Dynamic myocardial contractile parameters from left ventricular pressure-volume measurements

A new dynamic model of left ventricular (LV) pressure-volume relationships in beating heart was developed by mathematically linking chamber pressure-volume dynamics with cardiac muscle force-length dynamics. The dynamic LV model accounted for >80% of the measured variation in pressure caused by small-amplitude volume perturbation in an otherwise isovolumically beating, isolated rat heart. The dynamic LV model produced good fits to pressure responses to volume perturbations, but there existed some systematic features in the residual errors of the fits. The issue was whether these residual errors would be damaging to an application where the dynamic LV model was used with LV pressure and volume measurements to estimate myocardial contractile parameters. Good agreement among myocardial parameters responsible for response magnitude was found between those derived by geometric transformations of parameters of the dynamic LV model estimated in beating heart and those found by direct measurement in constantly activated, isolated muscle fibers. Good agreement was also found among myocardial kinetic parameters estimated in each of the two preparations. Thus the small systematic residual errors from fitting the LV model to the dynamic pressure-volume measurements do not interfere with use of the dynamic LV model to estimate contractile parameters of myocardium. Dynamic contractile behavior of cardiac muscle can now be obtained from a beating heart by judicious application of the dynamic LV model to information-rich pressure and volume signals. This provides for the first time a bridge between the dynamics of cardiac muscle function and the dynamics of heart function and allows a beating heart to be used in studies where the relevance of myofilament contractile behavior to cardiovascular system function may be investigated.

Smooth muscle relaxation and local hydraulic impedance properties of the aorta

Smooth muscle relaxation is expected to yield beneficial effects on hydraulic impedance properties of large vessels. We investigated the effects of intravenous diltiazem infusion on aortic wall stiffness and local hydraulic impedance properties. In seven anesthetized, closed-chest dogs, instantaneous cross-sectional area and pressure of the descending thoracic aorta were measured using transesophageal echocardiography combined with acoustic quantification and a micromanometer, respectively. Data were acquired during a vena caval balloon inflation, both at the control condition and with diltiazem infusion. At the operating point, diltiazem reduced blood pressure in all dogs but did not alter aortic dimensions or wall stiffness. Over the observed pressure range, aortic area-pressure relationships were linear. Whereas diltiazem affected the slope of this relationship variably (no change in 3 dogs, increase in 1 dog, decrease in 3 dogs), the zero-pressure area intercept was significantly increased in every case such that higher area was observed at any given pressure. When comparisons were made at a common level of wall stress, wall stiffness was either increased or unchanged during diltiazem infusion. In contrast, diltiazem decreased wall stiffness in every case when comparisons were made at a common level of aortic midwall radius. Aortic characteristic impedance and pulse wave velocity, components of left ventricular hydraulic load that are determined by aortic elastic and geometric properties, were affected variably. A comparison of wall stiffness at matched wall stress appears inappropriate for assessing changes in smooth muscle tone. Because of the competing effects of changes in vessel diameter and wall stiffness, smooth muscle relaxation is not necessarily accompanied by the expected beneficial changes in local aortic hydraulic impedance. These results can be reconciled by recognizing that components other than vascular smooth muscle (e.g., elastin, collagen) contribute to aortic wall stiffness.

Accuracy of echocardiographic estimates of left ventricular mass in mice

Genetically modified mice have created the need for accurate noninvasive left ventricular mass (LVM) measurements. Recent technical advances provide two-dimensional images adequate for LVM calculation using the area-length method, which in humans is more accurate than M-mode methods. We compared the standard M-mode and area-length methods in mice over a wide range of LV sizes and weights (62-210 mg). Ninety-one CD-1 mice (38 normal, 44 aortic banded, and 9 inherited dilated cardiomyopathy) were imaged transthoracically (15 MHz linear transducer, 120 Hz). Compared with necropsy weights, area-length measurements showed higher correlation than the M-mode method (r = 0.92 vs. 0.81), increased accuracy (bias +/- SD: 1.4 +/- 27.1% vs. 36.7 +/- 51.6%), and improved reproducibility. There was no significant difference between end-systolic and end-diastolic estimates. The truncated ellipsoid estimation produced results similar in accuracy to the area-length method. Whereas current echocardiographic technology can accurately and reproducibly estimate LVM with the two-dimensional, area-length formula in a variety of mouse models, additional technological improvements, rather than refinement of geometric models, will likely improve the accuracy of this methodology.

The left ventricular stress-velocity relation in transgenic mice expressing a dominant negative CREB transgene in the heart

OBJECTIVE

CREB(A133) transgenic mice that express a dominant negative CREB transcription factor in cardiomyocytes develop a dilated cardiomyopathy that is anatomically, physiologically, and clinically similar to human idiopathic dilated cardiomyopathy. The goals of this study were to quantitate left ventricular (LV) contractility and measure cardiac reserve in CREB(A133) mice by using the relation of end-systolic wall stress to the velocity of fiber shortening.

METHODS

A total of 37 adult CD-1 mice (including both nontransgenic and CREB(A133) transgenic mice) were studied with simultaneously acquired high-fidelity instantaneous aortic pressures and 2-dimensionally targeted M-mode echocardiograms.

RESULTS

CREB(A133) mice displayed significantly lower values of LV fiber shortening velocities over a wide range of afterloads, and they displayed smaller dobutamine-induced shifts from baseline contractility relations. Counterbalancing effects of differences in LV geometry and aortic pressures resulted in comparable levels of LV wall stress during ejection in both groups.

CONCLUSION

These results demonstrate directly that CREB(A133) mice display reduced LV contractility at baseline and decreased cardiac reserve.

Disparate effects of three types of extracellular acidosis on left ventricular function

Effects of acidosis on muscle contractile function have been studied extensively. However, the relative effects of different types of extracellular acidosis on left ventricular (LV) contractile function, especially the temporal features of contraction, have not been investigated in a single model. We constituted perfusion buffers of identical ionic composition, including Ca2+ concentration ([Ca2+]), to mimic physiological control condition (pH 7.40) and three types of acidosis with pH of 7.03: inorganic (IA), respiratory (RA), and lactic (LA). Isolated rabbit hearts (n = 9) were perfused with acidotic buffers chosen at random, each preceded by the control buffer. Under steady-state conditions, instantaneous LV pressure (Pv) and volume (Vv) were recorded for a range of Vv. The results were as follows. 1) LV passive (end-diastolic) elastance increased with IA and RA. However, this increase may not be a direct effect of acidosis; it can be explained on the basis of myocardial turgor. 2) Although LV inotropic state (peak active Pv and elastance) was depressed by all three acidotic buffers, the magnitude of inotropic depression was significantly less for LA. 3) Temporal features of Pv were altered differently. Whereas IA and RA reduced time to peak Pv (tmax) and hastened isovolumic relaxation at a common level of LV wall stress, LA significantly increased tmax and retarded relaxation. These results and a model-based interpretation suggest that cooperative feedback (i.e., force-activation interaction) plays an important role in acidosis-induced changes in LV contractile function. Furthermore, it is proposed that LA-induced responses comprise two components, one due to intracellular acidosis and the other due to pH-independent effects of lactate ions.

Ejection has both positive and negative effects on left ventricular isovolumic relaxation

In isovolumically beating hearts, the speed of left ventricular (LV) relaxation is uniquely determined by peak active stress (sigma max). In contrast, such a succinct description of relaxation is lacking for the ejection beats, although ejection is generally thought to hasten relaxation. We set out to determine how ejection modifies the relaxation-sigma max relationship obtained in the isovolumically beating hearts. Experiments were performed on five isolated rabbit hearts subjected to various loading conditions. Instantaneous LV pressure and volume were recorded and converted to active stress, from which isovolumic relaxation time (Tr) was defined as the time for stress to fall from 75 to 25% of sigma max (isovolumic beats) or its end-ejection value (ejection beats). Steady-state and transient isovolumic beat and steady-state ejection beat data were used to develop a multiple regression model. This model identified stress, current beat ejection, and previous beat ejection history as independent predictor variables of Tr and fit the data well in all hearts (r2 > 0.98). Furthermore, this model could predict relaxation in transient ejection beats (r2 = 0.30 for all hearts). Whereas the coefficient for the current beat ejection was negative (i.e., negative effect or hastening relaxation), the ejection history coefficient was positive (i.e., positive effect or slowing relaxation). The sum of these two coefficients was negative, corresponding to the commonly observed net negative effect of ejection on relaxation. The expected positive inotropic effect of ejection was also observed. The dissipations of both positive inotropic and relaxation effects were slow, suggesting a nonmechanical underlying mechanism(s). We postulate that these two effects are linked and caused by ejection-mediated changes in myofilament Ca2+ sensitivity.

