Comparison of directly measured left ventricular wall stress and stress calculated from geometric reference figures

A magnetics-based approach for fine-tuning afterload in engineered heart tissues

Afterload plays important roles during heart development and disease progression, however, studying these effects in a laboratory setting is challenging. Current techniques lack the ability to precisely and reversibly alter afterload over time. Here, we describe a magnetics-based approach for achieving this control and present results from experiments in which this device was employed to sequentially increase afterload applied to rat engineered heart tissues (rEHTs) over a 7-day period. The contractile properties of rEHTs grown on control posts marginally increased over the observation period. The average post deflection, fractional shortening, and twitch velocities measured for afterload-affected tissues initially followed this same trend, but fell below control tissue values at high magnitudes of afterload. However, the average force, force production rate, and force relaxation rate for these rEHTs were consistently up to 3-fold higher than in control tissues. Transcript levels of hypertrophic or fibrotic markers and cell size remained unaffected by afterload, suggesting that the increased force output was not accompanied by pathological remodeling. Accordingly, the increased force output was fully reversed to control levels during a stepwise decrease in afterload over 4 hours. Afterload application did not affect systolic or diastolic tissue lengths, indicating that the afterload system was likely not a source of changes in preload strain. In summary, the afterload system developed herein is capable of fine-tuning EHT afterload while simultaneously allowing optical force measurements. Using this system, we found that small daily alterations in afterload can enhance the contractile properties of rEHTs, while larger increases can have temporary undesirable effects. Overall, these findings demonstrate the significant role that afterload plays in cardiac force regulation. Future studies with this system may allow for novel insights into the mechanisms that underlie afterload-induced adaptations in cardiac force development.

Transmural gradients of myocardial structure and mechanics: Implications for fiber stress and strain in pressure overload

Although a truly complete understanding of whole heart activation, contraction, and deformation is well beyond our current reach, a significant amount of effort has been devoted to discovering and understanding the mechanisms by which myocardial structure determines cardiac function to better treat patients with cardiac disease. Several experimental studies have shown that transmural fiber strain is relatively uniform in both diastole and systole, in contrast to predictions from traditional mechanical theory. Similarly, mathematical models have largely predicted uniform fiber stress across the wall. The development of this uniform pattern of fiber stress and strain during filling and ejection is due to heterogeneous transmural distributions of several myocardial structures. This review summarizes these transmural gradients, their contributions to fiber mechanics, and the potential functional effects of their remodeling during pressure overload hypertrophy.

Cardiac computed tomography imaging: a history and some future possibilities

Cardiac computed tomography (CT) is a special subset of CT, a subject about which much has been written in terms of the underlying concepts and mathematics and the sociologic impact. Cardiac CT has passed through three, chronologically overlapping, developmental stages and is now in its fourth stage of development. The first stage was fluoroscopy-based CT (1972-1995) stimulated by physiologic research needs, and the next was clinical CT-based exploration (1975-1980) of the potential of clinical CT in cardiology. This was followed by the electron beam CT-based stage (1980-present), which was the first CT approach applicable to clinical cardiology. Finally, volume-scanning CT imaging methods achieved with multislice scanning approaches of helical CT and by flat panel-based CT (1990-present), show great promise for clinically applicable CT of the cardiovascular system.

Alterations in myocardial collagen content affect rat papillary muscle function

We investigated the influence of myocardial collagen volume fraction (CVF, %) and hydroxyproline concentration (microg/mg) on rat papillary muscle function. Collagen excess was obtained in 10 rats with unilateral renal ischemia for 5 wk followed by 3-wk treatment with ramipril (20 mg. kg(-1). day(-1)) (RHTR rats; CVF = 3.83 +/- 0. 80, hydroxyproline = 3.79 +/- 0.50). Collagen degradation was induced by double infusion of oxidized glutathione (GSSG rats; CVF = 2.45 +/- 0.52, hydroxyproline = 2.85 +/- 0.18). Nine untreated rats were used as controls (CFV = 3.04 +/- 0.58, hydroxyproline = 3.21 +/- 0.30). Active stiffness (AS; g. cm(-2). %L(max)(-1)) and myocyte cross-sectional area (MA; micrometer(2)) were increased in the GSSG rats compared with controls [AS 5.86 vs. 3.96 (P < 0.05); MA 363 +/- 59 vs. 305 +/- 28 (P < 0.05)]. In GSSG and RHTR groups the passive tension-length curves were shifted downwards, indicating decreased passive stiffness, and upwards, indicating increased passive stiffness, respectively. Decreased collagen content induced by GSSG is related to myocyte hypertrophy, decreased passive stiffness, and increased AS, and increased collagen concentration causes myocardial diastolic dysfunction with no effect on systolic function.

