The Ventricle: Basic and Clinical Aspects PDF
Preview The Ventricle: Basic and Clinical Aspects
THE VENTRICLE THE VENTRICLE Basic and Clinical Aspects Edited by Herbert]. Levine William H. Gaasch Martinus Nijhoff Publishing a member of the Kluwer Academic Publishers Group BOSTON DOR.DRE.CH T LANCASTER Copyright 1985 @ by Martinus Nijhoff Publishing, Boston Softcover reprint of the hardcover 1st edition 1985 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, mechanical, photocopying, recording, or otherwise, without written permission of the publisher, Martinus Nijhoff Publishing, 190 Old Derby Street, Hingham, Massachusetts 02043. for North America for all other countries Kluwer Academic Publishers Kluwer Academic Publishers Group 190 Old Derby Street Distribution Centre Hingham, MA 02043 P.O. Box 322 3300 AH Dordrecht The Netherlands Library of Congress Cataloging in Publication Data Main entry under title: The Ventricle. Includes index. 1. Heart-Ventricles-Diseases. 2. Heart Ventricles. I. Levine, Herbert J. (Herbert Jerome), 1928- . II. Gaasch, William H. [DNLM: 1. Heart Diseases-physiopathology. 2. Heart Ventricle physiology. 3. Heart Ventricle-physiopathology. 4. Myocardial Contraction-physiopathology. WG 202 V4665] RC682.V46 1985 616.1'2 85-4976 ISBN -13: 978-1-4612-9628-7 e-ISBN -13: 978-1-4613-2599-4 DOl: 10.1007/978-1-4613-2599-4 CONTENTS Contributing Authors Vll Preface Xl 1. Pathologic Anatomy of Acquired 9. Experimental Myocardial Hypertrophy Ventricular Disease 1 185 e. by jeffrey M. Imer and William Roberts by Burt B. Hamrell arid Norman R. Alpert 10. Pathophysiology of Heart Failure 209 2. Mechanics of Ventricular Muscle 41 by john E. Strobeck and Edmund H. Sonnenblick by William W. Parmley 11. Pressure Overload: Human Studies 3. The Biochemistry of Excitation-Contraction 225 Coupling: Implications with Regard to by Blase A. Carabello and William Grossman Pump Failure 63 by Mark L. Entman, W. Barry Van Winkle, and jeanie 12. Chronic Aortic and Mitral Regurgitation: B. McMillin-Wood Mechanical Consequences of the Lesion and the Results of Surgical Correction 4. Ventricular End-Systolic Pressure-Volume 237 Relations 79 by William H. Gaasch, Herbert j. Levine, and Michael by Kiichi Sagawa, Kenji Sunagawa, and W. Lowell R. Zile Maughan 13. The Coronary Circulation in Ventricular 5. Autonomic Reflex Control of Cardiac Hypertrophy 259 Contractility 105 by Loren F. Hiratzka, Charles L. Eastham, Donald B. by Alan M. Fujii and Stephen F. Vatner Doty, Creighton B. Wright, and Melvin L. Marcus 14. Ventricular Function in Ischemia and 6. Ventricular Relaxation 123 Infarction and Following Reperfusion by 'Dirk L. Brutsaert, Frank E. Rademakers, Stanis las U. 271 e. Sys, Thierry Gillebert, and Philippe R. Housmans by HIe. Swan 7. Diastolic Properties of the Left Ventricle 15. Current Status of Interventions Designed 143 to Limit Infarct Size 289 by William H. Gaasch, Carl S. Apstein, and Herbert j. by Peter H. Stone, Robert E. Rude, james E. Muller, and Levine Eugene Braunwald 8. Ventricular Interaction and the Pericardium 16. Vasoactive Drugs and the Failing 171 Ventricle 3 1 5 by john V. Tyberg by Gary S. Francis and jay N. Cohn Index 337 v CONTRIBUTING AUTHORS Norman R. Alpert, Ph.D. Professor of Medicine and Biochemistry Professor of Physiology and Biophysics Baylor College of Medicine University of Vermont College of Medicine Houston, Texas Burlington, Vermont Gary S. Francis, M.D. Carl S. Apstein, M.D. Director, Cardiovascular Research Chief of Cardiology, Boston City Hospital V A Medical Center Professor of Medicine and Director, Muscle Re- Associate Professor of Medicine search Laboratory University of Minnesota Medical School Boston University School of Medicine Minneapolis, Minnesota Boston, Massachusetts Alan M. Fujii, M.D. Assistant in Cardiology, Children's Hospital Eugene Braunwald, M.D. Research Associate, Brigham and Women's Physician-in-Chief Hospital, Boston, and Brigham and Beth Israel