Mechanism for depressed cardiac function in left ventricular volume overload.
To assess the effects of left ventricular chamber volume on the mechanism of changes in left ventricular developed pressure we performed phosphorous-31 nuclear magnetic resonance spectroscopy, hydrogen-1 nuclear magnetic resonance spectroscopy with a shift reagent, two-dimensional echocardiography, atomic absorption spectrophotometry, microsphere analysis, and surface fluorometry on isovolumic isolated perfused rat hearts with incremental intraventricular balloon volumes, while left ventricular pressure was concurrently monitored. A three-phasic response of developed pressure was noted: 0 to 100 microliters balloon volumes resulted in an increase in developed pressure, whereas developed pressure remained constant at 250 microliters and fell at 400 microliters. Oxygen consumption and [Ca2+]i transients followed the same pattern as developed pressure and coronary flow. Intraventricular volumes of 250 microliters or greater (a volume overload) caused endocardial ischemia, a greater decrease in extracellular versus intracellular water, thinning of the left ventricular free wall, and an increase in chamber size. Mechanical pressure on the tissue, induced by the volume overload, caused ischemia as further evidenced by (1) a negative effect on developed pressure, (2) a decrease in [Ca2+]i transients, (3) a [Ca2+]i overload, (4) a moderate decrease in the phosphorylation potential, and (5) an increase in the oxidation-reduction state (nicotinamide-adenine dinucleotide). The high intracellular calcium associated with volume overload may have been due to both compression and ischemia, which leads to an increased number of cross-bridges in rigor, a high end-diastolic pressure, and an increase in wall stress.
Holt
W
W
Department of Medicine, University of California, San Francisco 94143.
Auffermann
W
W
Wu
S T
ST
Parmley
W W
WW
Wikman-Coffelt
J
J
D000818:Animals; D002306:Cardiac Volume / Q000502:physiology*; D003326:Coronary Circulation / Q000502:physiology; D003971:Diastole / Q000502:physiology; D004452:Echocardiography / Q000379:methods; D005110:Extracellular Space / Q000502:physiology; D006321:Heart / Q000502:physiology*; D066298:In Vitro Techniques; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D008863:Microspheres; D008929:Mitochondria, Heart / Q000737:chemistry; D009243:NAD / Q000032:analysis; D010477:Perfusion / Q000379:methods; D051381:Rats; D013050:Spectrometry, Fluorescence / Q000379:methods; D016277:Ventricular Function, Left / Q000502:physiology*
D009243:NAD