Circulation, Vol 83, 635-644, Copyright © 1991 by American Heart Association
M Tomita, FG Spinale, FA Crawford and MR Zile
Chronic supraventricular tachycardia causes a dilated cardiomyopathy in
man. Terminating this tachycardia appears to result in symptomatic
improvement; however, its effects on left ventricular (LV) volume, mass,
and function have not been fully examined. Accordingly, hemodynamic studies
using simultaneous echocardiography and catheterization were performed in
three groups of pigs: 1) those subjected to rapid left atrial pacing (240
beats/min) for 3 weeks (SVT, n = 8), 2) those subjected to supraventricular
tachycardia for 3 weeks followed by termination of pacing and a 4-week
recovery period (PSVT, n = 9), and 3) sham-operated controls (CTR, n = 10).
Systolic pump function was assessed using fractional shortening (FS), peak
ejection rate [peak (-)dD/dt], and maximum rate of pressure development
[peak (+)dP/dt]. Diastolic function was assessed using the time constant of
isovolumic pressure decline (tau), peak early diastolic filling rate [peak
(+)dD/dt], the chamber stiffness constant (Kc), and the myocardial
stiffness constant (Km). Supraventricular tachycardia caused LV dilation
(end-diastolic dimension [EDD] increased from 3.5 +/- 0.4 cm in CTR to 4.9
+/- 0.5 cm in SVT, p less than 0.05) but no change in LV mass (LV
weight-to-body weight ratio [LV/BW]) was 2.58 +/- 0.3 g/kg in CTR and 2.66
+/- 0.4 g/kg in SVT), all indexes of systolic function became abnormal (FS
fell from 30 +/- 4% in CTR to 13 +/- 5% in SVT, p less than 0.05), and the
indexes of relaxation and filling were slowed (tau increased from 36 +/- 3
msec in CTR to 51 +/- 13 msec in SVT, p less than 0.05). There were no
significant changes in Kc or Km. After terminating the supraventricular
tachycardia, LV volume fell but remained greater than that in CTR (EDD was
4.2 +/- 0.4 cm in PSVT, p less than 0.05 versus CTR) and substantial LV
hypertrophy developed (LV/BW was 3.48 +/- 0.5 g/kg in PSVT, p less than
0.05 versus CTR). Systolic function returned to normal (FS was 31 +/- 5% in
PSVT) but diastolic function remained abnormal. In PSVT, tau remained
prolonged (49 +/- 12 msec, p less than 0.05 versus CTR), Kc increased from
3.7 +/- 1.0 in CTR to 7.4 +/- 1.2 (p less than 0.05), and Km increased from
4.4 +/- 1.5 in CTR to 13.9 +/- 9.7 (p less than 0.05). Thus, the
improvement in systolic function that occurs after the termination of
supraventricular tachycardia is associated with the development of LV
hypertrophy and persistent diastolic dysfunction.
ARTICLES
Changes in left ventricular volume, mass, and function during the development and regression of supraventricular tachycardia-induced cardiomyopathy. Disparity between recovery of systolic versus diastolic function
Department of Medicine, Cardiology Division, F.A.C., Medical University of South Carolina, Charleston 29425.
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