Myocardial tactile stiffness during acute reduction of coronary blood flow

BACKGROUND

Evaluation of regional myocardial contractile function is of clinical importance. We have developed a new tactile sensor system for accurate measurement of myocardial stiffness in situ. We found that the myocardial stiffness measured by this sensor, which we call tactile stiffness, can be a very useful index for accurate quantification of regional myocardial function. In this study, we used a coronary stenosis model to investigate regional myocardial tactile stiffness under conditions of reduced coronary blood flow.

METHODS

The myocardial tactile stiffness, coronary blood flow, and ventricular pressure and volume, of five open chest mongrel dogs weighing 15 to 17 kg, were measured. After measuring the baseline myocardial stiffness, coronary arterial stenosis was induced with a balloon occluder.

RESULTS

Reducing the coronary flow to 50% and 25% of the baseline level reduced the end-systolic tactile stiffness significantly from 2.20+/-0.16 g/mm2 to 2.05+/-0.20 g/mm2 (p<0.05) and from 2.21+/-0.16 g/mm2 to 1.96+/-0.18 g/mm2 (p<0.01), respectively. Reducing the flow, to 50% and 25%, increased the end-diastolic stiffness significantly from 1.29+/-0.15 g/mm2 to 1.39+/-0.14 g/mm2 (p<0.01) and from 1.30+/-0.16 g/mm2 to 1.46+/-0.14 g/mm2 (p<0.05), respectively.

CONCLUSIONS

We consider that the regional myocardial tactile stiffness will be a useful index sensitive enough to detect changes in regional contractile function under conditions of reduced coronary blood flow.

Myocardial tactile stiffness: a variable of regional myocardial function

OBJECTIVES

We developed a new sensor system for in situ measurement of myocardial tactile stiffness-stiffness in a direction perpendicular to the wall-and validated its use for providing a reasonable estimation of regional myocardial function.

BACKGROUND

Numerous attempts have been made to directly assess regional myocardial function. The complexity and highly invasive nature of the measuring devices have hampered their in situ application.

METHODS

In open chest mongrel dogs, myocardial tactile stiffness, ventricular pressure and ventricular volume were monitored. Under the preload reduction, these variables were measured to determine the relation between the end-systolic pressure-volume relation (ESPVR) and the end-systolic tactile stiffness-volume relation (ESSVR). The changes in myocardial tactile stiffness were monitored in the regional ischemic myocardial model and infarcted model to evaluate their usefulness as indexes of regional myocardial function.

RESULTS

Myocardial tactile stiffness changed cyclically and followed a time course similar to left ventricular pressure. When preload was altered, the ESSVR was as linear as the ESPVR. The slope of the ESSVR and that of the ESPVR showed a strong correlation over a wide range of contractility. These results suggest that myocardial tactile stiffness can be a good index of regional wall stress or fiber stress. End-systolic myocardial tactile stiffness of ischemic and infarcted regions decreased significantly, with a concomitant increase in end-diastolic stiffness compared with that of intact myocardium.

CONCLUSIONS

Using our tactile sensor system, regional myocardial tactile stiffness of a beating heart was measured with reasonable temporal resolution. We consider myocardial tactile stiffness to be a useful index of regional myocardial function.

Estimation of myocardial mechanical properties with dynamic transverse stiffness

There are currently no validated methods for accurately estimating regional ventricular mechanical properties. We recently developed a dynamic indentation system that can determine dynamic transverse stiffness (the slope of the relation between the indentation stress and indentation strain during high frequency indentations) in as little as 10 msec. The apparatus consists of an indentation probe coupled to a linear-motor and a computerized control system. This indentation system was tested on beating, canine ventricular septa that were mounted in a biaxial system that could apply strains in the plane of the septum and measure the resulting in-plane stresses. The probe indented the septa with peak displacements of 0.1-0.5 mm at frequencies of 20 and 50 Hz. The transverse stiffness was shown to be related to the in-plane stress and stiffness in the isolated septa. Dynamic transverse stiffness was then used to study the effects of myocardial perfusion on passive tissue stiffness and on contractility. In addition, the transverse stiffness was studied in intact canine hearts during diastole, where it was related to the chamber stiffness. Thus, dynamic transverse stiffness appears to allow estimation of myocardial mechanical properties.

Effects of simultaneous alterations in preload and afterload on measurements of left ventricular contractility in patients with dilated cardiomyopathy: comparisons of ejection phase, isovolumetric and end-systolic force-velocity indexes

OBJECTIVES

The study was designed to critically evaluate the clinical utility of ejection phase and nonejection phase indexes of contractile state in patients with severe left ventricular dysfunction.

BACKGROUND

Ejection phase indexes of left ventricular systolic performance are unable to differentiate contractility changes from alterations in loading conditions. Isovolumetric and end-systolic force-velocity indexes have been proposed as alternative measurements of contractile state that are load independent.

METHODS

Seventeen patients with nonischemic dilated cardiomyopathy were studied during cardiac catheterization. High fidelity central aortic and left ventricular pressure measurements were made with simultaneous echocardiographic recordings of chamber minor- and long-axis dimensions and wall thickness. Data were acquired under control conditions, during nitroprusside infusion and with dopamine (6 micrograms/kg per min).