Doppler echocardiographic reference values for healthy rhesus monkeys under ketamine hydrochloride sedation

Cardiac ultrasound is a noninvasive technique that is commonly used to serially evaluate cardiac structure and function. Recent advances in Doppler-Echocardiography enable the ultrasonographer to perform a sophisticated noninvasive assessment of cardiovascular physiology. The Rhesus monkey is a frequently used non-human primate animal model of human cardiovascular disease because this species closely models human anatomy and physiology. However, while this species is frequently used in cardiovascular research, standardized echocardiographic values generated from large numbers of normal Rhesus are not available. In the present study, we performed cardiac ultrasound imaging on 28 healthy Rhesus monkeys to obtain normal reference values of cardiovascular structure and function in this species. Nomograms were generated from these data by plotting parameters of cardiovascular geometry and function with body weight. These normal reference data were compared to previously reported values obtained from prior studies that used noninvasive, invasive, and morphometric techniques.

Evaluation of ventricular and arterial hemodynamics in anesthetized closed-chest mice

Transgenic and knock-out mice with cardiovascular phenotypes have created the need for methods to measure murine arterial and ventricular mechanics. The aims of this study were (1) to develop a method for the assessment of wall stress (sigma es)-rate corrected velocity of fiber shortening (Vcfc) relation and (2) to assess the feasibility of quantifying global arterial function in normal mice. This method can thus serve as a reference for future studies in genetically altered mice by establishing normal values for comparison. Ten anesthetized closed-chest mice were studied with targeted M-mode echocardiography of the left ventricle recorded simultaneously with high-fidelity aortic pressures. Data were acquired at baseline and during infusions of methoxamine and isoproterenol. Tracings were digitized to obtain end-systolic wall stress (sigma es) and rate-corrected velocity of fiber shortening (Vcfc) relationships and plots of systolic meridional wall stress. Instantaneous aortic pressures and continuous wave aortic Doppler velocities were digitized to study arterial hemodynamics. The Vcfc-sigma es relationship was inverse and linear in all mice studied with a median value of r2 = 0.94. Isoproterenol resulted in an upward shift from the baseline contractility line obtained with methoxamine (mean shift = 2.0 +/- 0.3 circ/sec). Relative to baseline the integral of wall stress decreased with isoproterenol and increased with methoxamine. Methoxamine increased mean arterial pressure and total vascular resistance and decreased heart rate, cardiac output, and arterial compliance. Isoproterenol decreased total vascular resistance and increased cardiac output. Stress-shortening relationships, systolic wall stress, and evaluation of vascular function can be obtained in a closed-chest mouse model.

Serial assessment of the cardiovascular system in normal pregnancy. Role of arterial compliance and pulsatile arterial load

BACKGROUND

Temporal changes in systemic arterial compliance and wave propagation properties (pulsatile arterial load) and their role in ventricular-systemic arterial coupling during gestation have not been explored. Noninvasive methods combined with recently developed mathematical modeling techniques were used to characterize vascular and left ventricular (LV) mechanical adaptations during normal gestation.

METHODS AND RESULTS

Fourteen healthy women were studied at each trimester of pregnancy and again postpartum. Experimental measurements included instantaneous aortic pressure (subclavian pulse tracings) and flow (aortic Doppler velocities) and echocardiographic imaging of the LV. A small increase in LV muscle mass and end-diastolic chamber dimension occurred by late gestation, with no significant alterations in myocardial contractility. Cardiac output increased and the steady component of arterial load (total vascular resistance) decreased during pregnancy. Several changes in pulsatile arterial load were noted: Global arterial compliance increased (approximately 30%) during the first trimester and remained elevated thereafter. The magnitude of peripheral wave reflections at the aorta was reduced. The mathematical model-based analysis revealed that peripheral wave reflections at the aorta were delayed and that both conduit and peripheral vessels contributed to the increased arterial compliance. Finally, coordinated changes in the pulsatile arterial load and LV properties were responsible for maintaining the efficiency of LV-to-arterial system energy transfer.

CONCLUSIONS

The rapid time course of compliance changes and the involvement of both conduit and peripheral vessels are consistent with reduced vascular tone as being the main underlying mechanism. The pulsatile arterial load alterations during normal pregnancy are adaptive in that they help to accommodate the increased intravascular volume while maintaining the efficiency of ventricular-arterial coupling and diastolic perfusion pressure.

Detachment of low-force bridges contributes to the rapid tension transients of skinned rabbit skeletal muscle fibres

1. To probe the cross-bridge cycle and to learn more about the cardioplegic agent BDM (2,3-butanedione monoxime), its effects on the force-velocity properties and tension transients of skinned rabbit muscle fibres were studied at 1-2 degrees C and pH 7.0. 2. Three millimolar BDM decreased isometric force by 50%, velocity by 29%, maximum power by 73%, and stiffness by 25%, so that the relative stiffness (stiffness/force ratio) increased by 50% compared with reference conditions in the absence of BDM. 3. Tension transients obtained under the reference condition (0 BDM) could be represented by three components whose instantaneous stiffness accounted for the initial (Phase 1) force deviation and whose exponential recoveries caused the rapid, partial (Phase 2) force recovery following the step. The fastest component had non-linear extension-force properties that accounted for about half the isometric stiffness and it recovered fully. The two slower components had linear extension-force properties that together accounted for the other half of the sarcomere stiffness. These components recovered only partially following the step, producing the intermediate (T2) level which the force approached during Phase 2. 4. Matching the force transients obtained under test conditions (3 mM BDM) required three alterations: (1) reducing the amplitude of the two slower components by 50%, in proportion to isometric force, (2) adding a non-relaxing component and (3) decreasing the amplitude of the rapidly recovering component by 12.5% so that its relative amplitude (amplitude/isometric force) was increased by 75%. The non-recovering component and the increase in relative amplitude of the rapid component were responsible for the increase in relative stiffness of the fibres produced by BDM. The rapidly recovering component had the same time constant and step-size-dependent recovery rates as the fastest of the three mono-exponential components isolated from the tension transient response under the reference condition. BDM therefore appeared to augment the fastest component of the tension transient under the reference condition. 5. The results suggest that BDM detains cross-bridges in low-force, attached states. Since these bridges are attached, they contribute to sarcomere stiffness. Since they are detained, relaxation or reversal of their immediate responses is probably due to bridge detachment rather than to their undergoing the power stroke. The observation that a portion of the test response matched the fastest component of the reference response when the amplitude of the fastest component was increased suggests that a part of the normal rapid, transient tension recovery following a release step is due to detachment of low-force bridges moved to negative-force positions by the step.

Echocardiographic contrast agents and left ventricular contractility: evaluation using an isolated rabbit heart model

The effects of Albunex (Molecular Biosystems, Inc., San Diego, Calif.) and a second generation contrast agent, FS069, on left ventricular (LV) contractility were evaluated using an isolated rabbit heart model under constant loading conditions and heart rate. Contrast injections (2 ml total volume) were performed in two separate protocols (N1 = 6, N2 = 6). In protocol 1, various doses of Albunex (0.1 to 2.0 ml in saline solution) were used, and paired control injections of a matched dose of 5% solution of human albumin in saline solution were administered. In protocol 2, LV contractility was assessed during injections of the following solutions: (1) 1:250 suspension of FS069 in saline solution, which caused optimal myocardial contrast enhancement; (2) a 1:25 suspension of FS069; (3) a 1:25 suspension of FS069 prefiltered using an 8 microns pore filter; and (4) 2 ml saline solution as a control. Instantaneous LV pressure was analyzed for variations in peak systolic pressure (peak P) and maximum pressure derivative (peak P'), both indices of LV contractility under conditions of fixed heart rate and chamber volume. Albumin alone caused a transient, dose-dependent depression of LV contractility, reflected by decreases in both peak P and peak P' values. These decreases presumably were caused by the decreasing availability of ionized calcium as a result of calcium binding. No further decrease in contractility was noted when Albunex microspheres were present in the solution. Saline injections caused a transient minor increase in LV contractility, reflected by increases of 4.5% +/- 1.1% and 10.6% +/- 3.8% in peak P and peak P' values, respectively. These levels returned to baseline levels within 2 minutes. A similar response was observed when a 1:250 suspension of FS069 was used. The 1:25 suspension of FS069 caused a bimodal response, with initial rises in peak P and peak P' levels (5.2% +/- 3.6% and 12.8% +/- 6.5%, respectively), followed by minor reductions in contractility (2.0% +/- 2.4% and 1.7% +/- 2.1%, respectively). The latter decrease in contractility caused by the 1:25 suspension of FS069 was eliminated by filtering. The isolated rabbit heart model is a highly sensitive tool that allows accurate and direct assessment of possible adverse effects of intravascular contrast agents on LV contractility. Using this model, we showed that neither Albunex microspheres nor FS069 microspheres impaired myocardial contractility.

