title: New advances in dynamic cardiomyoplasty: Doppler flow wire shows improved cardiac assistance in demand protocol.
abstract: No data have been published on real cardiac assistance with demand dynamic cardiomyoplasty. We tested the utility of a Doppler flow wire in measuring beat by beat aortic flow velocity and evaluating cardiac assistance in demand cardiomyoplasty patients. The technique was tested in seven patients (M/W = 6/1; age, 57.1+/-6.2 years; atrial fibrillation/ sinus rhythm = 1/6; New York Heart Association [NYHA] classification = 1.4+/-0.5). Measurements were done using a 0.018 inch peripheral Doppler flow wire advanced through a 5 French arterial femoral sheath. Three 1 minute periods with the stimulator off, and three 1 minute periods with clinical stimulation were recorded. We measured peak aortic flow velocity in all beats. Latissimus dorsi mechanogram was simultaneously recorded. Comparison between preoperative and follow-up data showed significantly higher values of tetanic fusion frequency and ejection fraction at follow-up, whereas mean NYHA class was significantly lower. Statistical analysis showed an increase in aortic flow velocity not only in the assisted versus rest period, but also in assisted versus unassisted beats (8.42+/-6.98% and 7.55+/-3.07%). A linear correlation was found between increase in flow velocity and latissimus dorsi wrap tetanic fusion frequency (r2 = 0.53). In demand dynamic cardiomyoplasty, systolic assistance is significant and correlated to the latissimus dorsi speed of contraction; a demand stimulation protocol maintains muscle properties and increases muscle performance.
authors.affiliation: Department of Cardiology, Legnago General Hospital, Verona, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Rigatelli
authors.forename: Ugo
authors.initials: U
authors.lastname: Carraro
authors.forename: Mario
authors.initials: M
authors.lastname: Barbiero
authors.forename: Mario
authors.initials: M
authors.lastname: Zanchetta
authors.forename: Luigi
authors.initials: L
authors.lastname: Pedon
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Dimopoulos
authors.forename: Giorgio
authors.initials: G
authors.lastname: Rigatelli
authors.forename: Pietro
authors.initials: P
authors.lastname: Maiolino
authors.forename: Franco
authors.initials: F
authors.lastname: Cobelli
authors.forename: Riccardo
authors.initials: R
authors.lastname: Riccardi
authors.forename: Sergio Dalla
authors.initials: SD
authors.lastname: Volta
mesh_terms: D000368:Aged; D001011:Aorta / Q000000981:diagnostic imaging / Q000502:physiology; D001783:Blood Flow Velocity; D018421:Cardiomyoplasty / Q000295:instrumentation* / Q000639:trends*; D003971:Diastole; D005260:Female; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008297:Male; D008875:Middle Aged; D013599:Systole; D014463:Ultrasonography