title: Mechanical alternans in human idiopathic dilated cardiomyopathy is caused with impaired force-frequency relationship and enhanced poststimulation potentiation.
abstract: Mechanical alternans (MA) is frequently observed in patients with heart failure, and is a predictor of cardiac events. However, there have been controversies regarding the conditions and mechanisms of MA. To clarify heart rate-dependent contractile properties related to MA, we performed incremental right atrial pacing in 17 idiopathic dilated cardiomyopathy (DCM) patients and in six control patients. The maximal increase in left ventricular dP/dt during pacing-induced tachycardia was assessed as the force gain in the force-frequency relationship (FG-FFR), and the maximal increase in left ventricular dP/dt of the first post-pacing beats was examined as the force gain in poststimulation potentiation (FG-PSP). As a result, MA was induced in 9 DCM patients (DCM MA(+)) but not in the other 8 DCM patients (DCM MA(-)), and not in any of the control patients. DCM MA(+) had significantly lower FG-FFR (34.7 ± 40.9 vs 159.4 ± 103.9 mmHg/s, P = 0.0091) and higher FG-PSP (500.0 ± 96.8 vs 321.9 ± 94.9 mmHg/s, P = 0.0017), and accordingly a wider gap between FG-PSP and FG-FFR (465.3 ± 119.4 vs 162.5 ± 123.6 mmHg/s, P = 0.0001) than DCM MA(-) patients. These characteristics of DCM MA(+) showed clear contrasts to those of the control patients. In conclusion, MA is caused with an impaired force-frequency relationship despite significant poststimulation potentiation, suggesting that MA reflects ineffective utilization of the potentiated intrinsic force during tachycardia.
authors.affiliation: Division of Cardiology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi, Niigata, 951-8510, Japan. kashi@med.niigata-u.ac.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kashimura
authors.forename: Makoto
authors.initials: M
authors.lastname: Kodama
authors.forename: Komei
authors.initials: K
authors.lastname: Tanaka
authors.forename: Keiko
authors.initials: K
authors.lastname: Sonoda
authors.forename: Satoru
authors.initials: S
authors.lastname: Watanabe
authors.forename: Yukako
authors.initials: Y
authors.lastname: Ohno
authors.forename: Makoto
authors.initials: M
authors.lastname: Tomita
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Obata
authors.forename: Wataru
authors.initials: W
authors.lastname: Mitsuma
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ito
authors.forename: Satoru
authors.initials: S
authors.lastname: Hirono
authors.forename: Haruo
authors.initials: H
authors.lastname: Hanawa
authors.forename: Yoshifusa
authors.initials: Y
authors.lastname: Aizawa
mesh_terms: D000328:Adult; D006328:Cardiac Catheterization; D002304:Cardiac Pacing, Artificial; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000503:physiopathology*; D016022:Case-Control Studies; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000503:physiopathology*; D013997:Time Factors; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D017725:Ventricular Pressure