Dor procedure for dyskinetic anteroapical myocardial infarction fails to improve contractility in the border zone

Background

Endoventricular patch plasty (Dor) is used to reduce left ventricular volume after myocardial infarction and subsequent left ventricular remodeling.

Methods and Results

End-diastolic and end-systolic pressure–volume and Starling relationships were measured, and magnetic resonance images with noninvasive tags were used to calculate 3-dimensional myocardial strain in 6 sheep 2 weeks before and 2 and 6 weeks after the Dor procedure. These experimental results were previously reported.

The imaging data from 1 sheep were incomplete. Animal specific finite element models were created from the remaining 5 animals using magnetic resonance images and left ventricular pressure obtained at early diastolic filling. Finite element models were optimized with 3-dimensional strain and used to determine systolic material properties, T_{max,skinned-fiber}, and diastolic and systolic stress in remote myocardium and border zone.

Six weeks after the Dor procedure, end-diastolic and end-systolic stress in the border zone were substantially reduced. However, although there was a slight increase in T_{max,skinned-fiber} in the border zone near the myocardial infarction at 6 weeks, the change was not significant.

Conclusions

The Dor procedure decreases end-diastolic and end-systolic stress but fails to improve contractility in the infarct border zone. Future work should focus on measures that will enhance border zone function alone or in combination with surgical remodeling.

Abbreviations and Acronyms: BZ, border zone, CABG, coronary artery bypass grafting, LV, left ventricular, MI, myocardial infarction, MRI, magnetic resonance imaging (image), MSE, mean square error, STICH, Surgical Treatment for Ischemic Heart failure, T_max, maximum isometric tension achieved at the longest sacromere length