Aortic elastic properties with transesophageal echocardiography with automated border detection: validation according to regional differences between proximal and distal descending thoracic aorta

We have previously described the use of transesophageal echocardiography with automated border detection to quantify regional aortic elastic properties. The purpose of this study was to validate this technique further by measuring regional variations of aortic elastic properties and comparing them with previously published data acquired by invasive methods. In nine anesthetized, closed-chest dogs, aortic pressure and lumenal area (transesophageal echocardiography with automated border detection) signals were recorded simultaneously at two aortic sites: just distal to the branching site of the left subclavian artery (proximal) and at the level of the diaphragm (distal). Instantaneous wall thickness was estimated by combining M-mode measurement of aortic end-diastolic thickness with instantaneous lumenal area. Data were acquired over a wide range of loading conditions, generated by inferior vena caval balloon occlusion. Aortic compliance per unit length, midwall radius, midwall stress, and incremental elastic modulus were computed. Aortic midwall radius and incremental elastic modulus values for proximal and distal aortic sites were compared at a common level of midwall stress. Compliance per unit length was higher in the proximal compared with the distal descending thoracic aorta (0.013 +/- 0.003 versus 0.008 +/- 0.003 cm2/mm Hg; mean +/- SD; p = 0.0011). Midwall radius was larger at the proximal location (0.76 +/- 0.07 cm versus 0.64 +/- 0.07 cm; p = 0.0001), whereas incremental elastic modulus was greater distally (0.799 +/- 0.052 dynes x 10(6)/cm2 versus 0.912 +/- 0.130 dynes x 10(6)/cm2; p = 0.02). Lower compliance values at the distal site of the descending thoracic aorta resulted from greater wall stiffness and a smaller radius. Transesophageal echocardiography with automated border detection provides reliable measurements of instantaneous aortic areas necessary for quantifying regional elastic properties.

Wave propagation in coupled left ventricle-arterial system. Implications for aortic pressure

The objective of this study was to examine the effects of wave propagation properties (global reflection coefficient gamma IG; pulse wave velocity, c(ph); and characteristic impedance zeta(o) on the mechanical performance of the coupled left ventricle-arterial system. Specifically, we sought to quantify effects on aortic pressure (P(ao)) and flow Q(ao) while keeping constant other determinants of P(ao) and Q(ao) (left ventricular end-diastolic volume, V(ed), and contractility, heart rate, and peripheral resistance, R(s)). Isolated rabbit hearts were subjected to real-time, computer-controlled physiological loading. The arterial circulation was modeled with a lossless tube terminating in a complex load. The loading system allowed for precise and independent control of all arterial properties as evidenced by accurate reproduction of desired input impedances and computed left ventricular volume changes. While propagation phenomena affected P(ao) and Q(ao) morphologies as expected, their effects on absolute P(ao) values were often contrary to the current understanding. Diastolic (Pd) and mean (Pm) P(ao) and stroke volume decrease monotonically with increases in gamma G, c(ph), or zeta(o) over wide ranges. In contrast, these increase had variable effects on peak systolic P(ao) (Ps): decreasing with gamma G, biphasic with c(ph), and increasing with zeta(o). There was an interaction between gamma G and c(ph) such that gamma G effects on P(m) and P(d) were augmented a higher C(ph) and vice versa. Despite large changes in system parameters, effects on Pm and Ps were modest ( < 10% and < 5%, respectively); effects on Pd were always two to four times greater. Similar results were obtained when the single-tube model of the arterial system was replaced by an asymmetrical T-tube configuration. Our data do not support the prevailing hypothesis that P(s) (and therefore ventricular load) can be selectively and significantly altered by manipulating gamma G, c(ph), and/or zeta o.

Fit to diastolic arterial pressure by third-order lumped model yields unreliable estimates of arterial compliance

The pressure pulse contour analysis method uses a third-order lumped model to evaluate the elastic properties of the arterial system and their modifications with adaptive responses or disease. A fundamental assumption underlying this method is that the estimates of model parameters (two compliances, an inertance, and a peripheral resistance) obtained from a measurement of cardiac output, and a simultaneous measurement of an arterial pressure, are independent of the pressure measurement site. If true, this hypothesis would provide a minimally invasive method for estimation of arterial compliance. The aim of the present study was to test the validity of this assumption and the ability of the method to assess changes of compliance in response to vasoactive drug administration. In five anaesthetised, open-chest dogs we measured pulsatile pressure and flow in the ascending aorta and pulsatile pressure in the terminal aorta, under basal, vasoconstricted (methoxamine), and vasodilated (sodium nitroprusside) conditions. Model peripheral resistance was assumed equal to the ratio of mean pressure to cardiac output. Estimates of inertance and compliances, and the associated estimation errors, were determined by fitting the model output to either the diastolic portions of ascending aortic pressure, P(adt), or terminal aortic pressure, Ptd(t). Results showed that the assumption of independency of model parameter estimates on the arterial pressure measurement site was not verified. Different images of the vasoactive drug-induced changes in vascular compliance were obtained from fits to P(adt) and Ptd(t). Model parameter estimates were associated with high estimation errors and were very sensitive to the choice of the period of diastolic pressure to be fitted. Model predicted aortic pressure, over the entire heart cycle, did not compare well with experimental ascending aortic pressure. Our results question the reliability of the pressure pulse contour analysis method for evaluating arterial compliance.

Contrast echocardiographic quantification of regional myocardial perfusion: validation with an isolated rabbit heart model

Quantification of regional myocardial tissue blood flow (RMBF) based on contrast echocardiography has yet to be achieved. This study validated our recently proposed algorithm for quantification of RMBF with colored microspheres. Experiments were carried out in an isolated rabbit heart preparation (n = 11). Aortic root injections of perfluoropropane-filled albumin microsphere solution (FS069) and colored microspheres were performed at five levels of coronary flow achieved by altering perfusion pressure. During each injection of contrast material, consecutive end-diastolic images of the heart and an extracardiac reference chamber were acquired with a 7.5 MHz transducer and digitized. Time-intensity curves from the reference chamber and myocardial regions of interest, corresponding to the anatomic segments used for colored microsphere analysis, were analyzed for RMBF. Blood flow was calculated as the intravascular volume fraction (ratio of areas under myocardial and reference curves) divided by mean transit time (deconvolution of impulse response) and compared with those obtained with colored microspheres. Injections of FS069 resulted in highly reproducible enhancement of myocardial contrast. Analysis of time-intensity curves provided consistent measurements of RMBF (r = 0.91), which correlated highly with microsphere data (r = 0.84). The use of this new algorithm allows accurate quantification of RMBF in the isolated heart model. Further validation of this approach in an animal model with peripheral intravenous injections of contrast material will allow noninvasive clinical measurements of RMBF.

Physiological relevance of T-tube model parameters with emphasis on arterial compliances

The T-tube model of systemic arterial circulation was examined with respect to the physiological relevance of model parameters. root aortic pressure [Pao(t)] and flow [Qao(t)] and descending aortic flow [Qb(t)] were measured in anesthetized, open-chest dogs under control conditions, during inflation of a balloon positioned in the left external iliac artery (n = 5), and during infusion of vasoactive drugs nitroprusside (NTP, n = 4) and phenylephrine (PHL, n = 5). With Pao(t) as the input, the model accurately predicted both Qao(t) and Qb(t) under all conditions (r2 > 0.96). The balloon inflation data established the ability of the model to discriminate between proximal and distal arterial mechanical properties. Furthermore, proximal properties (i.e., tube characteristic impedances and transit times) were independent of distal properties such as terminal compliances and resistances (or equivalently, wave reflections). The effects of NTP and PHL were pharmacologically consistent and served to further validate this model. NTP primarily affected distal (load) properties, whereas PHL altered both load and tube parameters. Physiological interpretation of model parameters, particularly compliance, is also discussed. The ability of the model to correctly discriminate between proximal and distal arterial properties is relevant because these properties may affect cardiovascular function differently.