RESULTS

Patients were classified into those without (group 1, n = 10) and those with (group 2, n = 7) a decrease in end-diastolic circumferential wall stress in response to dopamine. There were no baseline differences between the groups in functional class, left ventricular chamber geometry or cardiovascular hemodynamics. Ejection phase indexes were variably altered by changes in preload, afterload and heart rate, thereby complicating physiologic interpretation of data. Dopamine increased the commonly used isovolumetric index, maximal rate of rise in left ventricular pressure (dP/dtmax), by 64% for group 1 but by only 16% for group 2 (p less than 0.001), resulting in an underestimation of contractile state change in 41% of patients. In contrast, the left ventricular end-systolic circumferential wall stress-rate-corrected velocity of fiber shortening relation, which incorporates afterload, ventricular wall mass and heart rate in its analysis, was a sensitive contractility measurement that was preload independent and equally augmented by dopamine for both groups.

CONCLUSIONS

Of the left ventricular contractility indexes evaluated, the end-systolic circumferential wall stress-rate-corrected velocity of fiber shortening relation was the most physiologically appropriate for assessing pharmacologically induced changes in inotropic state that were accompanied by complex alterations in loading conditions in patients with dilated cardiomyopathy.

Diastolic anisotropic properties of the left ventricle in the conscious dog

The role of myocardial anisotropy in determining change in left ventricular shape during diastolic filling has not yet been demonstrated. Therefore, 11 conscious dogs were instrumented with global ultrasonic dimension transducers to measure left ventricular major and minor axis diameters and equatorial wall thickness. Myocardial geometry was represented as a three-dimensional ellipsoidal shell. Left ventricular transmural pressure was measured with micromanometers, and ventricular volume was varied by inflation of vena caval occluders. Left ventricular wall strains and stresses calculated from the ellipsoidal shell model agreed closely with those measured directly by myocardial force and dimension transducers. Unequal normalized diastolic stress-strain relations were observed in the latitudinal, longitudinal, and wall thickness directions, reflecting anisotropic mechanical properties of the myocardium. Although a greater wall stress in the latitudinal versus longitudinal axis was predicted adequately from left ventricular geometry alone, the observed latitudinal strain exceeded longitudinal strain by an amount greater than was predicted by geometric considerations alone, suggesting that myocardial anisotropy contributes significantly to changes in ventricular shape during diastolic filling.

Impaired diastolic function and coronary reserve in genetic hypertension. Role of interstitial fibrosis and medial thickening of intramyocardial coronary arteries

Left ventricular hypertrophy (LVH) in rats with genetic hypertension is accompanied by abnormal myocardial diastolic stiffness and impaired coronary reserve. Whether these functional defects are related to a structural remodeling of the myocardium that includes an interstitial and perivascular fibrosis, myocyte hypertrophy, and medial thickening of intramyocardial coronary arteries is uncertain. To address these issues, 14-week-old male spontaneously hypertensive rats with established hypertension and LVH were treated with low-dose (SLO group: 2.5 mg/kg/day, n = 11) or high-dose (SHI group: 20 mg/kg/day, n = 9) oral lisinopril for 12 weeks to sustain hypertension and LVH or to normalize arterial pressure and myocardial mass, respectively. When SHI and SLO groups were compared with age- and sex-matched 26-week-old untreated spontaneously hypertensive rats (n = 11) and normotensive Wistar-Kyoto rats (n = 9), we found 1) normalization of blood pressure (p less than 0.005) and complete regression of LVH (p less than 0.005) in the SHI group and no significant blood pressure or LVH reduction in the SLO group, 2) complete regression of morphometrically determined myocardial interstitial and perivascular fibrosis in SHI and SLO groups (p less than 0.025) associated with normalization of diastolic stiffness, measured in the isolated heart (p less than 0.025), and 3) regression of medial wall thickening of intramyocardial coronary arteries only in the SHI group (P less than 0.005), accompanied by a normalization of coronary vasodilator reserve to adenosine (p less than 0.005). Thus, interstitial fibrosis and not LVH is responsible for abnormal myocardial diastolic stiffness, whereas medical wall thickening of intramyocardial resistance vessels, influenced by arterial pressure, is associated with impaired coronary reserve.

