Dynamic cardiac compression improves contractile efficiency of the heart Osamu Kawaguchi, MDa, Yoichi Goto, MDb, Yuichi Ohgoshi, MDb, Hitoshi Yaku, MDb,

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Date of download: 9/16/2016 Copyright © The American College of Cardiology. All rights reserved. From: Oxygen-Saving Effect of a New Cardiotonic Agent,

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Dynamic cardiac compression improves contractile efficiency of the heart Osamu Kawaguchi, MDa, Yoichi Goto, MDb, Yuichi Ohgoshi, MDb, Hitoshi Yaku, MDb, Mitsuya Murase, MDa, Hiroyuki Suga, MDc The Journal of Thoracic and Cardiovascular Surgery Volume 113, Issue 5, Pages 923-931 (May 1997) DOI: 10.1016/S0022-5223(97)70266-6 Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 1 A, Schematic illustration of ventricular P-V loop, systolic PVA, external mechanical work (EW), and end-systolic potential energy (PE). ESPVR, End-systolic P-V relation; EDPVR, end-diastolic P-V relation. B, The relation between Vo2 and total mechanical energy (PVA). Vo2 above the Vo2-axis intercept represents excess Vo2 used for mechanical contraction, whereas Vo2 below the Vo2-axis intercept represents nonmechanical energy expenditure for excitation-contraction (EC) coupling and basal metabolism. The slope of the Vo2-PVA relationship indicates the oxygen cost of PVA and its reciprocal is called contractile efficiency. C, The relation between excess Vo2 and PVA and a family of isoefficiency lines. The excess Vo2 is equal to the total Vo2 minus unloaded Vo2 or Vo2-axis intercept. The isoefficiency is a constant efficiency from the excess Vo2 to PVA. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 923-931DOI: (10.1016/S0022-5223(97)70266-6) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 1 A, Schematic illustration of ventricular P-V loop, systolic PVA, external mechanical work (EW), and end-systolic potential energy (PE). ESPVR, End-systolic P-V relation; EDPVR, end-diastolic P-V relation. B, The relation between Vo2 and total mechanical energy (PVA). Vo2 above the Vo2-axis intercept represents excess Vo2 used for mechanical contraction, whereas Vo2 below the Vo2-axis intercept represents nonmechanical energy expenditure for excitation-contraction (EC) coupling and basal metabolism. The slope of the Vo2-PVA relationship indicates the oxygen cost of PVA and its reciprocal is called contractile efficiency. C, The relation between excess Vo2 and PVA and a family of isoefficiency lines. The excess Vo2 is equal to the total Vo2 minus unloaded Vo2 or Vo2-axis intercept. The isoefficiency is a constant efficiency from the excess Vo2 to PVA. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 923-931DOI: (10.1016/S0022-5223(97)70266-6) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 1 A, Schematic illustration of ventricular P-V loop, systolic PVA, external mechanical work (EW), and end-systolic potential energy (PE). ESPVR, End-systolic P-V relation; EDPVR, end-diastolic P-V relation. B, The relation between Vo2 and total mechanical energy (PVA). Vo2 above the Vo2-axis intercept represents excess Vo2 used for mechanical contraction, whereas Vo2 below the Vo2-axis intercept represents nonmechanical energy expenditure for excitation-contraction (EC) coupling and basal metabolism. The slope of the Vo2-PVA relationship indicates the oxygen cost of PVA and its reciprocal is called contractile efficiency. C, The relation between excess Vo2 and PVA and a family of isoefficiency lines. The excess Vo2 is equal to the total Vo2 minus unloaded Vo2 or Vo2-axis intercept. The isoefficiency is a constant efficiency from the excess Vo2 to PVA. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 923-931DOI: (10.1016/S0022-5223(97)70266-6) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 2 Schematic diagram of the excised, cross-circulated heart preparation. Ao, Aorta; AVo2 , arteriovenous oxygen content difference analyzer; DC pressure, dynamic compression pressure; PA, pulmonary artery; RA, right atrium. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 923-931DOI: (10.1016/S0022-5223(97)70266-6) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 3 Representative tracing of P-V loops in the control and DCC runs. LVP, LV pressure; LVV, LV volume; DCP, dynamic compression pressure; ECG, electrocardiogram. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 923-931DOI: (10.1016/S0022-5223(97)70266-6) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 3 Representative tracing of P-V loops in the control and DCC runs. LVP, LV pressure; LVV, LV volume; DCP, dynamic compression pressure; ECG, electrocardiogram. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 923-931DOI: (10.1016/S0022-5223(97)70266-6) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 4 Representative Vo2-PVA relationship in the control, DCC, and DCP-subtracted conditions. A, Control Vo2-PVA relationship. B, DCC Vo2-PVA relationship. C, DCP-subtracted Vo2-PVA relationship. D, Control Vo2-PVA relationship versus DCC Vo2-PVA relationship. E, DCC Vo2-PVA relationship versus DCP-subtracted Vo2-PVA relationship. F, Control Vo2-PVA relationship versus DCP-subtracted Vo2-PVA relationship. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 923-931DOI: (10.1016/S0022-5223(97)70266-6) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 4 Representative Vo2-PVA relationship in the control, DCC, and DCP-subtracted conditions. A, Control Vo2-PVA relationship. B, DCC Vo2-PVA relationship. C, DCP-subtracted Vo2-PVA relationship. D, Control Vo2-PVA relationship versus DCC Vo2-PVA relationship. E, DCC Vo2-PVA relationship versus DCP-subtracted Vo2-PVA relationship. F, Control Vo2-PVA relationship versus DCP-subtracted Vo2-PVA relationship. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 923-931DOI: (10.1016/S0022-5223(97)70266-6) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 4 Representative Vo2-PVA relationship in the control, DCC, and DCP-subtracted conditions. A, Control Vo2-PVA relationship. B, DCC Vo2-PVA relationship. C, DCP-subtracted Vo2-PVA relationship. D, Control Vo2-PVA relationship versus DCC Vo2-PVA relationship. E, DCC Vo2-PVA relationship versus DCP-subtracted Vo2-PVA relationship. F, Control Vo2-PVA relationship versus DCP-subtracted Vo2-PVA relationship. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 923-931DOI: (10.1016/S0022-5223(97)70266-6) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 4 Representative Vo2-PVA relationship in the control, DCC, and DCP-subtracted conditions. A, Control Vo2-PVA relationship. B, DCC Vo2-PVA relationship. C, DCP-subtracted Vo2-PVA relationship. D, Control Vo2-PVA relationship versus DCC Vo2-PVA relationship. E, DCC Vo2-PVA relationship versus DCP-subtracted Vo2-PVA relationship. F, Control Vo2-PVA relationship versus DCP-subtracted Vo2-PVA relationship. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 923-931DOI: (10.1016/S0022-5223(97)70266-6) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 4 Representative Vo2-PVA relationship in the control, DCC, and DCP-subtracted conditions. A, Control Vo2-PVA relationship. B, DCC Vo2-PVA relationship. C, DCP-subtracted Vo2-PVA relationship. D, Control Vo2-PVA relationship versus DCC Vo2-PVA relationship. E, DCC Vo2-PVA relationship versus DCP-subtracted Vo2-PVA relationship. F, Control Vo2-PVA relationship versus DCP-subtracted Vo2-PVA relationship. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 923-931DOI: (10.1016/S0022-5223(97)70266-6) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 4 Representative Vo2-PVA relationship in the control, DCC, and DCP-subtracted conditions. A, Control Vo2-PVA relationship. B, DCC Vo2-PVA relationship. C, DCP-subtracted Vo2-PVA relationship. D, Control Vo2-PVA relationship versus DCC Vo2-PVA relationship. E, DCC Vo2-PVA relationship versus DCP-subtracted Vo2-PVA relationship. F, Control Vo2-PVA relationship versus DCP-subtracted Vo2-PVA relationship. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 923-931DOI: (10.1016/S0022-5223(97)70266-6) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 5 Schematic diagram of P-V relationship and Vo2-PVA relationship during DCC. A and B, P-V loop with increased Emax. P-V loop shifts to the left with increases in Emax during DCC. Loops I and II represent the P-V loops of the control and DCC conditions, respectively. The dotted areas represent the PVA of the native heart. C and D, P-V loop with a leftward, parallel shift of the end-systolic P-V relationship. Loop I represents the P-V loop of the control. Loop III represents the P-V loop of the native heart during DCC. The areas including both the dashed and dotted areas in panels B and D represent the PVA of overall heart during DCC. E, Schematic diagram of Vo2-PVA relationship during DCC. With decreases in PVA of the native heart in DCC, Vo2 decreased to move the Vo2-PVA data point from A to B along the native Vo2-PVA relationship. X and Y indicate the expected Vo2-overall PVA data plot under enhanced or leftward shift of the end-systolic P-V relationship, respectively. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 923-931DOI: (10.1016/S0022-5223(97)70266-6) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 5 Schematic diagram of P-V relationship and Vo2-PVA relationship during DCC. A and B, P-V loop with increased Emax. P-V loop shifts to the left with increases in Emax during DCC. Loops I and II represent the P-V loops of the control and DCC conditions, respectively. The dotted areas represent the PVA of the native heart. C and D, P-V loop with a leftward, parallel shift of the end-systolic P-V relationship. Loop I represents the P-V loop of the control. Loop III represents the P-V loop of the native heart during DCC. The areas including both the dashed and dotted areas in panels B and D represent the PVA of overall heart during DCC. E, Schematic diagram of Vo2-PVA relationship during DCC. With decreases in PVA of the native heart in DCC, Vo2 decreased to move the Vo2-PVA data point from A to B along the native Vo2-PVA relationship. X and Y indicate the expected Vo2-overall PVA data plot under enhanced or leftward shift of the end-systolic P-V relationship, respectively. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 923-931DOI: (10.1016/S0022-5223(97)70266-6) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 5 Schematic diagram of P-V relationship and Vo2-PVA relationship during DCC. A and B, P-V loop with increased Emax. P-V loop shifts to the left with increases in Emax during DCC. Loops I and II represent the P-V loops of the control and DCC conditions, respectively. The dotted areas represent the PVA of the native heart. C and D, P-V loop with a leftward, parallel shift of the end-systolic P-V relationship. Loop I represents the P-V loop of the control. Loop III represents the P-V loop of the native heart during DCC. The areas including both the dashed and dotted areas in panels B and D represent the PVA of overall heart during DCC. E, Schematic diagram of Vo2-PVA relationship during DCC. With decreases in PVA of the native heart in DCC, Vo2 decreased to move the Vo2-PVA data point from A to B along the native Vo2-PVA relationship. X and Y indicate the expected Vo2-overall PVA data plot under enhanced or leftward shift of the end-systolic P-V relationship, respectively. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 923-931DOI: (10.1016/S0022-5223(97)70266-6) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 5 Schematic diagram of P-V relationship and Vo2-PVA relationship during DCC. A and B, P-V loop with increased Emax. P-V loop shifts to the left with increases in Emax during DCC. Loops I and II represent the P-V loops of the control and DCC conditions, respectively. The dotted areas represent the PVA of the native heart. C and D, P-V loop with a leftward, parallel shift of the end-systolic P-V relationship. Loop I represents the P-V loop of the control. Loop III represents the P-V loop of the native heart during DCC. The areas including both the dashed and dotted areas in panels B and D represent the PVA of overall heart during DCC. E, Schematic diagram of Vo2-PVA relationship during DCC. With decreases in PVA of the native heart in DCC, Vo2 decreased to move the Vo2-PVA data point from A to B along the native Vo2-PVA relationship. X and Y indicate the expected Vo2-overall PVA data plot under enhanced or leftward shift of the end-systolic P-V relationship, respectively. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 923-931DOI: (10.1016/S0022-5223(97)70266-6) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 5 Schematic diagram of P-V relationship and Vo2-PVA relationship during DCC. A and B, P-V loop with increased Emax. P-V loop shifts to the left with increases in Emax during DCC. Loops I and II represent the P-V loops of the control and DCC conditions, respectively. The dotted areas represent the PVA of the native heart. C and D, P-V loop with a leftward, parallel shift of the end-systolic P-V relationship. Loop I represents the P-V loop of the control. Loop III represents the P-V loop of the native heart during DCC. The areas including both the dashed and dotted areas in panels B and D represent the PVA of overall heart during DCC. E, Schematic diagram of Vo2-PVA relationship during DCC. With decreases in PVA of the native heart in DCC, Vo2 decreased to move the Vo2-PVA data point from A to B along the native Vo2-PVA relationship. X and Y indicate the expected Vo2-overall PVA data plot under enhanced or leftward shift of the end-systolic P-V relationship, respectively. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 923-931DOI: (10.1016/S0022-5223(97)70266-6) Copyright © 1997 Mosby, Inc. Terms and Conditions