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The Annals of Thoracic Surgery, Vol 56, 38-45, Copyright © 1993 by The Society of Thoracic Surgeons
PW Cho, HR Levin, WE Curtis, JE Tsitlik, JM DiNatale, DA Kass, TJ Gardner, RW Kunel and MA Acker
Reports of clinical improvement in human studies of dynamic cardiomyoplasty
lack support by consistent objective hemodynamic evidence. Animal studies
have also yielded conflicting results, likely due to nonuniform models,
particularly the use of unconditioned wraps, and to limitations in commonly
used study modalities caused by exaggerated heart motion during wrap
stimulation. Our purpose was to assess the primary functional properties of
the heart wrapped by conditioned muscle using pressure-volume relation
analysis based on conductance catheter volume data. Compared with the
unstimulated state, 1:1 stimulation caused an increase in contractility and
decreases in end-diastolic volume and stroke work. Assisted beats during
1:2 stimulation showed an increase in contractility and a decrease in end-
diastolic volume. Unassisted beats (1:2) showed decreases in end- diastolic
volume and stroke work. There was no augmentation of cardiac output or
ejection fraction with stimulation (1:1 or 1:2). We conclude that in the
nonfailing heart, increased contractility does not augment cardiac output,
ejection fraction, and stroke work because of a simultaneous decrease in
end-diastolic volume. These changes in contractility and end-diastolic
volume may prove therapeutic for dilated cardiomyopathy.
ARTICLES
Pressure-volume analysis of changes in cardiac function in chronic cardiomyoplasty
Division of Cardiac Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.
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