Servo-controlled indenter for determining the transverse stiffness of ventricular muscle

Regional ventricular wall stress is a critical determinant of cardiac function. There are, however, no validated methods for accurately estimating this stress. We have shown in the isolated ventricular septum that, during steady-state indentations, the transverse stiffness (the ratio of indentation stress [pressure acting on indenter face] to indentation strain [amount of indentation/nonindented thickness]) can be used as an estimate of the in-plane wall stress. Because of the long acquisition time for those transverse stiffness determinations, it was not possible to follow changes in wall stress over a single contraction. We recently developed a dynamic indentation system that can determine transverse stiffness in as little as 10 ms, allowing estimation of wall stress over a single contraction cycle. The apparatus consists of an indentation probe coupled to a linear motor. This indentation system was tested on two beating canine ventricular septa that were mounted in a biaxial system the could apply strains in the plane of the septa and measure the resulting in-plane stresses. The probe indented the septa with peak displacements of 0.1-0.5 mm at frequencies of 20 and 50 Hz. The transverse stiffness was calculated as the slope of the relation between the indentation stress and indentation strain during each high-frequency indentation. Consistent with earlier studies, the transverse stiffness was related to the inplane stress. In contrast to earlier studies, however, these dynamic transverse stiffness determinations could be made during a single contraction. Thus, dynamic transverse stiffness determinations allow estimation of wall stress in the isolated septa by minimal surface contact, and may lead to methods for estimating wall stress in the intact heart.

Time-invariant oxygen cost of mechanical energy in dog left ventricle: consistency and inconsistency of time-varying elastance model with myocardial energetics

We studied whether the oxygen cost of mechanical energy is time-invariant in the excised, cross-circulated canine heart. The total mechanical energy generated by ventricular contraction can be quantified by the total pressure-volume area (PVA) according to the time-varying elastance model. In this model, mechanical energy generated until a specified time (t) during systole can be quantified by the partial pressure-volume area, PVA(t). PVA(t) was obtained by quickly releasing ventricular volume at a varied time during isovolumic contraction. The quick release aborted further development of mechanical energy. We found that PVA(t) at a constant end-diastolic volume linearly correlated with myocardial oxygen consumption (VO2). This indicates that the oxygen cost of mechanical energy is time-invariant. However, we also found that the slope of the VO2-PVA(t) relation decreased with increasing quick-release speed. This indicates a decrease in VO2 by the quick release despite the same PVA(t). The time-invariant oxygen cost of mechanical energy is consistent with the time-varying elastance model of the ventricle, but the decreased VO2 with increasing quick-release speed despite the same PVA(t) is not.

Functional significance of ventricular dilatation. Reconsideration of Linzbach's concept of chronic heart failure

On the basis of theoretical considerations and experimental data this study deals with the functional consequences of structural dilatation, particularly in view of Linzbach's concept of chronic heart failure (34-38). After a short review of the literature, a theoretical analysis of the relationship between stroke volume and ventricular inner radius is presented assuming a thick-walled sphere. Presupposing constant contractility, end-diastolic sarcomere length, end-diastolic wall thickness and end-systolic pressure, only a considerable increase of ventricular radius could be the direct cause of ventricular pumping failure - despite increasing wall stress and reduced ejection fraction. Impaired contractility, as well as insufficient hypertrophy and increased systemic pressure, would intensify the adverse consequences of ventricular enlargement to a predictable extent. Thus, hemodynamic and energetic consequences of dilation, although mutually interacting, should in principle be distinguished. Despite considerable simplifications involved in model calculations, the relative significance of contractility, ventricular size, wall thickness, and extracardiac factors (mechanical overload; neuroendocrine reactions) can be estimated in various animal models with congestive failure. Hence, this theoretical and experimental approach permits the modification and deepening of previous concepts of structural dilatation and also has implications for interpreting the effects of therapeutical interventions.

End-systolic radius to thickness ratio: an echocardiographic index of regional performance during reversible myocardial ischemia in the conscious dog

Regional myocardial dysfunction induced by ischemia is associated with less thickening and a larger ventricular radius at end-systole. Thus, end-systolic radius to thickness ratio measured by echocardiography may provide an accurate index of regional left ventricular function that is totally independent of cardiac motion. To test this hypothesis, a total of 14 transient (less than or equal to 10 minutes) coronary artery occlusions (8 left anterior descending, 6 left circumflex) followed by up to 24 hours of reperfusion were performed in six chronically instrumented conscious dogs providing multiple grades of regional ventricular dysfunction. Regional myocardial thickening fraction was determined with epicardial pulsed Doppler probes and served as an independent standard for comparison with simultaneous echocardiographic measurements. End-systolic radius to thickness ratio and radial shortening fraction were derived from the two-dimensional echocardiographic short-axis view along 12 equidistant radii. In the ischemic zone, percent thickening fraction averaged 22 +/- 5% during baseline, decreased to -4 +/- 4% during occlusion with gradual return to baseline after reperfusion. End-systolic radius to thickness ratio averaged 1.39 +/- 0.25 before coronary occlusion and increased to 2.97 +/- 0.48 during occlusion with a gradual return to baseline values. A significant correlation was found between Doppler-determined thickening fraction measurements and echocardiographic end-systolic radius to thickness ratio as well as radial shortening fraction for absolute values (r = -0.83 and 0.75, respectively; n = 65) and percent change from baseline (r = -0.86 and 0.78, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Transverse stiffness: a method for estimation of myocardial wall stress

