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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 ,Revised 13 August 2002 ,Accepted 30 December 2002.

A, Schematic of the CardioClasp (CardioClasp Inc, Pine Brook, NJ). The device consists of 2 external structural elements to geometrically reshape the left ventricular (LV) chamber. B, Structures of th

A, Schematic of the CardioClasp (CardioClasp Inc, Pine Brook, NJ). The device consists of 2 external structural elements to geometrically reshape the left ventricular (LV) chamber. B, Structures of the CardioClasp device and its placement on a heart.
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Schematic of isolated canine heart preparation showing donor heart perfused by blood from a “support” dog.

Schematic of isolated canine heart preparation showing donor heart perfused by blood from a “support” dog.
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An echocardiograph obtained from an intact animal, indicating a significant “reshaping” of the LV once the CardioClasp was placed on the heart. In this case, there was an approximately 35% reduction i

An echocardiograph obtained from an intact animal, indicating a significant “reshaping” of the LV once the CardioClasp was placed on the heart. In this case, there was an approximately 35% reduction in the short axis of the LV, and the bi-lobe appearance of the heart is clearly seen.
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An echocardiograph image from an isolated heart illustrates the impact of the device on the short axis diameter and the elongation of the heart with reduction of radius of curvatures of the anterior a

An echocardiograph image from an isolated heart illustrates the impact of the device on the short axis diameter and the elongation of the heart with reduction of radius of curvatures of the anterior and posterior “lobes” of the heart.
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LV end-systolic pressure-volume relationship (ESPVR) and end-diastolic pressure-volume relationship (EDPVR) before (blue lines) and after (red and black lines) placement of the CardioClasp. Under base

LV end-systolic pressure-volume relationship (ESPVR) and end-diastolic pressure-volume relationship (EDPVR) before (blue lines) and after (red and black lines) placement of the CardioClasp. Under baseline conditions (before the LV-reshaping device), there was an approximately linear relationship between LV end-systolic pressure and LV volume with a nonlinear EDPVR. CardioClasp placement resulted in a shift toward lower volumes of both relationships. It was noted that the originally linear relationship of ESPVR could be accurately described by 2 linear relationships with a breakpoint dividing the 2 regions of the curves. Below the breakpoint volume, the ESPVR slope was basically the same as under baseline conditions, although it shifted toward lower volumes. Above the breakpoint, the ESPVR slope (Ees) increased (red dot line) from baseline (blue dot line), indicating an influence of the device on LV contractile strength. EDPVR was not significantly changed by placement of the CardioClasp (CardioClasp on: + clasp).
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Ees, the slope of the ESPVR, was 1.4 ± 0.44 mm Hg/mL at control. After CardioClasp placement, Ees increased to 2.4 ± 0.63 mm Hg/mL above the breakpoint (LVV > VBP), whereas Ees below the breakpoint (L

Ees, the slope of the ESPVR, was 1.4 ± 0.44 mm Hg/mL at control. After CardioClasp placement, Ees increased to 2.4 ± 0.63 mm Hg/mL above the breakpoint (LVV > V_BP), whereas Ees below the breakpoint (LVV < V_BP) was not changed by CardioClasp placement. After removing the device, Ees returned to the baseline level (Re-control), 1.46 ± 0.27 mm Hg/mL (*P < .01).
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A typical LV pressure response to a rapid removal of the CardioClasp. Both LV systolic and diastolic pressures decreased. However, the decrease in systolic pressure was greater than the decrease in LV

A typical LV pressure response to a rapid removal of the CardioClasp. Both LV systolic and diastolic pressures decreased. However, the decrease in systolic pressure was greater than the decrease in LV diastolic pressure, indicating a slight but significant increase in LV development pressure (LV development pressure: vertical line with 2 arrows).
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