Circulation, Vol 89, 142-150, Copyright © 1994 by American Heart Association
MR Moon, NB Ingels Jr, GT Daughters 2nd, EB Stinson, DE Hansen and DC Miller
BACKGROUND: Left ventricular (LV) twist, the longitudinal gradient of
circumferential rotation about the LV long axis, may play an important role
in the storage of potential energy at end systole and its subsequent
release as elastic recoil during early diastole; however, the effects of
load and inotropic state on LV systolic twist and diastolic untwist in
human subjects have not previously been characterized. METHODS AND RESULTS:
Six cardiac transplant recipients with 12 implanted radiopaque midwall LV
myocardial markers were studied 1 year after transplantation. Biplane
cinefluoroscopic marker images and LV pressure were recorded during control
conditions and after afterload augmentation (methoxamine, 5 to 10
micrograms.kg-1 x min-1), inotropic stimulation (dobutamine, 5
micrograms.kg-1 x min-1), and preload augmentation (volume loading with
normal saline). Systolic twist dynamics were assessed by maximum twist
(Tmax[rad/cm]), peak negative twist rate (-dT/dtmin[rad.cm-1 x s-1]), and
the slope of the twist normalized-ejection fraction relation (T-nEFR,
Msys[rad/cm]) during systole. Diastolic untwist was assessed by the peak
positive untwist rate (+dT/dtmax [rad.cm-1 x s-1]) and the slopes (rad/cm)
of the T-nEFR during early diastole (Mear-dia) and mid diastole (Mmid-
dia). Compared with control values, LV pressure and volume loading had no
significant effect on Tmax, -dT/dtmin, or Msys; however, inotropic
stimulation significantly increased all parameters describing systolic
twist (Tmax: -0.10 +/- 0.03 versus -0.06 +/- 0.02 rad/cm, P < .001; -
dT/dtmin: -0.72 +/- 0.19 versus -0.44 +/- 0.22 rad.cm-1 x s-1, P < .001;
Msys: -0.10 +/- 0.03 versus -0.06 +/- 0.01 rad/cm, P < .001). Pressure
loading had no effect on early diastolic untwisting; however, dobutamine
significantly increased M(ear)-dia (-0.24 +/- 0.06 versus - 0.13 +/- 0.04
rad/cm, P < .0001) and +dT/dtmax (0.78 +/- 0.24 versus 0.45 +/- 0.16
rad.cm-1 x s-1, P < .001). Conversely, volume loading significantly
decreased M(ear)-dia (-0.08 +/- 0.04 versus -0.13 +/- 0.04 rad/cm, P <
.05). M(ear)-dia correlated directly with LV contractile state (as assessed
as maximum dP/dt, r = .60, P < .0001) and inversely with end-systolic
volume (r = -.87, P < .0001) but was unrelated to stroke volume (r =
.08, P = .30) or LV afterload (estimated as effective arterial elastance, r
= .08, P = .29). Mmid-dia did not change during any intervention.
CONCLUSIONS: In conscious human transplant patients, (1) pressure and
volume loading do not affect systolic LV twist; (2) dobutamine augments
systolic twist and early diastolic untwisting, suggesting more end-systolic
potential energy storage and early diastolic elastic recoil with enhanced
inotropic state; (3) volume loading decreases early diastolic untwisting,
possibly reflecting diminished recoil forces after preload augmentation
associated with larger end-systolic volumes (ESV); and (4) M(ear)-dia
correlates strongly with ESV (in an inverse fashion), and less strongly,
but directly, with LV dP/dtmax.
ARTICLES
Alterations in left ventricular twist mechanics with inotropic stimulation and volume loading in human subjects
Department of Cardiovascular and Thoracic Surgery, Stanford University School of Medicine, Calif. 94305.
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