Determination of regional ventricular wall stress would allow quantification of both regional contractile state and its interplay with global function. Current methods for quantifying regional stress include mathematical modelling and measurements with strain gauges. Both methods are difficult to validate. We hypothesized that transverse stiffness (i.e., the ratio of indentation stress to strain as the ventricular wall is indented in the direction perpendicular to the wall) would be proportional to the stresses in the plane of the wall and could be used to estimate the latter. To test this hypothesis, 6 arterially perfused canine ventricular septa were mounted in an apparatus that could exert biaxial load in the plane of the wall. A servo system maintained the central third of the septa isometric during active contractions while the septa were paced at 30-60 pulses/min. In the center of the isometric region, a probe of 7 mm diameter indented the septa while the transverse indentation stress and strain were measured. For values of peak systolic in-plane stress from 0.56 to 2.6 g/mm2, the transverse stiffness varied from 1.2 to 11.7 g/mm2 and was linearly related to the in-plane wall stress in each septum (p less than 0.001, ANOVA). After cardioplegia, the transverse stiffness also correlated with passively applied wall stress for each dog (p less than 0.001). The slopes of the individual relations between transverse stiffness and wall stress from active contractions were similar to those from passively applied stress (mean +/- SEM; 1.82 +/- 0.36 versus 1.45 +/- 0.31, NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Preload dependence of right ventricular blood flow: I. The normal right ventricle

Right ventricular (RV) failure is commonly treated with intravascular volume expansion to increase the RV-left atrial pressure gradient and improve left-sided filling. As RV pressure rises, chamber distention occurs and wall tension increases. These studies were designed to determine if increased wall tension might impede RV myocardial blood flow in the normal canine right ventricle and thus contribute to RV failure. Hemodynamic data, the septal-RV free wall dimension, and RV myocardial blood flow were obtained at low and high levels of preload and in both the autoregulated and vasodilated (adenosine, 2 mg per kilogram of body weight per minute) states. Elevated filling pressure decreased RV myocardial blood flow in both the autoregulated (0.85 +/- 0.18 to 0.67 +/- 0.15 ml/min/gm; p less than .05) and vasodilated (2.25 +/- 0.50 to 0.85 +/- 0.25 ml/min/gm; p less than .05) states but did not change the transmural distribution of blood flow to the right ventricle. Vasodilator reserve was markedly impaired in the high-preload state. These observations suggest that preload is an important determinant of RV myocardial blood flow. Volume loading to treat RV dysfunction may be limited by impairment of RV myocardial blood flow.

Reconsideration of normalization of Emax for heart size

We previously proposed Emax Vd as a normalized form of Emax for heart size relatively independent of wall volume Vm, where Emax is the slope of the end-systolic pressure-volume line and Vd is its volume axis intercept. When Emax Vd remains constant, average circumferential stress for a specified average circumferential strain in the ventricular wall also remains relatively constant, despite changes in Vd/Vm around its normal value. Because accurate determination of Vd is difficult and stress for a given Emax Vd changes slightly with Vd/Vm, we investigated whether Vd could be replaced with Vm in a normalized Emax in this analysis. As the result, we obtained a function of Vd/Vm as the coefficient by which to multiply Emax Vd or Emax Vm to yield stress for a specified strain. Using this coefficient, one can easily calculate stress for any strain from Emax, Vd, and Vm in order to compare myocardial contractility among left ventricles of different sizes. The present study confirms the importance of Vd as an indispensable reference volume for normalization of Emax, as well as the low sensitivity of Emax Vd as a normalized Emax to changes in Vd/Vm. Only when Vd/Vm remains constant is Emax Vm proportional to Emax Vd and can replace Emax Vd.

Impaired thickening of nonischemic myocardium during acute regional ischemia in the dog

To study the regional function of nonischemic myocardium after the onset of regional ischemia, graded circumflex coronary arterial stenosis was induced in 18 open-chest anesthetized dogs. Two-dimensional echocardiographic views were obtained at each degree of occlusion in a cross-sectional plane marked by two to three metal beads sewn to the left ventricular epicardium. Percent systolic thickening was measured at 16 equally spaced points around the left ventricle and correlated with microsphere-determined regional myocardial blood flow. Baseline thickening averaged 44.9 +/- 6.4%. During transmural ischemia percent systolic thickening decreased to -16.1 +/- 4.0% in the ischemic region and also decreased in adjacent nonischemic regions (to 2.4 +/- 2.4% in segments closest to the ischemic region [adjacent 1] and to 15.5 +/- 3.9 in segments further away [adjacent 2]), but was unchanged in segments directly opposite the ischemic region (remote region). During subendocardial ischemia, percent systolic thickening fell only in the ischemic and adjacent 1 regions (1.4 +/- 5.2% and 24.9 +/- 5.0%, respectively). Dipyridamole, 0.21 to 0.42 mg/min iv, given to seven dogs during transmural ischemia, caused a three- to fivefold increase in flow to the nonischemic and no change in flow to the ischemic region; function was not altered in any region. Propranolol, 0.1 mg/kg iv, was given to five dogs during transmural ischemia to depress contractility in the remote region. Percent systolic thickening fell in the remote (from 50.0 +/- 7.7% to 34.6 +/- 5.6%), but increased in adjacent 1 (from -0.25 +/- 3.7% to 15.2 +/- 3.9%) and in adjacent 2 (from 17.4 +/- 2.8% to 33.4 +/- 3.9%) regions, and remained unchanged in the ischemic region. We conclude the following: During transmural ischemia percent systolic thickening is markedly impaired in nonischemic myocardium immediately adjacent to the ischemic region, and is impaired to a lesser degree in regions located relatively far from the ischemic border. Dysfunction therefore overestimates the extent of regional ischemia after total coronary occlusion. During subendocardial ischemia function ceases in the ischemic region and functional impairment of nonischemic myocardium is restricted to immediately adjacent regions. Dysfunction of adjacent regions is not caused by "relative ischemia" related to increased local oxygen demands or to a steal phenomenon. Mechanical tethering of nonischemic myocardium adjacent to ischemic regions, secondary to changes in left ventricular shape during contraction, may contribute to the impairment of systolic thickening in adjacent regions during transmural ischemia.