Hospitals the New England Regional Primate Research Hersey Professor of Medicine Center, Southboro, MA Harvard Medical School Instructor in Pediatrics Boston, Massachusetts Harvard Medical School Dirk 1. Brutsaert, M.D., Ph.D. Boston, Massachusetts Academic Hospital William H. Gaasch, M.D. Antwerp University Chief of Cardiology Antwerp, Belgium Veterans Administration Medical Center Professor of Medicine Blase A. Carabello, M.D. Tufts University School of Medicine Director, Diagnostic Laboratory Boston, Massachusetts Temple University Health Sciences Center Associate Professor of Medicine T.e. Gillebert, M.D. Temple University School of Medicine Academic Hospital Philadelphia, Pennsylvania Antwerp University Antwerp, Belgium Jay N. Cohn, M.D. Head, Cardiovascular Division William Grossman, M.D. Chief, Cardiovascular Division Professor of Medicine University of Minnesota Medical School Beth Israel Hospital Minneapolis, Minnesota Herman Dana Professor of Medicine Harvard Medical School Donald B. Doty, M.D. Boston, Massachusetts Attending Surgeon Burt B. Hamrell, M.D., Ph.D. Primary Children's Medical Center and LDS Assistant Professor Hospital Department of Physiology and Biophysics Clinical Professor of Surgery University of Vermont College of Medicine University of Utah Medical Center Burlington, Vermont Salt Lake City, Utah Loren F. Hiratzka, M.D. Charles 1. Eastham, B.A. Associate Professor of Surgery Senior Research Assistant Division of Thoracic-Cardiovascular Surgery University of Iowa University of Iowa Iowa City, Iowa Iowa City, Iowa Mark 1. Entman, M.D. Philippe Housmans, M.D. Chief, Section of Cardiovascular Sciences Academic Hospital VII Vlll CONTRIBUTING AUTHORS Antwerp University Clinical Professor of Pathology and Medicine Antwerp, Belgium Georgetown University School of Medicine Washington, D.C. Jeffrey M. Isner, M.D. Associate Director, Cardiac Catheterization Lab- Robert E. Rude, M.D. oratory Director, Medical Intensive Care Unit-Coronary New England Medical Center Hospital Care Unit Associate Professor of Medicine and Pathology Parkland Memorial Hospital Tufts University School of Medicine Assistant Professor of Internal Medicine Boston, Massachusetts University of Texas, Health Science Center Dallas, Texas Herbert J. Levine, M.D. Chief, Cardiology Division Kiichi Sagawa, M.D. New England Medical Center Hospital Professor of Biomedical Engineering Professor of Medicine Johns Hopkins University School of Medicine Tufts University School of Medicine Baltimore, Maryland Boston, Massachusetts Edmund H. Sonnen blick, M.D. Melvin L. Marcus, M.D. Chief, Division of Cardiology Professor of Medicine Director, Cardiovascular Center Department of Internal Medicine and the Car- The Olson Professor of Cardiology diovascular Center Professor of Medicine University of Iowa Albert Einstein College of Medicine Iowa City, Iowa Bronx, New York W. Lowell Maughan, M.D. Peter H. Stone, M.D. Assistant Professor of Medicine Associate Physician Johns Hopkins Medical School Brigham and Women's Hospital Baltimore, Maryland Assistant Professor of Medicine Harvard Medical School Jeanie B. McMillin-Wood, Ph.D. Boston, Massachusetts Associate Professor of Medicine and Biochemistry John E. Strobeck, M.D., Ph.D. Section of Cardiovascular Sciences Assistant Clinical Professor of Medicine Baylor College of Medicine Albert Einstein College of Medicine Houston, Texas Bronx, New York James E. Muller, M.D. Kenji Sunagawa, M.D. Associate Physician Assistant Professor of Medicine Brigham and Women's Hospital Research Institute of Angiocardiology and Assistant Professor of Medicine Cardiovascular Clinic Harvard Medical School Kyushu University Medical School Boston, Massachusetts Fukuoka, Japan William W. Parmley, M.D. HJ.C. Swan, M.D., Ph.D. Chief of Cardiology Director, Division of Cardiology Moffitt Hospital Cedars-Sinai Medical Center Professor of Medicine Professor of Medicine University of California University of California School of