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(Circulation. 1997;96:2348-2352.)
© 1997 American Heart Association, Inc.

Articles

Decrease in Forces Responsible for Diastolic Suction During Acute Coronary Occlusion

Stephen P. Bell, BA; Judit Fabian, BS; Matthew W. Watkins, MD; ; Martin M. LeWinter, MD

From the Cardiology Unit, College of Medicine, University of Vermont, Burlington.

Correspondence to Martin M. LeWinter, MD, Cardiology Unit, Fletcher Allen Health Care, MCHV Campus, 111 Colchester Ave, Burlington, VT 05401. E-mail mlewinte{at}salus.uvm.edu

Background The production of left ventricular (LV) restoring forces generated during contraction, which are responsible for diastolic suction, is dependent on end-systolic volume (ESV) and systolic transmural and 3D deformation. We tested the hypothesis that acute coronary occlusion would result in loss of forces that cause suction.

Methods and Results Ten open-chest dogs were subjected to a 10-minute acute coronary occlusion (proximal left anterior descending coronary artery). A servomotor connected to the left atrium (LA) was used to rapidly clamp LA pressure during systole below the level of the succeeding LV diastolic pressure, resulting in nonfilling diastoles during which the LV fully relaxed at its ESV. LA clamps at multiple ESVs (conductance catheter) allowed delineation of positive and negative portions of the fully relaxed LV pressure-volume relation (FRPVR). A negative fully relaxed pressure (FRP) indicates the presence of restoring forces. After 10 minutes of acute coronary occlusion, there was an upward shift of the FRPVR. Thus, for example, at matched ESVs before and during coronary occlusion, FRP was -1.1±1.1 (±SD) mm Hg before versus 0.2±1.2 mm Hg after 10 minutes of coronary occlusion (P<.05).

Conclusions Acute coronary occlusion results in a rapid decrease in forces responsible for suction. This phenomenon is independent of the level of ESV and may contribute to ischemic diastolic dysfunction.

Key Words: restoring forces • ventricular function • diastolic filling • coronary occlusion

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