Acute Right Ventricular Dilatation in Response to Ischemia Significantly Impairs Left Ventricular Systolic Performance

• DOI: 10.1161/01.cir.100.7.761
• Publication Date: 2012-06-12T00:42:29Z
• Authors: Carl Brookes; Hanne Ravn; Paul White; Ulla Moeldrup; Paul Oldershaw; Andrew Redington
• Keywords: Male; Cardiotonic Agents; Swine; Systole; Heart Ventricles; Myocardial Ischemia; Reproducibility of Results; Pilot Projects; Myocardial Contraction; Ventricular Dysfunction, Left; 03 medical and health sciences; 0302 clinical medicine; Dobutamine; Pericardiectomy; Animals; Female; Cardiac Output; Pericardium; Echocardiography, Transesophageal; Dilatation, Pathologic

Background —Right ventricular (RV) dilatation that occurs as a consequence of RV infarction is thought to produce hemodynamic instability by reducing left ventricular (LV) preload and compliance. We hypothesized that these geometric changes may also adversely affect LV systolic performance.

Methods and Results —Twelve 40-kg pigs were studied. Integrated conductance catheters and micromanometers were placed in both the LV and RV to allow simultaneous recordings of pressure and volume and derivation of indices of contractile function. RV ischemia was induced by balloon occlusion of the proximal right coronary artery (RCA) under 3 conditions: 1) with the pericardium intact, 2) with the pericardium intact and inotropic support, and 3) with the pericardium wide open. With an intact pericardium, RCA occlusion produced a decrease in LV end-diastolic volume associated with a marked decline in the contractile function. With the pericardium open, the same ischemic insult resulted in both LV and RV dilatation, which produced a significantly smaller negative effect on cardiac output ( P =0.03), LV systolic pressure ( P =0.02), LV preload-recruitable stroke work ( P <0.01), and LV end-systolic pressure-volume relations ( P <0.01). Similarly, administration of dobutamine during RCA occlusion decreased the ventricular volume changes and produced a relative improvement in LV contractile performance.

Conclusions —The hemodynamic compromise seen in association with acute RV dilatation within an intact pericardium is partly attributable to impaired LV systolic performance and cannot be wholly ascribed to changes in LV preload or compliance.