Isolated Systolic and Diastolic Ventricular Interactions in Pacing-Induced Dilated Cardiomyopathy and Effects of Volume Loading and Pericardium

Farrar, David J.; Chow, E.; Brown, Craig

doi:10.1161/01.cir.92.5.1284

Cited by 19 publications

(11 citation statements)

References 30 publications

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“…15 Systolic ventricular interdependence was found to be more pronounced in an experimental tachycardia-induced cardiomyopathy models in pigs than in normal hearts. 25 The overall RV function does not depend solely on the function of the right free wall, but also on septal contractility, which is irreversibly impaired in ICM. 7 It is known that RV function depends on afterload, resulting in its deterioration when pulmonary artery pressure is elevated, but this relationship may be dependent on the etiology of the cardiomyopathy.…”

Section: Discussionmentioning

confidence: 99%

Right Ventricular Function in Ischemic or Idiopathic Dilated Cardiomyopathy

Parcharidou

Giannakoulas

Efthimiadis

et al. 2008

Circ J

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hronic heart failure (CHF) has emerged as the most prevalent cause of mortality, morbidity and hospitalization in industrialized countries over the past years. 1 Despite the advances in medical and invasive treatment of CHF, its incidence is expected to rise in the future because of improved survival rates following acute myocardial infarction (MI), which is the principal etiology of CHF in >70% of patients. 2 Traditionally, great emphasis was put on evaluation of the various etiologic factors of this syndrome. Differentiation between ischemic cardiomyopathy (ICM) and idiopathic dilated cardiomyopathy (DCM) has important therapeutic implications because the former may gain substantial benefit from coronary revascularization. 3 Conventional echocardiography is commonly used for the evaluation of left ventricular (LV) and right ventricular (RV) function, but does not provide detailed information about myocardial systolic and diastolic properties in the regional segments. Tissue Doppler echocardiography (TDE) is a promising ultrasonographic technique that quantitatively measures the velocity of the myocardium in systole and diastole. 4 Traditionally, the principal target of the cardiologist is the evaluation of the LV function, with little interest in the RV. In spite of the fact that several recent studies have used the TDE technique in the assessment of RV function in various clinical conditions, 5,6 the literature on the RV and its impact on the pathophysiologic processes is limited. However, there is a growing body of evidence that RV function is a powerful predictor of mortality in patients with CHF. 7 We hypothesized that ICM and DCM differ in terms of RV function. Thus, the aim of our study was to investigate the RV function in patients with ICM and DCM using pulsed wave TDE and to compare the TDE parameters of the RV among the patients with ischemic and idiopathic dilated causes of LV dysfunction. Methods Study PopulationWe prospectively studied 82 consecutive patients with CHF who had undergone an echocardiographic examination at the AHEPA Hospital (Thessaloniki, Greece). CHF was defined as the presence of heart failure symptoms plus a dilated (>55 mm in end-diastolic diameter) LV with a depressed (<40%) ejection fraction of uncertain origin. The inclusion criteria were: (a) good quality echocardiographic imaging of tricuspid and mitral annular motion, (b) adequate tricuspid valve regurgitation Doppler signal in order to assess pulmonary artery systolic pressure, (c) sinus rhythm on electrocardiography (ECG), and (d) stable clinical condition. The following were considered as exclusion criteria:

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Section: Discussionmentioning

confidence: 99%

Right Ventricular Function in Ischemic or Idiopathic Dilated Cardiomyopathy

Parcharidou

Giannakoulas

Efthimiadis

et al. 2008

Circ J

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“…Experimental model. Rapid ventricular pacing (220-250 beats/min for 4-6 wk) produced severe congestive heart failure (severe LV dysfunction observed echocardiographically, associated with lassitude, dyspnea, and ascites) in six dogs (both sexes, 20-25 kg) as previously described (2,11,14,15,29,32). The pacemakers were then turned off, and the dogs were studied acutely.…”

Section: Methodsmentioning

confidence: 99%

Ventricular interaction and external constraint account for decreased stroke work during volume loading in CHF

