Passive ventricular constraint to improve left ventricular function and mechanics in an ovine model of heart failure secondary to acute myocardial infarction

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Passive ventricular constraint to improve left ventricular function and mechanics in an ovine model of heart failure secondary to acute myocardial infarction James J Pilla, PhD, Aaron S Blom, BA, Daniel J Brockman, BVSc, Victor A Ferrari, MD, Qing Yuan, PhD, Michael A Acker, MD The Journal of Thoracic and Cardiovascular Surgery Volume 126, Issue 5, Pages 1467-1475 (November 2003) DOI: 10.1016/S0022-5223(03)00739-6

Figure 1 Representative short-axis MRI images of heart at level of midventricle. A, Control end-diastole. B, Control end-systole. C, CSD end-diastole. D, CSD end-systole. Control animals (A, B) have greater EDV and ESV, larger areas of thinned myocardium (arrows), and more abnormal geometry than CSD counterparts (C, D). The Journal of Thoracic and Cardiovascular Surgery 2003 126, 1467-1475DOI: (10.1016/S0022-5223(03)00739-6)

Figure 2 Graph depicting EDV changes. EDV was increased significantly in control group between baseline and 2-month time point. EDV was decreased significantly between the control and CSD groups at terminal time point. Dagger indicates P < .05 between baseline and 2-month time points; asterisk indicates P < .05 between control and CSD groups. The Journal of Thoracic and Cardiovascular Surgery 2003 126, 1467-1475DOI: (10.1016/S0022-5223(03)00739-6)

Figure 3 Graph depicting ejection fraction (EF) changes between control and CSD groups at baseline, 1 week after infarct, and 2 months after infarct. In control group there was significant decrease in ejection fraction between baseline and 2 months and 1 week and 2 months. In CSD group there was significant decrease in ejection fraction between baseline and 2-month time points. Finally, ejection fraction was increased significantly between control and CSD groups at terminal time point. Double dagger indicates P < .05 between 1-week and 2-month time points; dagger indicates P < .05 between baseline and 2-month time points; circle indicates P < .05 between baseline and 2-month time points; asterisk indicates P < .05 between control and CSD groups. The Journal of Thoracic and Cardiovascular Surgery 2003 126, 1467-1475DOI: (10.1016/S0022-5223(03)00739-6)

Figure 4 Graph depicting changes in end-systolic elastance (Ees). Elastance was decreased significantly in control group between baseline and 2 months. Elastance was increased significantly between control and CSD groups at 2-month time point. Dagger indicates P < .05 between baseline and 2-month time points; asterisk indicates P < .05 between control and CSD groups. The Journal of Thoracic and Cardiovascular Surgery 2003 126, 1467-1475DOI: (10.1016/S0022-5223(03)00739-6)

Figure 5 MRI-generated composite pressure-volume loops from control (A) and CSD (B) animals. Rightward shift of loops in control group demonstrates increase in EDV and ESV and deterioration in cardiac function between baseline and terminal time points. CSD loops show increase in volumes between baseline and 1 week but stabilization in function (as shown by leftward shift) at terminal time point. The Journal of Thoracic and Cardiovascular Surgery 2003 126, 1467-1475DOI: (10.1016/S0022-5223(03)00739-6)

Figure 6 A, Stroke work (EW), at 2-month time point. B, Potential energy (PE, measure of heat loss from work) at 2-month time point. C, Efficiency (EFF) at 2-month time point. D, Oxygen consumption (VO2) at 2-month time point. Potential energy and oxygen consumption were significantly decreased between control and CSD groups at 2-month time-point. Efficiency was significantly increased between control and CSD groups at 2-month time-point. Asterisk indicates P < .05 between control and CSD groups. The Journal of Thoracic and Cardiovascular Surgery 2003 126, 1467-1475DOI: (10.1016/S0022-5223(03)00739-6)

Figure 7 Forces on cross-section of myocardium depicted without CSD (A) and with CSD (B). Sum of forces without CSD results in internal pressure being opposed solely by stress in myocardium. With CSD placement internal pressure is opposed by stress in myocardium and stress on CSD, thus reducing myocardial wall stress. Assumes an isotropic homogeneous sphere at static equilibrium. The Journal of Thoracic and Cardiovascular Surgery 2003 126, 1467-1475DOI: (10.1016/S0022-5223(03)00739-6)