title: Left ventricular pressure-volume relationships before and after cardiomyoplasty in patients with heart failure.
abstract: BACKGROUND
  The aim of this study was to elucidate whether beneficial effects of cardiomyoplasty (CMP) in patients with dilated cardiomyopathy are the result of a decrease in existing ventricular dilatation or a prevention of further dilatation.
  
  
  RESULTS
  Combined micromanometer-conductance catheters were used to evaluate left ventricular pressure-volume relationships in six patients with dilated cardiomyopathy before and at 6 and 12 months after CMP. Acute changes in preload and afterload were induced by a standardized leg-tilting intervention and a bolus infusion of nitroglycerin. After CMP, end-diastolic volume (EDV) decreased from 138+/-10 to 103+/-18 mL/m2 (P<.01) at 6 months and to 83+/-17 mL/m2 (P<.01) at 12 months. End-diastolic pressure (EDP) decreased from 20.2+/-6.4 to 13.9+/-7.7 mm Hg (P<.01) at 6 months after CMP. Peak ejection rate and ejection fraction increased at 6 months after CMP from 594+/-214 to 799+/-214 mL/s (P<.05) and from 26.6+/-4.7% to 40.1+/-8.3% (P<.05), respectively. Peak dP/dt decreased at 12 months after CMP from -842+/-142 to -712+/-168 mm Hg/s (P<.05). Leg-tilting before CMP increased EDP from 20.2+/-6.4 to 25.6+/-5.2 mm Hg (P<.01), end-systolic pressure (ESP) from 118+/-17 to 122+/-17 mm Hg (P<.05), and tau from 50.8+/-2.8 to 53.8+/-2.3 ms (P<.05). Six months after CMP, leg-tilting also increased EDV from 103+/-18 to 110+/-22 mL/m2 (P<.05) and ESV from 62+/-14 to 66+/-14 mL/m2 (P<.05). Before CMP, nitroglycerin decreased EDP from 20.2+/-6.4 to 10.4+/-3.8 mm Hg (P<.01), ESP from 118+/-17 to 96+/-11 mm Hg (P<.05), ESV from 100+/-11 to 89+/-7 mL/m2 (P<.05), and tau from 50.8+/-2.8 to 44.5+/-3.7 ms (P<.05). Six months after CMP, nitroglycerin decreased EDP, ESP, and tau to similar values.
  
  
  CONCLUSIONS
  Our findings show that up to 1 year after CMP, marked decreases in left ventricular volume are present. Our measurements suggest that CMP actively reduced the dilated ventricle but did not prevent a higher EDV on an increased venous return. The latissimus dorsi muscle wrap contraction results in better synchronization of contraction and more rapid emptying of the left ventricle.
authors.affiliation: Department of Anesthesiology and Cardiology, Cardiovascular Research Institute, University Hospital Maastricht, The Netherlands. JSCHR@SANE.AZM.NL
authors.forename: J J
authors.initials: JJ
authors.lastname: Schreuder
authors.forename: F H
authors.initials: FH
authors.lastname: van der Veen
authors.forename: E T
authors.initials: ET
authors.lastname: van der Velde
authors.forename: F
authors.initials: F
authors.lastname: Delahaye
authors.forename: O
authors.initials: O
authors.lastname: Alfieri
authors.forename: O
authors.initials: O
authors.lastname: Jegaden
authors.forename: R
authors.initials: R
authors.lastname: Lorusso
authors.forename: J R
authors.initials: JR
authors.lastname: Jansen
authors.forename: S A
authors.initials: SA
authors.lastname: Hoeksel
authors.forename: G
authors.initials: G
authors.lastname: Finet
authors.forename: M
authors.initials: M
authors.lastname: Volterrani
authors.forename: H G
authors.initials: HG
authors.lastname: Kaulbach
authors.forename: J
authors.initials: J
authors.lastname: Baan
authors.forename: H J
authors.initials: HJ
authors.lastname: Wellens
mesh_terms: D002311:Cardiomyopathy, Dilated / Q000503:physiopathology* / Q000601:surgery; D018421:Cardiomyoplasty; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008875:Middle Aged; D005996:Nitroglycerin / Q000494:pharmacology; D016277:Ventricular Function, Left
chemical_list: D005996:Nitroglycerin