Dynamic micromechanical properties of cultured rat atrial myocytes measured by atomic force microscopy

The atomic force microscope (AFM) was used to quantify micromechanical properties (i.e., localized to an area of approximately 0.015 microns 2) of cultured rat atrial myocytes. Quiescent cells in calcium-free solution were quite compressible over the nuclear region, e.g., a force of 3-4 nN produced 180-225 nm cell indentation. Transverse stiffness of quiescent cells increased by approximately 2-fold after an increase in extracellular calcium from 0 to 5 mM and by approximately 16-fold after fixation with Formalin. There was five- to eightfold variation in stiffness of quiescent cells over the cell surface, such that stiffness was lowest over the nuclear region, and it increased toward the cell periphery. These regional variations correlated with the cytoskeletal heterogeneity as revealed by the AFM and fluorescence imaging. Localized contractile activity of beating cells could be monitored in terms of the surface deformation with high transverse spatial (approximately 1-3 nm) and temporal (60-100 microseconds) resolutions. Alterations in cell contractile activity with physiological perturbations and dynamic changes in cell stiffness during a single contraction could be observed. These results demonstrate the feasibility of AFM-based characterization of highly localized cellular micromechanical properties. Relationships among localized cell mechanical behavior and the underlying biochemical and/or structural environment, a crucial aspect in understanding cellular (dys)function, can now be directly examined.

Alterations in systemic arterial mechanical properties during septic shock: role of fluid resuscitation

The effects of septic shock (endotoxin; EDTX) on arterial mechanical properties were studied in anesthetized rabbits, both in the absence (EDTX alone) and presence (EDTX + fluids) of fluid resuscitation. Aortic pressure-flow (n = 20) and pressure-diameter (n = 10) measurements were used to calculate systemic arterial and regional aortic mechanical properties. At 3 h of EDTX shock, EDTX-alone rabbits had elevated total peripheral resistance (TPR, + 30%, P < 0.05), reduced cardiac output (CO, -40%, P < 0.05), and increased aortic characteristic impedance (Zc, +78%, P < 0.05). In contrast, the EDTX + fluids group responded with decreased TPR (-30%, P < 0.05), a tendency to increase CO (+23%), and elevated Zc (+46%, P < 0.05). A reduction in aortic diameter (-20%, P < 0.05) and an increase in elastic modulus (+50%, P < 0.05) and water content (+23%, P < 0.02) of the aortic wall were observed following endotoxemia. Thus following EDTX 1) "hyperdynamic" septic shock profile (i.e., low TPR, high CO) was observed only when concomitant fluid replacement was provided, 2) aortic wall stiffening was present due to both increased smooth muscle tone and vessel wall edema, and 3) fluid resuscitation resulted in discordant changes in TPR and Zc, suggesting differential flow-induced vasodilation between arteriolar and aortic smooth muscle.

Differential effects of chronic oral antihypertensive therapies on systemic arterial circulation and ventricular energetics in African-American patients

BACKGROUND

A comprehensive evaluation of arterial load characteristics and left ventricular energetics in systemic hypertension has been limited by the need for invasive techniques to access instantaneous aortic pressure and flow. As a consequence of this methodological limitation, no data exist on the effects of long-term antihypertensive therapy on global arterial impedance properties and indexes of myocardial oxygen consumption (MVO2). Using recently validated noninvasive techniques, we compared in hypertensive patients the effects of chronic oral treatment with ramipril, nifedipine, and atenolol on arterial impedance and mechanical power dissipation as well as indexes of MVO2.

METHODS AND RESULTS

Sixteen African-American subjects with systemic hypertension were studied with a randomized, double-blind, crossover protocol. Instantaneous central aortic pressure and flow, from which arterial load characteristics can be derived, were estimated from calibrated subclavian pulse tracings (SPTs) and continuous-wave aortic Doppler velocity in conjunction with two-dimensional (2D) echocardiographic measurements of the aortic annulus, respectively. To derive ventricular wall stress and indexes of MVO2, left ventricular short- (M-mode) and long-axis (2D echo) images were acquired simultaneously with SPTs. Data were collected at the end of a 2-week washout period (predrug control) and after 6 weeks of treatment with each agent. Although all three agents reduced diastolic blood pressure to the same extent, different effects on mean and systolic pressures and vascular impedance properties were noted. Nifedipine reduced total peripheral resistance (TPR; 1744 +/- 398 versus 1290 +/- 215 dyne-s/cm5) and increased arterial compliance (ACL; 1.234 +/- 0.253 versus 1.776 +/- 0.415 mL/mm Hg). This improvement in arterial compliance was not entirely accounted for by the reduction in distending pressure. Ramipril also decreased TPR (1740 +/- 292 versus 1437 +/- 290 dyne-s/cm5) and increased ACL (1.214 +/- 0.190 versus 1.569 +/- 0.424 mL/mm Hg), but with this agent, the change in arterial compliance was explained solely on the basis of a reduction in distending pressure. Atenolol, in contrast, did not affect either TPR or ACL. In agreement with the compliance results, nifedipine and ramipril significantly lowered the first two harmonics of the impedance spectrum, but atenolol did not. None of these agents resulted in a significant change in characteristic impedance or in the relative amplitude of the reflected pressure wave. Total vascular mechanical power and percent of oscillatory power remained unaltered with all antihypertensive treatments. Only ramipril and nifedipine reduced the integral of both meridional and circumferential systolic wall stresses, indicating that MVO2 per beat was reduced with these agents. Stress-time index, a measure of MVO2 per unit time, decreased significantly with ramipril but not with nifedipine because of an increase in heart rate noted in 10 of 16 patients (mean increase, 10 beats per minute). Thus, a reduction in MVO2 coupled with unchanged total vascular mechanical power suggests improved efficiency of ventriculoarterial coupling with ramipril and with nifedipine in the subset of patients in whom heart rate remained unchanged. In contrast, there was no evidence of a reduction in wall stress, stress integral, or stress-time index with atenolol.

CONCLUSIONS

The noninvasive methodology used in this study constitutes a new tool for serial and simultaneous evaluation of arterial hemodynamics and left ventricular energetics in systemic hypertension. In this study, we demonstrate the differential effects of chronic antihypertensive therapies on systemic arterial circulation and indexes of MVO2 in African-American subjects. Consideration of drug-induced differential responses of arterial load and indexes of MVO2 with each drug may provide a more physiological approach to the treatment of systemic hypertension in indivi

Effects of left ventricular pressure on sonicated albumin microbubbles: evaluation using an isolated rabbit heart model

OBJECTIVES

We used an isolated, crystalloid-perfused rabbit heart model to test the hypothesis that the phasic changes in left ventricular contrast are due to bubble compression and decompression during systole and diastole, respectively.

BACKGROUND

Contrast enhancement of the left ventricular cavity has been shown to decrease during ventricular systole. This phenomenon has been attributed to pressure-induced microbubble destruction. Such destruction, if confirmed, would severely confound the quantitative interpretation of contrast echocardiographic data.

METHODS

A fixed volume of contrast solution (5% human albumin and Albunex, approximately 400:1 ratio) was introduced into a latex balloon placed within the left ventricular cavity of an isolated paced rabbit heart preparation (n = 12). Instantaneous left ventricular pressure was measured using a high fidelity microtip catheter and digitized on-line. The beating heart was placed in a water tank, and ultrasound images were obtained using a 7.5-MHz transducer and were recorded and digitized off-line at 12 frames/s. Simultaneously, the pacing signal was used for gated on-line acquisition of end-diastolic frames. A simple theoretic model based on surface tension physical principles was used to predict changes in bubble size and, consequently, the reflection intensity in response to the measured changes in left ventricular pressure.

RESULTS

We found that under peak left ventricular systolic pressures ranging from 89 to 155 mm Hg, 1) end-diastolic videointensity decreased by 8 +/- 6% (mean +/- SD) over 25 consecutive heart beats; and 2) intracyclic variations in measured videointensity were in close agreement with the theoretic calculations: 80.1 +/- 2.9% versus 80.2 +/- 4.6% of diastolic videointensity at systole.

