Stabilization of chronic remodeling by asynchronous cardiomyoplasty in dilated cardiomyopathy

Effects of a conditioned muscle wrap

Himanshu J. Patel, David J. Polidori, James J. Pilla, Theodore Plappert, David A Kass, Martin St John Sutton, Edward B. Lankford, Michael A. Acker

Research output: Contribution to journalArticle

Abstract

Background: Dynamic cardiomyoplasty is a promising new therapy for dilated cardiomyopathy. The girdling effects of a conditioned muscle wrap alone have recently been postulated to partly explain its mechanism. We investigated this effect in a canine model of chronic dilated cardiomyopathy. Methods and Results: Twenty dogs underwent rapid ventricular pacing (RVP) for 4 weeks to create a model of dilated cardiomyopathy. Seven dogs were then randomly selected to undergo subsequent cardiomyoplasty, and all dogs had 6 weeks of additional RVP. The cardiomyoplasty group also received 6 weeks of concurrent skeletal muscle stimulation consisting of single twitches delivered asynchronously at 2 Hz to transform the wrap without active assistance. All dogs were studied by pressure-volume analysis and echocardiography at baseline and after 4 and 10 weeks of pacing. Systolic indices, including ejection fraction (EF), end-systolic elastance (Ees), and pre-load-recruitable stroke work (PRSW) were all increased at 10 weeks in the wrap versus controls (EF, 34.0 versus 27.1, P=.008; Ees, 1.65 versus 1.26, P=.09; PRSW, 35.9 versus 25.5, P=.001). Ventricular volumes, diastolic relaxation, and left ventricular end-diastolic pressures stabilized in the cardiomyoplasty group but continued to deteriorate in controls. Both the end- systolic and end-diastolic pressure-volume relationships shifted farther rightward in controls but remained stable in the cardiomyoplasty group. Conclusions: In addition to potential benefits from active systolic assistance, benefits from dynamic cardiomyoplasty appear to be partially accounted for by the presence of a conditioned muscle wrap alone. This conditioned wrap stabilizes the remodeling process of heart failure, arresting progressive deterioration of systolic and diastolic function.

Original languageEnglish (US)
Pages (from-to)3665-3671
Number of pages7
JournalCirculation
Volume96
Issue number10
StatePublished - Nov 18 1997

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Cardiomyoplasty
Dilated Cardiomyopathy
Muscles
Dogs
Stroke
Blood Pressure
Echocardiography
Canidae
Skeletal Muscle
Heart Failure
Pressure

Keywords

  • Cardiomyopathy
  • Electrical stimulation
  • Heart failure
  • Mechanics
  • Remodeling
  • Surgery

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Patel, H. J., Polidori, D. J., Pilla, J. J., Plappert, T., Kass, D. A., Sutton, M. S. J., ... Acker, M. A. (1997). Stabilization of chronic remodeling by asynchronous cardiomyoplasty in dilated cardiomyopathy: Effects of a conditioned muscle wrap. Circulation, 96(10), 3665-3671.

Stabilization of chronic remodeling by asynchronous cardiomyoplasty in dilated cardiomyopathy : Effects of a conditioned muscle wrap. / Patel, Himanshu J.; Polidori, David J.; Pilla, James J.; Plappert, Theodore; Kass, David A; Sutton, Martin St John; Lankford, Edward B.; Acker, Michael A.

In: Circulation, Vol. 96, No. 10, 18.11.1997, p. 3665-3671.

Research output: Contribution to journalArticle

Patel, HJ, Polidori, DJ, Pilla, JJ, Plappert, T, Kass, DA, Sutton, MSJ, Lankford, EB & Acker, MA 1997, 'Stabilization of chronic remodeling by asynchronous cardiomyoplasty in dilated cardiomyopathy: Effects of a conditioned muscle wrap', Circulation, vol. 96, no. 10, pp. 3665-3671.
Patel, Himanshu J. ; Polidori, David J. ; Pilla, James J. ; Plappert, Theodore ; Kass, David A ; Sutton, Martin St John ; Lankford, Edward B. ; Acker, Michael A. / Stabilization of chronic remodeling by asynchronous cardiomyoplasty in dilated cardiomyopathy : Effects of a conditioned muscle wrap. In: Circulation. 1997 ; Vol. 96, No. 10. pp. 3665-3671.
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