Medicine San Francisco, California Los Angeles, California Frank E. Rademakers, M.D. Stanislas Sys, Drs. Sc. Academic Hospital Drs. Sc. Math. RUCA Antwerp University Antwerp University Antwerp, Belgium Antwerp, Belgium William C. Roberts, M.D. John V. Tyberg, M.D., Ph.D. Chief, Pathology Branch Consultant in Cardiology National Heart, Lung and Blood Institute Foothills Provincial Hospital National Institutes of Health Professor of Medicine and Medical Physiology CONTRIBUTING AUTHORS IX Faculty of Medicine The New England Regional Primate Research University of Calgary Center Canada Southboro, Massachusetts W. Barry Van Winkle, Ph.D. Creighton B. Wright, M.D. Associate Professor of Medicine and Professor of Clinical Surgery Biochemistry University of Cincinnati and Cardiac Surgery Section of Cardiovascular Sciences Crist Hospital Baylor College of Medicine Cincinnati, Ohio Houston, Texas Michael R. Zile, M.D. Stephen F. Vatner, M.D. Director, Cardiac Catheterization Laboratory Associate Professor of Medicine Veterans Administration Medical Center Harvard Medical School Assistant Professor of Medicine Brigham and Women's Hospital Tufts University School of Medicine Boston, and Boston, Massachusetts PREFACE Cardiac anatomy had already been a subject of and its control in health and disease has been great interest for centuries when Harvey de published. Studies of hypertrophy, heart failure, scribed the dynamic nature of blood flow, but ischemia, and infarction have been vigorously the concept of defining ventricular function was pursued in experimental animals and in human first introduced with the measurement of a subjects, and as a result new areas for study have mare's blood pressure by Steven Hales in 1733. emerged. These include the process of hypertro Amidst the important contributions of a number phy as an adaptive mechanism, the coronary vas of European physiologists, the primal relation cular reserve in hypertrophy, the role of the ship between the mechanical energy of the heart microvasculature in myocardial failure, active and the length of a myocardial fiber was enun relaxation and other diastolic mechanisms that ciated by E.H. Starling in 1912; this became contribute to the syndrome of congestive heart known as the "law of the heart." Perhaps the failure, ventricular interaction and the role of first major refinement of this law was suggested the normal pericardium, ischemic-stunned by Sarnoff and co-workers, who introduced the reperfused myocardium, and vasoactive drugs in concept of homeometric autoregulation to ex the treatment of heart failure. The Ventricle seeks plain the intrinsic adaptations to myocardial con to take inventory of our current knowledge of traction that were not related to fiber length. these areas. A special effort was made to present While measures of cardiac pump function were information that overlapped studies of the ex being refined and extended to the diseased perimental animal, the normal and diseased heart, the principles of basic muscle mechanics human heart, and when appropriate, the isolated developed by A.V. Hill were applied to cardiac muscle or its constituents. The text will likely be muscle by Abbott and Mommaerts and by Son of greatest value to the physician-investigator nenblick in the 1950s and 1960s. This work who labors at the interface of clinical heart dis provided a framework for interrelating the me ease and its managements and the mechanisms chanics, ultrastructure, and biochemistry of underlying cardiac disorders. heart muscle. Among the challenges encoun The editors are grateful to Sandra Nauseda tered in applying these principles to hypertro for her expert secretarial skills and to Jeffrey phied and diseased hearts was the realization Smith of Martinus Nijhoff Publishing for his that methods were needed to characterize accu role in initiating and sustaining the necessary rately the diastolic properties of the ventricle. As momentum to bring The Ventricle