CONCLUSIONS

The major cause of systolic decrease in contrast enhancement is periodic bubble compression (as opposed to bubble destruction) induced by high systolic pressures. The minor progressive decrease in end-diastolic videointensity reflects the degree of instability of Albunex microbubbles under left ventricular pressures. However, the clinical impact of these destructive effects is likely to be only minor because of the rapid transit of microbubbles through the left heart chambers and myocardial microcirculation.

Measurement of regional elastic properties of the human aorta. A new application of transesophageal echocardiography with automated border detection and calibrated subclavian pulse tracings

BACKGROUND

Evaluation of regional aortic elastic properties in humans has been hampered by the need for invasive techniques to access instantaneous aortic pressure, wall thickness, and cross-sectional area or diameter. In this study, a new noninvasive method is presented for quantification of regional aortic elastic properties.

METHODS AND RESULTS

Twenty-five patients were studied during transesophageal echocardiographic procedures. Measurements of instantaneous aortic cross-sectional area were obtained with an automated border detection algorithm applied to short-axis transesophageal two-dimensional echocardiographic images of the proximal descending thoracic aorta. Instantaneous aortic wall thickness was derived from combined two-dimensional targeted M-mode end-diastolic wall thickness and instantaneous aortic area measurements. Instantaneous aortic pressures were estimated from calibrated subclavian pulse tracings recorded simultaneously. Data were digitized to generate aortic area-pressure loops. Regional aortic mechanical properties were quantified in terms of compliance per unit length (C is the slope of the area-pressure regression), aortic midwall radius (Rm), and incremental elastic modulus of the aortic wall (Einc). To assess the independent effect of age, Rm and Einc values were compared at a common level of aortic midwall stress (0.666 x 10(6) dynes/cm2). Mean values (+/- SD) for C, Rm, and Einc were 0.01 +/- 0.004 cm2/mm Hg, 1.14 +/- 0.17 cm, and 7.059 +/- 4.091 x 10(6) dynes/cm2, respectively. An inverse linear correlation was found between aortic compliance per unit length and age (r = -.68, P < .0007). Incremental elastic modulus was related to age (r = +.80, P < .00003) in a nonlinear fashion such that it increased sharply after the age of 60 years. Finally, midwall radius was less tightly correlated with age (r = +.45, P < .05). Values for C, Rm, and Einc as well as the age dependency of these properties are similar to those reported previously when invasive techniques were used.

CONCLUSIONS

This methodology constitutes a new tool to improve the clinical evaluation of regional aortic elastic properties in multiple disease states.

Cardiovascular physiology teaching: computer simulations vs. animal demonstrations

The roots of physiology lie in laboratory observation, and physiology courses continue to rely on laboratory observation to provide students with practical information to correlate with their developing base of conceptual knowledge. To this end, animal laboratories provide a functioning example of interactions among organ systems and a source of data for student analysis. However, there are continuing objections to using animals for teaching, and animal labs are costly in time and effort. As an alternative laboratory tool, computer software can simulate the operation of multiple organ systems: responses to interventions illustrate intrinsic organ behavior and integrated systems physiology. Advantages of software over animal studies include alteration of variables that are not easily changed in vivo, repeated interventions, and cost-effective hands-on student access. Nevertheless, simulations miss intangible aspects of experimental physiology, and results depend critically on the assumptions of the model. We used both computer and animal demonstrations in teaching cardiovascular physiology to first-year medical students. The students rated both highly, but the computer-based session received a higher rating. We believe that both forms of teaching have educational merit. At the introductory level, the computer appears to provide an effective alternative.

Series coupled non-contractile elements are functionally unimportant in the isolated heart

OBJECTIVE

In order to evaluate possible artefact in interpretations of contractile behaviour in isolated heart experiments, the relative elastances of series coupled non-contractile and contractile components of the left ventricle of the isolated heart were evaluated.

METHODS

Hearts were isolated from ferrets and rabbits and mounted on a servo-controlled volume regulation device. These hearts were made to beat isovolumetrically until a selected volume perturbation was introduced. Constant flow volume withdrawals at two flow values were performed over a period of < 20 ms centred around the time of peak isovolumetric pressure. Three levels of isovolumetric pressure were produced using basal, extrasystolic, and potentiated beats. Pressure responses to volume withdrawals at two flows and three isovolumetric pressures were then analysed using a mathematical model to evaluate relative values of series coupled contractile and non-contractile elastances. To validate the analysis procedure, a non-contractile series artefact with known elastance was coupled to the left ventricle; volume perturbations were then applied to the coupled left ventricle-artefact system; responses were analysed and the estimate of series coupled non-contractile elastance was compared to the known elastance of the added artefact.

RESULTS

A wide range of isovolumetric pressures [208(SD 40) mmHg] was produced in the ferret with basal, extrasystolic, and potentiated beats. A lesser range of isovolumetric pressures [50(15) mmHg] was produced in the rabbit. The mathematical model fitted the data very well in both the ferret and rabbit. The elastance of the series coupled non-contractile component could be estimated only in some ferrets. When estimated in the ferret, the elastance of the series coupled non-contractile component was never less than 4x that of the contractile component. When a series artefact of sufficiently low value was coupled with the native left ventricle, the elastance of the non-contractile component could be reliably estimated in both ferrets and rabbits and the estimated value approximated that of the added artefact. This indicated that the elastance of the series coupled non-contractile component of the native left ventricle was much higher than that of the added artefact.

CONCLUSIONS

The series coupled non-contractile component of the isolated heart possesses a very much higher elastance than the contractile component. In fact, the elastance of the non-contractile component is so great that it contributes very little to the dynamic behaviour of the left ventricle. Virtually all of the elastance of the left ventricle of the isolated heart is due to the contractile component.

Short time-scale LV systolic dynamics: pressure vs. volume clamps and effect of activation

We recently proposed a new model-based approach to quantifying short time-scale left ventricular (LV) systolic dynamics. In this study we examine the hypothesis that the quantitation of LV dynamics using the proposed approach is independent of external mechanical perturbations and the level of activation. Mechanical perturbation independence was assessed in seven isolated ferret hearts in which controlled changes in pressure (pressure clamp) or volume (volume clamp) were introduced at the time of peak isovolumetric pressure (protocol 1), and responses to these clamps were analyzed over the first 16 ms. The model described both pressure- and volume-clamps responses equally well. Model parameters were not different among various pressure clamps, and parameters estimated from volume clamps could accurately predict responses to pressure clamps [r2 range: 0.993-0.999; normalized root-mean-square error (NRMSE) range: 2.35-5.86%]. To examine activation independence, volume- (4 hearts) and pressure-clamp (4 hearts) responses were obtained and analyzed for baseline and postextrasystolic potentiated beats in a manner similar to protocol 1. The model parameter values estimated from the baseline state accurately predicted responses for the postextrasystolic potentiated state (r2 and NRMSE range for volume-clamp data: 0.989-0.998 and 3.35-6.88%, respectively; r2 and NRMSE range for pressure-clamp data: 0.992-0.996 and 4.26-5.23%, respectively). Thus the proposed approach can dissect the contributions of changes in activation from those due to changes in contractile unit properties on the function of the intact LV.

Left ventricular function depends on previous beat ejection but not previous beat pressure load

Previous beat contraction history, in which the performance of the left ventricle on any one beat is influenced by the mechanical events of the previous beat, may be important in the beat-to-beat regulation of left ventricular performance in the intact cardiovascular system. Prior studies of this phenomenon have established that mechanical events of the previous beat influence the function of the current beat, but it is not known whether the important mechanical influence is exerted by previous beat ejection or previous beat pressure. In addition, the magnitude of the effect of previous beat contraction history on left ventricular performance is unknown. To make these determinations, we performed experiments in six isolated rabbit left ventricle preparations buffer perfused at 30 degrees C. Left ventricular pressure and volume were controlled precisely with a servo-controlled linear motor system. After steady-state ejecting conditions were established by clamping left ventricular ejection pressure at 60% of peak isovolumic pressure, single test beats, which were pressure clamped at 40%, 60%, 80%, and 100% of peak isovolumic pressure, were introduced and followed by an isovolumic reference beat. As the level of pressure clamp decreased from 100% to 40%, developed pressure on the isovolumic beat following the single test beats increased from 139 +/- 15 (mean +/- SD) to 151 +/- 13 mm Hg. Similarly, peak positive left ventricular dP/dt increased from 1,718 +/- 209 to 1,864 +/- 181 mm Hg.sec-1 (both p less than 0.01). Multiple regression analysis showed that this increase in left ventricular function was related to previous beat ejection but not to previous beat pressure load or relaxation.(ABSTRACT TRUNCATED AT 250 WORDS)

