Left ventricular systolic performance in failing heart improved acutely by left ventricular reshaping

He, Kun-lun; Shimizu, Juichiro; Yi, Geng-hua; Gu, Anguo; Kashem, M.Abul; Crabbe, Deborah L.; Popilskis, Sulli; Wu, Ed X.; Santamore, William P.; Melvin, David; Wang, Jie

doi:10.1016/S0022-5223(02)73597-6

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 126, Issue 1 , Pages 56-65, July 2003

Left ventricular systolic performance in failing heart improved acutely by left ventricular reshaping☆☆☆

Kun-lun He, MD, PhD
- Division of Circulatory Physiology, Department of Medicine, Columbia University, New York, NY, USA
Juichiro Shimizu, MD, PhD
- Division of Circulatory Physiology, Department of Medicine, Columbia University, New York, NY, USA
Geng-hua Yi, MD
- Division of Circulatory Physiology, Department of Medicine, Columbia University, New York, NY, USA
Anguo Gu, MD,
- Division of Circulatory Physiology, Department of Medicine, Columbia University, New York, NY, USA
M.Abul Kashem, MD, PhD
- Cardiology Section, Temple University, Philadelphia, Pa, USA
Deborah L. Crabbe, MD
- Cardiology Section, Temple University, Philadelphia, Pa, USA
Sulli Popilskis, DVM
- Department of Comparative Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
Ed X. Wu, PhD
- Department of Radiology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
William P. Santamore, PhD
- Cardiology Section, Temple University, Philadelphia, Pa, USA
David Melvin, MD, PhD,
- Division of Cardiothoracic Surgery, Department of Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
- Address for reprints: Jie Wang, MD, PhD, The Heart Failure Center, Department of Medicine, Columbia University, MHB 5-435, 177 Ft Washington Ave, New York, NY 10032, USA
Jie Wang, MD, PhD
- Department of Radiology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Division of Circulatory Physiology, Department of Medicine, Columbia University, New York, NY, USA
- Address for reprints: Jie Wang, MD, PhD, The Heart Failure Center, Department of Medicine, Columbia University, MHB 5-435, 177 Ft Washington Ave, New York, NY 10032, USA

Received 16 July 2002; received in revised form 13 August 2002; accepted 30 December 2002.

Abstract

Objective

If the geometric distortion during dilated heart failure could be corrected, the tension on the myocytes would be decreased, thereby leading to an improvement in left ventricular systolic function. We tested the effects of the CardioClasp (CardioClasp Inc, Pine Brook, NJ), a left ventricular reshaping device, on the failing heart, and our empirical data were compared with computationally derived data.

Methods

Heart failure was induced by 4-week rapid cardiac pacing. At the terminal experiment, an isolated failing heart preparation (isovolumic contraction, n = 5) or an intact failing heart in vivo (n = 7) was used. The effects of the reshaping device on left ventricular performance were assessed by the slopes (Ees) of the left ventricular end-systolic pressure-volume relations, hemodynamics, and echocardiograph before and after placing the CardioClasp on the heart. The change in Ees as the result of left ventricular reshaping was also estimated from computed theoretical analysis and compared with empirical data.

Results

There was a significant change in left ventricular dimension after placing the CardioClasp on the heart. In isolated heart preparation, Ees significantly increased from 1.40 ± 0.44 mm Hg/mL to 2.42 ± 0.63 mm Hg/mL after placing the device on the heart but returned to the baseline level (1.46 ± 0.27 mm Hg) after removing it. Left ventricular developed pressure and left ventricular fractional area shortening were significantly increased as the result of left ventricular reshaping. Ees derived from computed theoretical analysis was highly correlated with confirming empirical data.