External work and arterial load in canine left ventricular ischaemic failure: evidence of ventricle-load mismatch

It has been proposed that a normal ventricle and its arterial load constitute a matched system, and that such matching is not present during ventricular failure, i.e., failure represents a state of mismatch between ventricle and arterial load. To investigate this assumption we studied the relationship between external work and load in an equatorial segment of left ventricle (LV) in an intact canine preparation under the hypothesis that the LV works at the peak of the work versus load relationship during control conditions, but is shifted from this peak during LV failure. LV systolic wall force (F) and circumferential segment work (W) were calculated in eight pentobarbital anaesthetized, open-chest dogs from LV pressure (P) and anterior-posterior diameter (D) before and after induction of LV ischaemic failure (50 micron microspheres were injected into the left coronary vascular bed). Variations of arterial load were created by acute partial occlusions of the aorta, raising aortic pressure by 45 mm Hg before and 15 mm Hg during failure. Before failure W was unaffected by the variations of arterial load, but W decreased significantly during failure. From the relation between end-systolic F and D, theoretically optimal F (Fopt) corresponding to maximum W was estimated. Before failure the observed F did not differ significantly from Fopt, but the observed F was significantly greater than Fopt during failure. These findings support the notion that ventricular failure represents a state of mismatch between the ventricle and its systolic load.

Clinical improvement in hypertrophic cardiomyopathy after inferior myocardial infarction

In cases of hypertrophic cardiomyopathy, the pathophysiologic role of the systolic pressure gradient across the left ventricular outflow tract is the subject of continued controversy. A patient with this disorder is described whose symptoms and provokable intraventricular gradient disappeared after inferior myocardial infarction. Diastolic left ventricular pressures were essentially unchanged, the isovolumic relaxation period became prolonged and the ejection fraction decreased from 0.77 to 0.61 after infarction. The peak ejection rate was unchanged, but the disappearance of systolic anterior motion of the mitral valve leaflet and obstructive manifestations may have resulted from enlarged mid to late systolic ventricular volumes. This case suggests a direct relation between symptoms and intraventricular pressure gradient in certain patients with hypertrophic cardiomyopathy.

Left ventricular adaptation to sustained pressure overload in the conscious dog

The early adaptation to aortic stenosis was studied in eight conscious dogs previously instrumented with a left ventricular micromanometer and ultrasonic crystals measuring left ventricular minor equator, left ventricular major axis, and ventricular wall thickness. Data were compared during control, acute inflation of a supravalvular aortic cuff occluder and 24 hours after aortic stenosis with and without beta-blockade. Acute aortic stenosis increased peak systolic pressure and end-systolic pressure with a decrease of percent systolic shortening of minor diameter (% delta L). Twenty-four hours after aortic constriction for heart rates, end-diastolic dimensions, and systolic pressures similar to those measured during acute aortic stenosis, % delta L was significantly increased, compared with acute aortic constriction, and was close to control values. End-systolic diameter was not significantly different from control during sustained pressure overload, although end-systolic stress was increased by 26.7 +/- 6.1% (P less than 0.01 with control), representing a leftward shift of the end-systolic stress-diameter relation. Similar results were obtained under beta-blockade. We conclude that there is, in this model of moderate pressure overload, a nonsympathetic increased inotropic state very early after aortic constriction.