Short-time-scale left ventricular systolic dynamics. Evidence for a common mechanism in both left ventricular chamber and heart muscle mechanics

Based on the premise that short-time-scale, small-amplitude pressure/volume/outflow behavior of the left ventricular chamber was dominated by dynamic processes originating in cardiac myofilaments, a prototype model was built to predict pressure responses to volume perturbations. In the model, chamber pressure was taken to be the product of the number of generators in a pressure-bearing state and their average volumetric distortion, as in the muscle theory of A.F. Huxley, in which force was equal to the number of attached crossbridges and their average lineal distortion. Further, as in the muscle theory, pressure generators were assumed to cycle between two states, the pressure-bearing state and the non-pressure-bearing state. Experiments were performed in the isolated ferret heart, where variable volume decrements (0.01-0.12 ml) were removed at two commanded flow rates (flow clamps, -7 and -14 ml/sec). Pressure responses to volume removals were analyzed. Although the prototype model accounted for most features of the pressure responses, subtle but systematic discrepancies were observed. The presence or absence of flow and the magnitude of flow affected estimates of model parameters. However, estimates of parameters did not differ when the model was fitted to flow clamps with similar magnitudes of flows but different volume changes. Thus, prototype model inadequacies were attributed to misrepresentations of flow-related effects but not of volume-related effects. Based on these discrepancies, an improved model was built that added to the simple two-state cycling scheme, a pathway to a third state. This path was followed only in response to volume change. The improved model eliminated the deficiencies of the prototype model and was adequate in accounting for all observations. Since the template for the improved model was taken from the cycling crossbridge theory of muscle contraction, it was concluded that, in spite of the complexities of geometry, architecture, and regional heterogeneity of function and structure, crossbridge mechanisms dominated the short-time-scale dynamics of left ventricular chamber behavior.

Relation between mixed venous oxygen saturation and cardiac index. Nonlinearity and normalization for oxygen uptake and hemoglobin

The ability of mixed venous oxygen saturation (SvO2) monitoring to reflect changes in cardiac index (CI) with therapy in critically ill patients is unclear. To this end, SvO2 and CI were measured before and during an infusion of enoximone and/or dobutamine in 30 patients with advanced heart failure. A nonlinear relationship was observed between SvO2 and CI with the nonlinear correlation coefficient being 0.52. On normalizing for individual differences in hemoglobin and oxygen consumption, this correlation coefficient became 0.90. Further analysis of individual data was performed using linear regression, and the slopes and correlation coefficients were found to span a wide range slope: -10.0 to 30.9 min-m2/L, r: -0.27 to 0.99). However, the mean slope and correlation coefficient for patients with baseline CI and SvO2 less than 21/min/m2 and less than 55 percent were 18.3 min-m2/L and 0.87, respectively, while those for the remainder of patients were only 3.1 min-m2/L and 0.42, respectively. Thus, the nonlinear correlation coefficient of the SvO2-CI relationship in a group of patients is dependent on the homogeneity of their oxygen consumption and hemoglobin concentration. Furthermore, the ability of SvO2 to serve as a therapeutic indicator in any given patient is dependent on baseline SvO2 and CI.

Determination of pulse wave velocities with computerized algorithms

Careful determination of pulse wave velocity is important in the study of arterial viscoelastic properties, wave reflections, and ventricular-arterial interactions. In spite of its increasingly widespread use, there is as yet no standardized method for its determination. Most studies have manually identified the transit time of the pressure wave front as it travels over a known distance in the arterial system, but the issues of accuracy and reproducibility have not been addressed. This study was designed to investigate the efficacy of four computerized algorithms in the determination of pulse wave velocities in invasive as well as in noninvasive pressure determinations. The four methods were the identification of: (1) the point of minimum diastolic pressure, (2) the point at which the first derivative of pressure is maximum, (3) the point at which the second derivative of pressure is maximum, and (4) the point yielded by the intersection of a line tangent to the initial systolic upstroke of the pressure tracing and a horizontal line through the minimum point. High-fidelity aortic pressure recordings were obtained in 26 patients with a multi-sensor micromanometer catheter. Noninvasive brachial and radial pressure waveforms were recorded in 11 volunteers with external piezoelectric transducers. The results show that the first derivative method consistently provided results that were different from the other methods for both the invasive and noninvasive methods because of changes in the structure of the upstroke as the arterial pulse propagates distally. Although the minimum method worked well for the invasive determinations, it was erratic with the noninvasive determinations, probably because of the higher amount of noise and reflection in the latter. Among the four algorithms, the second derivative and the intersecting tangents methods worked well with both invasive and noninvasive determinations with mean variation coefficients of less than 7% and correlation coefficients between the methods of greater than 0.90 for all data. In conclusion, computerized algorithms allow accurate determination of pulse wave velocity in invasively and noninvasively measured arterial pressure waveforms.

Doppler and electromagnetic comparisons of instantaneous aortic flow characteristics in primates

Assessment of the pulsatile mechanical behavior of the coupled left ventricle and the peripheral arterial circulation requires accurate estimation of instantaneous aortic flow. Before the availability of Doppler technologies, this could only be achieved by invasive techniques. The purpose of this study was to assess the accuracy of Doppler-based measurement of instantaneous aortic blood flow and waveform morphology throughout ventricular ejection when compared with an established invasive method. Accordingly, data from electromagnetic flow and continuous-wave aortic Doppler recordings were simultaneously acquired and compared in five monkeys over a wide range of flows generated by intravenous infusions of the beta-adrenoceptor agonist dobutamine and the alpha-receptor agonist methoxamine. Instantaneous aortic pressure was measured using a high-fidelity micromanometer-tipped catheter placed in the ascending aorta. Excellent correlations were noted for stroke volume, cardiac output, left ventricular ejection time, maximal flow velocity, and maximal rate of change of flow velocity (dQ/dtmax). When compared with electromagnetic flows, continuous-wave aortic Doppler had significantly lower times to maximal flow velocity and dQ/dtmax. Frequency domain analysis indicated that both the magnitude and phase were within +/- 6% up to the third harmonic. Instantaneous comparison disclosed that during early systole (up to 10% of ejection) Doppler was higher than electromagnetic flow rate by 11 +/- 19% (p less than 0.05). At 20-30% of systolic ejection, electromagnetic flow rates were slightly higher than Doppler (5 +/- 4% at 20% of ejection, p less than 0.001 and 2 +/- 3% at 30% of ejection, p less than 0.05). From 40% of ejection to the end of systole, flow rates using both techniques were virtually identical.(ABSTRACT TRUNCATED AT 250 WORDS)

Relation between left ventricular systolic resistance and contractile rate processes

To test the hypothesis that left ventricular (LV) systolic resistance is determined by the intrinsic rate processes of the contractile system, we studied 40 spontaneously hypertensive male rats (SHR). Thyroid hormone manipulation was used to alter isomyosin composition and consequently the rate processes of the contractile system. Seven groups of rats were studied: control (SHRC, n = 9); propylthiouracil (PTU) treated for 10 days (SHRP-10, n = 5), 20 days (SHRP-20, n = 5), and 30 days (SHRP-30, n = 6); and thyroxine treated for 5 days (SHRT-05, n = 5), 10 days (SHRT-10, n = 5), and 15 days (SHRT-15, n = 5). In situ (n = 40) and isolated (n = 14; 5 SHRP-30, 5 SHRC, and 4 SHRT-15) heart experiments were performed. In comparison to SHRC, we observed the following: 1) LV pump performance was not different in any of the thyroxine-treated groups, whereas with PTU, pump performance was significantly depressed in rats with greater than 80% slow myosin. 2) Normalized LV peak elastance (Emaxn) was significantly increased in the SHRP-30, whereas it was not altered after thyroxine. These observations were further confirmed in the isolated heart on the basis of peak isovolumetric stress-strain relations. 3) Thyroxine increased and PTU decreased theoretical maximum flow (Qmax; a measure of LV resistance); thus an inverse relation between Qmax and percent slow myosin was observed (r2 = 0.86). 4) The time to peak isovolumetric pressure was increased in SHRP-30 and decreased in SHRT-15. The relaxation process was significantly slower for SHRP-30 group and was unchanged for SHRT-15 group. These observations support our hypothesis that LV systolic resistance quantifies an intrinsic rate-dependent property of the myocardium and that isomyosin composition is one of its determinants. In addition, with changes in isomyosin composition toward predominantly slow myosin, the responses in Emaxn and Qmax are discordant, which may be responsible for the preservation of pump performance. This underscores the importance of quantifying both LV systolic resistance and elastance in the assessment of the functional status of the LV as a mechanical pump.

