JANSEN, J. R. C, HOEKSEL, S. A. A. P, FINET, G
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 04-11-1997; American Heart Association, Inc
• Subjects: Biological and medical sciences; Cardiology. Vascular system; Cardiomyopathy, Dilated - physiopathology; Cardiomyopathy, Dilated - surgery; Cardiomyoplasty; Heart; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Hemodynamics - drug effects; Humans; Medical sciences; Middle Aged; Nitroglycerin - pharmacology; Ventricular Function, Left; Human; Heart failure; Plasty; Pressure volume ratio; Treatment; Heart disease; Surgery; Treatment efficiency; Myocardium; Cardiovascular disease; Hemodynamics; Left ventricle
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.CIR.96.9.2978

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.
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 tau 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 tau from 50.8+/-2.8 to 44.5+/-3.7 ms (P<.05). Six months after CMP, nitroglycerin decreased EDP, ESP, and tau to similar values.
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.