Moore

Frenneaux

Sas

et al. 2001

American Journal of Physiology-Heart and Circulatory Physiology

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The slope of the stroke work (SW)-pulmonary capillary wedge pressure (PCWP) relation may be negative in congestive heart failure (CHF), implying decreased contractility based on the premise that PCWP is simply related to left ventricular (LV) end-diastolic volume. We hypothesized that the negative slope is explained by decreased transmural LV end-diastolic pressure (LVEDP), despite the increased LVEDP, and that contractility remains unchanged. Rapid pacing produced CHF in six dogs. Hemodynamic and dimension changes were then measured under anesthesia during volume manipulation. Volume loading increased pericardial pressure and LVEDP but decreased transmural LVEDP and SW. Right ventricular diameter increased and septum-to-LV free wall diameter decreased. Although the slopes of the SW-LVEDP relations were negative, the SW-transmural LVEDP relations remained positive, indicating unchanged contractility. Similarly, the SW-segment length relations suggested unchanged contractility. Pressure surrounding the LV must be subtracted from LVEDP to calculate transmural LVEDP accurately. When this was done in this model, the apparent decrease in contractility was no longer evident. Despite the increased LVEDP during volume loading, transmural LVEDP and therefore SW decreased and contractility remained unchanged.

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“…Systolic interaction is therefore reduced by any increase in the elastance (i.e., stiffness) of the interventricular septum, such as that occurring during hypertrophy due to chronic pressure overload (21). On the other hand, low interventricular septum elastance is associated with an increase in left-to-right systolic ventricular interaction, as in case of pacing-induced dilated cardiomyopathy (9). Since the two ventricles share a good amount of muscle fibers, any reduction of LV free wall function is immediately translated in a lower RV pressure or function (13,17).…”

Section: Left and Right Ventricular Functionmentioning

confidence: 99%

Left-to-right systolic ventricular interaction in patients undergoing biventricular stimulation for dilated cardiomyopathy

Osculati

Malfatto

Chianca

et al. 2010

Journal of Applied Physiology

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Left-to-right systolic ventricular interaction (i.e., the phenomenon by which the left ventricle contributes to most of the flow and to two-thirds of the pressure generated by the right ventricle) originates from transmission of systolic forces between the ventricles through the interventricular septum and from the mechanical effect of the common muscle fibers encircling their free walls. As a consequence, any reduction of left ventricular free wall function translates in lower right ventricular pressure or function. We investigated whether systolic ventricular interaction could be evidenced in nine patients with dilated cardiomyopathy in whom a biventricular pacemaker was implanted. Changes in right and left ventricular pressures were measured with high-fidelity catheters, before and after periods of biventricular pacing from the right atrium with different stimulation intervals to the right and left ventricles, respectively. The steady-state changes of left and right ventricular systolic pressure obtained from any single pacing interval combination were considered. We then calculated, with a two-level mixed regression analysis of the entire data set, the relation between changes in left and right systolic pressures: the presence of a statistically significant slope was assumed as evidence of ventricular interaction. The slope of the regression replaced the crude pressure ratio as an estimate of the gain of the interaction; its value compared with values observed in experimental studies. Moreover, its dependence on septal elastance and on right ventricular volume was similar to that already demonstrated for ventricular interaction gain. In conclusion, the linear relationship we found between systolic pressure changes in the two ventricles of patients with dilated cardiomyopathy during biventricular pacing could be explained in terms of ventricular interaction.

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Isolated Systolic and Diastolic Ventricular Interactions in Pacing-Induced Dilated Cardiomyopathy and Effects of Volume Loading and Pericardium

Cited by 19 publications

References 30 publications

Right Ventricular Function in Ischemic or Idiopathic Dilated Cardiomyopathy

Right Ventricular Function in Ischemic or Idiopathic Dilated Cardiomyopathy

Ventricular interaction and external constraint account for decreased stroke work during volume loading in CHF

Left-to-right systolic ventricular interaction in patients undergoing biventricular stimulation for dilated cardiomyopathy

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