Differences in the shape of the normal, cardiomyopathic, and volume overloaded human left ventricle

A transformation from the normal elliptical shape of the left ventricle that may accompany various disease states and that may be indicative of myocardial remodeling, has not been completely addressed in part because of the need for a descriptor of shape that is independent of chamber size. Accordingly, the goal of this study was twofold: to derive dimensionless echocardiographic descriptors of left ventricle chamber shape that are independent of chamber volume and to use these descriptors to quantitatively compare the shape of left ventricles that were either of normal size (81 +/- 17 ml, 19 patients) or were enlarged secondary to idiopathic cardiomyopathy (194 +/- 61 ml, 46 patients) or chronic aortic or mitral valve incompetence (196 +/- 67 ml, 14 patients). Two-dimensional and M-mode determined descriptors of left ventricle shape based on its width, length, and area were found to be independent of left ventricle volume. These descriptors were significantly greater in cardiomyopathy compared with the normal or dilated left ventricle secondary to valvular incompetence, indicating that the left ventricle had become nearly spherical. A spherical shape of the left ventricle was not observed with valvular incompetence. The ability to classify a patient as having either a normal or a cardiomyopathic left ventricle by discriminant function analysis was enhanced when both left ventricle size and shape were considered. In a prospective study using discriminant function and fractional shortening, we found that patients with valvular incompetence could be classified as having either a normal discriminant function and fractional shortening, an abnormal discriminant function and normal fractional shortening, or an abnormal discriminant function and fractional shortening.(ABSTRACT TRUNCATED AT 250 WORDS)

Myocardial collagen and mechanics after preventing hypertrophy in hypertensive rats

To determine if a remodeling of the collagen matrix would occur in the absence of hypertrophy and cell necrosis and if such a remodeling could alter active and passive stiffness of the intact myocardium, five rats with genetic hypertension (SHR) were treated (SHRT) with hydralazine for 32 weeks, beginning at four weeks of age, and compared to six age- and sex-matched SHR and seven Wistar-Kyoto genetic control rats (WKY). Left ventricular (LV) weight of SHRT was 17% lower (P less than .001) than that of SHR and 19% higher (P less than .01) than that of WKY. Collagen volume fraction of SHR (13.7 +/- 3.2%) and SHRT (9.9 +/- 1.8%) were greater (P less than .01) than WKY (5.0 +/- 1.9%). Diastolic and systolic stress-strain relations were determined in the isolated heart. A comparison of these relations revealed: 1) a 24% increase in passive stiffness for SHR and SHRT; and 2) a reduced zero-strain intercept (41% to 54%) and slope (36% to 48%) of the developed stress-strain relation for the SHRT. Thus, in SHR, collagen remodeling occurred in the absence of hypertrophy which suggests that the muscular and collagenous compartments of the myocardium are under separate controls. The excess accumulation of collagen in SHR and SHRT leads to abnormal passive stiffness, and the prevention of hypertrophy with hydralazine reduces active stiffness.

Left ventricular systolic resistance in rats with hypertension and hypertrophy

Traditional indexes of ventricular performance often fail to identify differences between the normal and hypertrophied ventricle. This may not be the case for load-independent mechanical properties, elastance, and resistance. Accordingly, we derived these properties of the intact left ventricle (LV) in 25-wk-old male spontaneously hypertensive rats (SHR) and normotensive Wistar-Kyoto controls (WKY) using in-situ and isolated hearts. We found that 1) pump performance was similar in SHR and WKY, both at base line and after dextran; 2) the peak systolic elastance (Emax) was higher and theoretical maximum flow (Qmax, inverse of ventricular resistance) was lower in SHR; (3) slopes of peak isovolumetric pressure-volume and stress-strain relations were significantly higher in SHR; and 4) although end-diastolic pressure-volume relation for SHR was shifted to the right, there was no difference in end-diastolic stress-strain relations. Thus elastance in hypertrophied LV is augmented due to both an increase in muscle mass and the force-generating capacity of the myocardium. Furthermore, we propose that the decrease in Qmax seen in SHR reflects a change in certain velocity-dependent properties of the myocardium, whereas the preservation of pump performance is a result of the opposing effects of increased Emax and decreased Qmax. These observations underscore the importance of quantifying systolic resistance, together with elastance, for a better assessment of the LV as a mechanical pump.

Fibrillar collagen and myocardial stiffness in the intact hypertrophied rat left ventricle

This study tested the hypothesis that with hypertrophy, the proportion, distribution, and structural alignment of fibrillar collagen are important determinants of myocardial stiffness. Toward this end, the collagen volume fraction (morphometry), the transmural or subendocardial distribution of collagen, and the structural arrangement of fibrillar collagens (picrosirius red) were examined in the hypertrophied ventricle secondary to pressure overload (abdominal aorta banding or perinephritis), isoproterenol, and pressure overload plus isoproterenol. In the same hearts, the slopes of the systolic and diastolic stress-strain relations of the left ventricle, representing its active and passive stiffness, respectively, were obtained. In comparison with controls, we found 1) for a moderate rise in transmural collagen, active and passive stiffness increased with pressure-overload hypertrophy; 2) following isoproterenol alone there was a marked increase in subendocardial collagen, and active and passive stiffness increased; 3) in pressure-overload hypertrophy plus isoproterenol, active stiffness declined. Passive stiffness was increased except when fibrosis and thinning of the interventricular septum occurred, in which case it decreased; and 4) fibrillar collagens involved in remodeling included the formation of either collagen strands and fibers in a greater number of previously collagen-free intermuscular spaces in pressure-overload hypertrophy, or a dense crisscrossing latticework of fibers that encircled muscle fibers after isoproterenol. Thus, an increase in fibrillar collagen in pressure-overload hypertrophy is partially adaptive in that it enhances the tensile strength and three-dimensional delivery of force by the myocardium, but at the expense of reducing distensibility. The appearance of a dense collagen meshwork within the subendocardium after isoproterenol can be considered pathological in that it entraps muscle fibers causing active stiffness to fall while impairing distensibility. Finally, fibrosis may paradoxically reduce passive stiffness if it leads to a thinning of the interventricular septum.

Pathophysiology of the failing heart

Cardiac (or myocardial) failure of acute onset or of chronic duration is the result of a structural and/or biochemical remodeling of the myocardium. This, in turn, compromises the contractile performance of the myocardium. The hypertrophic growth of myocytes and the architectural transformation of ventricular chamber size and shape--while initially useful compensatory responses--do not prevent the inevitable appearance of pump failure where oxygen delivery to the metabolizing tissues becomes inadequate. Indeed, the severity of cardiac failure can be judged from the level of oxygen consumption that elicits this state of impaired oxygen supply and demand. A better understanding of the mechanical behavior of the ventricular chamber, including its elastic and resistive properties, together with recent advances in our ability to measure instantaneous ventricular pressure and volume, may prove useful in identifying pathologic features of hypertrophy and dilatation in individual patients. In grading the severity of failure and comparing groups of patients, a normalization of the mechanical parameters by differences in chamber size, shape, and mass is necessary. Symptomatic cardiac failure, based invariably on inadequate oxygen delivery and/or pulmonary congestion, is more commonly the result of ventricular systolic dysfunction. Abnormalities in diastolic function, including ventricular relaxation and filling, while less common and often associated with preserved systolic pump function, do occur. Finally, it must be recognized that the failing ventricle carries an additional hydraulic load that arises from the arterial circulation to which it is coupled.(ABSTRACT TRUNCATED AT 250 WORDS)

Collagen remodeling of the pressure-overloaded, hypertrophied nonhuman primate myocardium