Contractile function, myosin ATPase activity and isozymes in the hypertrophied pig left ventricle after a chronic progressive pressure overload

Experimental right ventricular pressure-overload hypertrophy in small mammals is associated with early muscle dysfunction, even before the onset of overt pump failure. Experimental results are quite heterogeneous regarding muscle function of the pressure hypertrophied left ventricle. Muscle dysfunction of the right or left ventricle, when found, may be causally related to alterations of myosin ATPase activity and isozyme type. However, the effect of a gradual pressure overload, analogous to that which occurs in human aortic stenosis, on myocardial contractile function and myosin ATPase activity has not been studied in a large animal whose normal myosin isozyme pattern resembles that of man. We therefore studied pump performance, myocardial contractile function, and myosin ATPase activity and isozyme pattern in pigs with severe, gradually applied left ventricular pressure overload. Thirteen weeks after supravalvular aortic banding, 10 pigs grew more than 7-fold in body weight and were found to have an aortic stenosis area of 0.5 +/- 0.1 cm2 with a gradient of 93 +/- 12 mm Hg. Compared with nine control animals, the banded animals had a 67% increase in left ventricular mass relative to body weight without overt pump failure as measured by cardiac index and pulmonary artery wedge pressure. Left ventricular ejection performance, measured as shortening fraction, was maintained except in three animals with extreme hypertrophy, in which depressed ejection performance may have been due to an afterload mismatch, myocardial dysfunction, or both. Myocardial contractile function, determined from the end-systolic stress-diameter relationship, was normal except in two pigs in which ejection performance was depressed and left ventricular mass was more than doubled. Only the slow V3 isozyme of myosin ATPase was found in both normal and hypertrophied pig myocardium, and the ATPase activity was normal in pigs with all degrees of hypertrophy. Thus, in a large animal model of severe, gradual left ventricular pressure overload, in which myosin isozyme pattern remains apparently unaltered, moderate hypertrophy can be associated with normal myosin ATPase activity and contractile function that is normal by current methods of evaluation.

End-systolic dimension-wall thickness relations during myocardial ischemia in conscious dogs. A new approach for defining regional function

Overall and regional left ventricular (LV) function was studied during progressive coronary stenosis in conscious dogs by determining the relations at end-systole between LV pressure, chamber dimensions, and regional LV wall thickness. An index of regional wall stress was also analyzed. Using ultrasonic dimension gauges, measurements were made of LV wall thickness in control and ischemic regions, and the external long- and short-axis LV diameters were determined; an implanted micromanometer measured LV pressure. Internal LV diameters were obtained from the external diameters by subtraction of wall thickness, and the index of regional wall stress employed a thick-walled ellipsoidal model. During regional ischemia, the LV long axis at end-systole did not change, whereas the short-axis diameter progressively increased (from 24 +/- 7 mm [standard deviation] to 30 +/- 9 mm, p less than 0.001, indicating a more spherical LV shape during ischemia). The end-systolic pressure did not change, and therefore the end-systolic pressure-diameter relation shifted progressively, suggesting a global decrease in LV contactility. The end-systolic points relating LV wall thickness in the ischemic region to the end-systolic LV pressure revealed the regional nature of the abnormality, showing a progressive displacement to the left, whereas there was no significant displacement of this relation in the control region. The application of this index over a range of loading conditions during partial vena caval occlusion was illustrated. Thus, the regional end-systolic wall thickness-pressure relation provides a new index for defining the regional contractile state of the LV myocardium which is potentially load-independent and offers the possibility for echocardiographic application.

Isolated cat trabeculae in a simulated feline heart and arterial system. Contractile basis of cardiac pump function

Isolated cat trabeculae were studied under conditions resembling those present for the muscle fibers in the wall of the left ventricle. To obtain such a situation experimental animals, perfusion fluid, temperature, stimulation frequency, peak stress values, contraction sequence, length, and force control were chosen with respect to that criterion. Results were compared with those described for the intact feline heart in previous studies. Special emphasis was placed on determinants of the pump function graph, i.e., the relationship between mean ventricular pressure and output. It was found that peak isometric stress values measured in the trabeculae were about twice as high as those existing on average at the base of the intact left ventricle in the circumferential direction. However, the duration of the mechanical activity, as measured in iso(volu)metric contractions, was in the isolated trabeculae (206 msec) significantly less (P less than 0.01) than found in intact right (292 msec) or intact left ventricle (344 msec). Furthermore the (maximum) output of the intact left ventricle at end-diastolic pressure could not be accounted for in a simple manner by the maximum amount of shortening found in isolated trabeculae. The points of the pump function graph obtained by varying the input impedance of the loading arterial system over a wide range of compliance and resistance values in the steady state deviated only little from the graph obtained from a series of constant pressure levels applied in a beat-to-beat fashion. Therefore, the insensitivity of the pump function graph to the nature of the arterial load is found in the intact heart as well as in isolated cardiac muscle.

Changes in control of renin release in congestive heart failure in dogs: response to acute and chronic vasodilator therapy

Neural control of renin secretion is an important physiologic mechanism, but alterations in the central nervous system feedback and control of renin release in heart failure have not been investigated. Accordingly we studied conscious dogs after volume overload (arteriovenous fistula) or chronic myocardial infarction. Acute infusion of nitroprusside was used to test the renin response to arterial hypotension and decreased central blood volume. Hydralazine and prazosin administration were used to test the response to chronic vasodilator administration. After 4 weeks of volume overload or 3 weeks after myocardial infarction, the renin response to a graded hypotensive stimulus was blunted. After 7 days of hydralazine or prazosin administration, plasma renin activity remained elevated and blood volume increased from baseline values. Our results indicate a decrease in the neural feedback control of renin release after chronic volume overload or myocardial infarction. However, chronic vasodilator administration still resulted in sustained augmented renin secretion and an increase in blood volume.

