Late Effects of Cardiomyoplast on Left Ventricular Mechanics and Diastolic Filling

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Abstract

Background

Dynamic cardiomyoplasty is a relatively new surgical procedure proposed for treatment of severe myocardial failure. Limited clinical experience suggests that this procedure reverses congestive heart failure, improving the long-term survival.

Methods and Results

In this investigation, the late effects (16.5±4.8 months after surgery) of cardiomyoplasty on left ventricular mechanics and diastolic filling were studied in eight male patients (mean age, 45±7 years). The investigation was performed with the myostimulator on and off (24± 1 hours off) using a microtip catheter to obtain the left ventricular pressures simultaneously with Doppler (inflow velocities) and M-mode and two-dimensional echocardiographic recordings. Statistical comparisons were made with Student's t test for paired data. Dynamic cardiomyoplasty increased the maximal elastance (17±1 versus 21±1 mm Hg/cm, P=.006) and decreased the systolic wall stress (253±17 versus 190±12 g/cm2, P=.029). Left ventricular end-diastolic pressure decreased (27.1±2.8 versus 17.6±1.7 mm Hg, P=.019), as did end-diastolic circumferential wall stress (69±8 versus 37±5 g/cm2, P=.002). The chamber and muscle stiffnesses decreased (120±31 versus 52±11 mm Hg/cm, P=.017; 994±185 versus 426±76 g/cm2, P=.002, respectively). The pattern of left ventricular diastolic filling changed, with a decrease of early peak flow (231±20 versus 217±21 mL/s, P=.022), of deceleration time (163±28 versus 116±26 seconds, P=.001), and of flow area during rapid filling (105±15 versus 75+12 mL, P=.004) and an increase of flow area during atrial contraction (39±4 versus 88±9 mL, P=.001).

Conclusions

Our detailed evaluation of left ventricular mechanics demonstrates that cardiomyoplasty has significant multiple beneficial effects on dilated myopathic heart.

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