Cardiac muscle is tethered within a fibrillar collagen matrix that serves to maximize force generation. In the human pressure-overloaded, hypertrophied left ventricle, collagen concentration is known to be increased; however, the structural and biochemical remodeling of collagen and its relation to cell necrosis and myocardial mechanics is less clear. Accordingly, this study was undertaken in a nonhuman primate model of left ventricular hypertrophy caused by gradual onset experimental hypertension. The amount of collagen, its light microscopic features, and proportions of collagen types I, III, and V were determined together with diastolic and systolic mechanics of the intact ventricle during the evolutionary, early, and late phases of established left ventricular hypertrophy (4, 35, and 88 weeks, respectively). In comparison to controls, we found 1) increased collagen at 4 weeks, as well as a greater proportion of type III, in the absence of myocyte necrosis; 2) collagen septae were thick and dense at 35 weeks, while the proportion of types I and III had converted to control; 3) necrosis was evident at 88 weeks, and the structural remodeling and proportion of collagen types I and III reflected the extent of scar formation; and 4) unlike diastolic myocardial stiffness, which was unchanged at 4, 35, or 88 weeks, the systolic stress-strain relation of the myocardium was altered in either a beneficial or detrimental manner in accordance with structural remodeling of collagen and scar formation. Thus, early in left ventricular hypertrophy, reactive fibrosis and collagen remodeling occur in the absence of necrosis while, later on, reparative fibrosis is present.(ABSTRACT TRUNCATED AT 250 WORDS)

Physiologic response to the inotropic and vasodilator properties of enoximone

In patients with chronic cardiac failure, improvement in ventricular function is observed after the administration of enoximone, a phosphodiesterase inhibitor with inotropic and vasodilator properties. The relative contributions of positive inotropy and vasodilation to the improvement in pump performance, however, remain uncertain. Therefore, findings from a series of dog experiments designed to resolve this issue are reviewed. Also, our current understanding of the physiologic response to enoximone in patients with cardiac failure, including the responses of myocardial oxygen consumption and efficiency, are considered. It is concluded that, enoximone produces a substantial (66 +/- 2% in dogs) increase in contractility, a relatively minor increase in heart rate (0 to 12%) and a decrease in systemic vascular resistance (-28 to -49%). These are the ranges of average responses based on review of published findings. These physiologic responses lead to an improvement in the pumping function of the failing heart; cardiac output (23 to 83%) and stroke work index (17 to 88%) are increased, and pulmonary capillary wedge pressure (-19 to -59%) and right atrial pressure (-29 to -60%) are decreased. The influence of enoximone on myocardial oxygen consumption is less consistent (-18 to +33%). Nevertheless, enoximone improves the efficiency of the failing heart.

Collagen in the hypertrophied, pressure-overloaded myocardium

The extracellular structural protein, collagen, is responsible for the functional integrity of the myocardium permitting reversible interdigitation and transmission of force between contracting myocytes. In the pressure-overloaded, hypertrophied myocardium, clinical and experimental evidence indicates that the proportion of collagen relative to muscle is increased. Factors that appear to influence collagen growth during the hypertrophic process include age, species, the rapidity with which the overload occurs, the nature of the lesion leading to the pressure-overload, and the severity and duration of the overload. Morphologically, the heart's collagen matrix consists of a complex weave with tendinous insertions that surrounds myocytes grouping them into myofibers, strands of collagen that connect adjoining myofibers, and collagenous struts that join myocytes to other myocytes and capillaries. In a primate preparation of perinephritis with systemic hypertension, it was observed that the tendinous elements of the weave and the strands of collagen lying between myofibers were increased in number and physical dimension. The functional consequences of a remodeling of the collagen matrix that accompanied myocardial hypertrophy remain to be elucidated. A better understanding of the dynamic behavior of the collagen matrix may offer new insights into the pathogenesis of ventricular dysfunction that accompanies the chronic pressure-overloaded state.

Evidence and quantitation of left ventricular systolic resistance

Instantaneous left ventricular pressure is a function of both volume (elastic behavior) and flow (resistive behavior). However, a quantitative description of ventricular resistance and its effects on ventricular performance remains to be elucidated. Accordingly, ventricular resistive behavior was studied in six isolated canine hearts. Our experimental findings indicate 1) for a specified time (ts), volume (Vs), and contractile state (CS), the ventricular pressure-flow relation was linear (r = 0.96-0.99) within the range of flows examined (0-250 ml/s); 2) ventricular resistance increased with increments in ts, Vs, and CS, whereas the zero-pressure flow intercept was invariant; 3) resistance could be uniquely quantified as a linear function of isovolumetric pressure. In six experiments, the slope of this relationship ranged from 1.1 to 2.1 X 10(-3) s/ml while the intercept did not differ from zero; and 4) end-systolic elastance, estimated from end-systolic pressure-volume data, was in substantial error under the conditions of finite (greater than 35 ml/s) end-systolic flows. Finally, the results from a computer simulation of the coupled ventricular-arterial system indicated that ventricular resistance primarily affects the pulsatile nature of aortic flow. The unique isovolumetric pressure-resistance relation suggests that the rate-limiting properties of the contractile process may be causally related to the observed ventricular resistive behavior.

Left ventricular systolic dynamics in terms of its chamber mechanical properties

To determine the mechanical properties of the left ventricle (LV) as a pump, a mathematical model of its systolic dynamics was developed. Initially the model consisted of three elements, i.e., elastance, resistance, and inertance. Results from three experiments, however, indicated that the inertial component was negligible compared with the other two components. The functional forms of elastance and resistance were determined by applying the flow-pulse response technique to an isovolumetrically beating, isolated canine heart. Results from three experiments indicated that the systolic elastance and resistance can be represented by a third-order polynomial in time and a linear function of instantaneous ventricular pressure (LVP), respectively. The simplified model was then tested by calculating the systolic elastance and resistance from LVP, volume, and flow data of an ejecting LV obtained over a single cardiac cycle. A total of 225 combinations (10 expts) of end-diastolic volume (EDV), ejection pressure (EP), heart rate (HR), and contractile state (CS) were evaluated. The results indicated that 1) the elastance function was insensitive to variations in EDV and EP but was a function of CS and HR; 2) the linear resistance-pressure relationship was insensitive to variations in EDV, EP, HR, and CS; and 3) the model could "prospectively" predict the LV isovolumetric pressure from the data of an ejecting beat. Thus a model of LV systolic dynamics has been established that can be used to calculate the intrinsic chamber mechanical properties, i.e., elastance and resistance, of an ejecting LV.

The mechanics of ventricular function

The introduction of new pharmacotherapies for long-term treatment of chronic cardiac failure has underscored the need for serial measurement of ventricular function in the ambulatory patient. Management strategies can best be guided by physiologic assessment of the heart's function as a muscular pump that must serve to propel gases to the metabolizing tissues on a moment-to-moment basis.

The cardiopulmonary unit. The body's gas transport system

In recent years cardiologists and pulmonologists alike have taken a very narrow view of the heart and lungs. Each specialty has focused its respective attention on either the left ventricle or the alveoli. Ejection fraction and arterial O2 tension have become the order of the day. These narrowly focused viewpoints of the heart and lungs have distracted us from an equally compelling and more global perspective--the cardiopulmonary unit, in which the heart and lungs function as an integrated metabolic unit responsible for the body's gas transport and, as such, serving the metabolic needs of the tissues. A disease involving the cardiovascular or respiratory systems will disrupt the ability of the cardiopulmonary unit to deliver O2 to the tissues. In more subtle expressions of disease, this defect in O2 transport may require the heightened O2 requirements of exercising muscle to become apparent. The integration of the heart and lungs and the right and left sides of the heart is fostered by a variety of physiologic factors, including pleural and airway pressures, the pericardium, the interventricular septum and alignment of muscle fibers between the ventricles and septum, and the thoracic cage itself. Through its functional integration, the cardiopulmonary unit has been able to link the metabolizing cells to the atmosphere.

The right ventricle: physiologic and pathophysiologic considerations

The right ventricle (RV) is responsible for accepting venous blood and propelling it to the lungs where it is oxygenated and its CO2 eliminated. Under normal conditions, at rest and during exercise, the pressure required by the RV to maintain the cardiac output (CO) is modest. The functional significance of the RV in sustaining circulatory homeostasis, therefore, appears to be minimal. However, whenever pulmonary vascular resistance (PVR) is elevated (e.g., left heart failure or pulmonary vascular disease) or whenever venous return is reduced (e.g., hypovolemia, increased pleural pressure), the necessity of this pulsatile pump is without question. As a muscular pump, the thin-walled RV is not unlike the left ventricle (LV) except that during diastole it is twice as distensible as the LV and during systole its stroke volume is twice as sensitive to the level of ejection pressure. However, under conditions of chronic pressure overload, the RV will hypertrophy and become capable of generating systemic levels of pressure. This is particularly necessary during physical activity in patients with pulmonary vascular disease. Thus, the RV is an integral component of the body's gas transport system and its contribution to sustaining circulatory homeostasis is without question.