The deformational characteristics of the left ventricle in the conscious dog

We studied left ventricular minor and major axis diameters and equatorial wall thickness in eleven conscious dogs with chronically implanted pulse-transit ultrasonic dimension transducers. Left ventricular transmural pressure was measured with micromanometers. Left ventricular volume was varied by inflation of implanted vena caval or aortic occluders. The geometry of the left ventricle was represented as a three-dimensioal ellipsoidal shell. Left ventricular eccentricity was found to be a linear function of ventricular volume during both diastole and ejection. However, the relationship was not the same for diastole and ejection, and during diastole the left ventricle was mre spherical at large volumes and more elliptical at small volumes than during ejection. The rearrangements in geometry observed during isovolumic contraction appeared to be transitional stages from the diastolic to the ejection-phase relationship. Thus, during isovolumic contraction, the left ventricle became more elliptical at large volumes and more spherical at small volumes. These relationships were not altered significantly by increased afterload or inotropic interventions. We also observed that the diastolic deformation of the ventricular chamber occurred in a set and predictable manner that seemed to be determined by the three-dimensional mechanical properties of the myocardium. The geometric inter-relationships of the ventricular wall determined the relationship between diastolic transmural pressure and mural stress. These findings probably reflect basic structural characteristics of the myocardium and provide a convenient method for quantitatively representing the dynamic geometry of the left ventricle.

"Pressure-volume" relations in isolated cat trabecula

We studied isolated cat trabecula under conditions closely resembling those present for muscle fibers in the left ventricular wall. The purpose of the study was to see if muscle contraction under those circumstances could be described by a time-varying compliance as reported for intact canine left ventricle. We found the time of the end of systole to depend on the history of contraction. This time varied between 100 and 160 msec as measured from the onset of contraction. Similar dependency, although less percentage-wise, was found by reanalysis for intact feline left ventricles. We conclude that the behavior of the canine left ventricle as a time-varying compliance may be related to the complex organization of the cardiac muscle fibers in the wall of the heart rather than to muscle properties.

A force-length-time relationship describes the mechanics of canine left ventricular wall segments during auxotonic contractions

We examined regional mechanics of the left ventricular free wall in naturally pumping dog hearts during beta-blockade. Local systolic wall force (F) and segment length (L) were obtained with an auxotonic force gauge and an ultrasonic dimension gauge, both inserted at the equatorial level of the wall to measure F and L in the circumferential direction. Shortening velocity (-dL/dt) was obtained by differentiation of L. Preload and afterload were changed by acute caval and/or aortic occlusion so that a wide variation in F, L, -dL/dt, and dF/dt during shortening was obtained. In all experiments, F vs. L at identical time (t) after end-diastole (ED) fell on well-defined lines, irrespective of the -dL/dt line (t = 200 msec) was equivalent to a drop of approximately 50% in F at 10% reduction in L. No defined relationship was observed between F, L, and -dL/dt. However, by superimposing F, L, and -dL/dt curves from contractions of high EDL and high -dL/dt on those from contractions of low EDL and low -dL/dt, and comparing F and -dL/dt at identical L and t, a slightly lower F (difference 2.23 +/- 1.09 g, P approximately 0.05) could be associated with the higher -dL/dt (difference 0.6 +/- 0.1 muscle length/sec, P less than 0.001). These data suggest that the F-L-t relationship is a valid descriptor of auxotonic contractions in the ventricular wall, and that the direct effect of shortening velocity on the wall force is modest.

Ventricular elastic modulus as a function of age in the Syrian golden hamster

Analysis of passive right and left ventricular pressure-volume curves for hearts of 72 Syrian golden hamsters studied in vitro showed increases in ventricular weight, volume, and compliance at mid-age. Both ventricles were filled by syringe pumps at a constant rate. Ventricular compliance (dV/dP) was determined by electronic differentiation of the intraventricular pressures and formation of the ratio (dV/dt)/(dP/dt) as a continuous function of intraventricular pressure between 0 and 30 mm Hg. By relating, with justification, the left ventricle to a thin-walled elastic sphere, ventricular elastic moduli, E, for different ages were compared at constant levels of myocardial wall stress, sigma. The elastic modulus E proved to be a linear function of sigma. The slope of the E-sigma plot yielded a stiffness constant, K, for each age group. Body weight, heart weight, end-diastolic volume, and dV/dP all varied by more than 200% up and then down as a function of age, but K was not a significant function of age. These results suggest that the aging heart does not normally undergo substantial alterations in passive properties that affect the muscle cells and fibers themselves, but rather that the observed changes in compliance are primarily attributable to alterations in ventricular size.