to press. The a result, the decade of the 1970s witnessed a editors particularly wish to thank the contribu renaissance of diastole, and with it emerged a tors to this volume for the tremendous effort clarification of the distinction between conges and meager rewards they have accepted. It is tive failure-a disease of cardiac diastole-and our hope that the ideas and information pre myocardial failure-a defect in systolic perform sented in this text will stimulate others to con ance. sider the current issues and ask new questions During the past two decades a prodigious vol to advance our iInderstanding of ventricular ume of information on left ventricular function function. THE VENTRICLE 1. PATHOLOGIC ANATOMY OF ACQUIRED VENTRICULAR DISEASE Jeffrey M. Isner William C. Roberts The ventricle of the human heart may cease to of nuclear chromatin, and relaxation of myofi function normally due to a variety of disorders. brils) [2]. In contrast, reinstitution of coronary This chapter discusses in detail the pathologic blood flow following total occlusion appears to anatomy associated with these various disorders, accelerate the development of light micro including ischemic heart disease, nonischemic scopic and ultrastructural alterations [2]. The myocardial inflammatory disease ("myocardi loss of a regular myofibrillar pattern and the tis"), and the cardiomyopathies. appearance of contraction bands are the most characteristic histologic changes found in in farcts resulting from temporary coronary occlu Myocardial Ischemia/Infarction sion. Other changes visible by light microscopy include intercellular edema, loss of stainable Myocyte necrosis does not occur simultane glycogen, and the development of an amylase ously with or even immediately following ces fast positive Schiff reaction; the basis for the lat sation of coronary blood flow. Total coronary ter has never been adequately explained. Ex arterial occlusion may be tolerated for periods amination by electron microscopy discloses of up to 18 minutes in an experimental canine accumulation of intracellular fluid manifested model without evidence of permanent injury, in several ways: an increased sarcoplasmic provided arterial reperfusion is reinitiated space, vacuole formation, mitochondrial swell within this time frame [ 1]. Postponing reperfu ing, and the formation of subsarcolemmal blebs sion more than 20 minutes following total oc that "lift" the cell membrane away from the clusion results in occasional small foci of suben myofibrils and compress adjacent capillaries. docardial necrosis, while greater than 40 Reperfusion also increases the size, number, minutes of coronary occlusion predictably re and calcium content of mitochondrial bodies sults in focal or confluent subendocardial ne [ 1]. The morphologic findings observed fol crosis [1]. The specific morphologic alterations lowing reperfusion have been attributed to a that result from such a brief period of coronary defect in cell volume regulation that develops occlusion differ, depending on whether or not as the result of prolonged (> 18 minutes) is flow is reinstituted. No reperfusion produces chemia [3 J. modest intracellular edema, mitochondrial bod As the duration of coronary occlusion is fur ies (amorphous matrix densities, margination ther prolonged, the extent of myocardial necro sis increases proportionately. Whereas 40 min Address for correspondence: Jeffrey M. Isner, M.D., Box 70, Tufts-New England Medical Center, 171 Harrison Ave utes of ischemic injury has been found nue, Boston, Massachusetts 02111. experimentally to result in necrosis of 38+4% of total wall thickness, prolongation of the ische Levine, H j. and Gaasch, W. H. (eds.), The Ventricle: Basic af/d + mic injury to 3 or 6 hours produces 57 7 % and Clinical Aspects. Copyright © 1985 by Martif/lls NljhoJ! Pllblish if/g. All rights resm'ed. 71 + 7 % transmural necrosis, respectively [4].
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