Dyssynchrony of segment shortening in the anterior wall of the feline left ventricle

Non-uniformity of regional contraction may be both spatial and temporal. This study was undertaken to deal with the temporal aspects of shortening and to quantify non-uniformity with regard to timing. Nine cats were anaesthetized and artificially ventilated. Two pairs of ultrasonic crystals were situated in the anterior midwall of the left ventricle to measure regional shortening. One pair, longitudinal segment, was oriented to align with midwall fibres. The other pair, transverse segment, was placed perpendicular to the first one. Registrations in control state, during caval occlusion, and during aortic constriction were carried out with and without isoprenaline infusion. Cyclic events were analysed in terms of phase angle, 0–2π representing one heart cycle. Transverse segments showed marked shift of duration of shortening, from 1.19π± 0.06π (meanæM) in the control state to 0.40π± 0.14π during caval occlusion with isoprenaline infusion. Duration of shortening of longitudinal segments showed less prominent shift with mean values between 1.38π and 1.11π. Regional uniformity of timing, expressed as synchronization index, varied markedly with interventions (P < 0.0005). Dyssynchrony was most prominent during caval occlusion with mean values less than 0.6. A simple model of force generation for the two segments visualizes that segment shortening of the transverse segment is of shorter duration than the longitudinal segment and a common mechanism for temporal and spatial non-uniformity within a region could be elaborated. This study quantifies both the time course of shortening and temporal non-uniformity of two cross-oriented segments within the same myocardial region.     

Non-uniformity of two-dimensional myocardial deformation in response to chronotropic and inotropic stimulation in cats

The degree of uniformity of myocardial deformation for cross-oriented segments in the anterior wall of the left ventricle is influenced both by loading conditions and by infusion of isoprenaline. The aim of this study was to clarify the chronotropic influence (atrial pacing) compared to the combined inotropic and chronotropic effects of isoprenaline on uniformity of contraction. In eight open-chest pentobarbitone-anaesthetized cats segment performance was measured by orthogonal sonomicrometry. Heart rate (HR) increased from control state, 199 ± 5 (mean ± SEM) beats min^-1, to 224 ± 6 and 227 ± 7 beats min^-1 during atrial pacing and isoprenaline infusion, respectively (P < 0.0005). Circumferential segment shortening remained unchanged during pacing but increased with isoprenaline (P < 0.0005). Longitudinal segments showed reduced shortening during pacing (P < 0.05), whereas shortening during isoprenaline infusion did not differ from control shortening. The ratio between shortening of longitudinal and circumferential segments, long/circ ratio, changed from 0.52 ± 0.13 in the control state to 0.36 ± 0.10 during pacing and 0.39 ± 0.11 with isoprenaline (P < 0.05). End-systolic pressure-length relations were unchanged by atrial pacing but showed leftward shifts during isoprenaline infusion. Myocardial tissue blood flow (microspheres) was unchanged during interventions. We conclude that both atrial pacing and isoprenaline infusion lead to a more non-uniform deformation in the anterior wall. However, non-uniformity during atrial pacing was primarily related to reduced longitudinal shortening whereas the non-uniformity during isoprenaline infusion was due to increased circumferential shortening.     

Decreased regional contractility in nonischemic myocardium during acute coronary artery occlusion in conscious pigs

The purpose of this study was to use the relationship between end-systolic left ventricular pressure and segment length to assess the inotropic state of nonischemic myocardium during acute coronary artery occlusion in the conscious pig. Eight pigs were chronically instrumented with sonomicrometers to measure midwall segmental shortening and a micromanometer to measure left ventricular pressure. Occlusion of the inferior vena cava with a pneumatic occlusive cuff caused transient decreases in left ventricular pressure so that the relationship of left ventricular pressure and segment length at end systole could be determined over a range of pressures. In preliminary studies using open-chest pigs, this relation was shown to be highly linear and best quantified using a calculated segment length at a left ventricular pressure of 100 mm Hg (ESL100). During acute, 1-min occlusion of the left anterior descending coronary artery, the ESL100 of the nonischemic lateral and posterior walls was significantly increased from 8.75 +/- .18 mm to 9.64 +/- .21 mm (mean +/- SD, p less than .01), indicating a decreased inotropic state. Similarly, during occlusion of the left circumflex coronary artery, the ESL100 of the nonischemic anterior wall increased from 8.44 +/- 2.53 mm to 9.26 +/- 3.12 mm (p less than .05). This was not associated with a change in the amount of shortening during systole. Pharmacological autonomic blockade using atropine and propranolol failed to alter the response of nonischemic zones to acute coronary artery occlusion.(ABSTRACT TRUNCATED AT 250 WORDS)     

Capsaicin-sensitive stretch responses in ferret trachealis muscle.

1. Stretch-induced electrical and mechanical responses in segments of ferret trachealis muscle were studied. Stretches and post-stretch length changes were quantified by measuring distances between two marker spheres placed on the muscle surface. Electrical responses were determined by measuring membrane potential in the muscle cell syncytium. 2. Smooth muscle mechanical and electrical responses to the stretch manoeuvre were characterized by an initial shortening and depolarization phase and a reversal-repolarization phase. Both phases were resistant to atropine and tetrodotoxin. During the initial phase, the membrane depolarized to potentials as low as -20 mV. For stretches to 1.0 Lmax, from a holding length of 0.75 Lmax, 50% repolarization occurred at 6.8 +/- 0.4 min post-stretch; 50% reversal of shortening of the stretched segment occurred at 6.9 +/- 0.8 min post-stretch. 3. Depolarizing currents generated within muscle cells in the stretched segment spread into cells in non-stretched muscle. Space constants in the transverse and longitudinal directions averaged 480 +/- 46 and 146 +/- 50 microns, respectively. 4. During infusion of capsaicin (10 microM), muscle cells depolarized by 5.5 +/- 2.3 mV. Maximal depolarization was achieved after 15-20 min. After inhibition of neutral enkephalinase, capsaicin-evoked depolarization occurred more rapidly. Muscles depolarized by 11.2 +/- 2.1 mV after about 10 min of capsaicin and then slowly repolarized during continued treatment. When muscle segments were stretched during administration of capsaicin, the initial phase was similar to that observed before capsaicin, but the reversal-repolarization phase was prolonged. Following wash exposure to capsaicin, maximal stretch-induced depolarization was unchanged, but the time for 50% repolarization (t50-repolarization) decreased from the pre-capsaicin value of 8.4 +/- 1.3 to 4.1 +/- 0.5 min. The t50-reversal of stretch-evoked muscle shortening decreased to 54% of control values. 5. Short exposures (< 2 min) to substance P (SP, 1-7.5 microM) depolarized smooth muscle cells. Maximal depolarization was delayed, and occurred after [SP] had decreased to < 10 nM. Repolarization was delayed as long as 6 min following wash-out of SP. Stretches performed when SP-induced depolarization had nearly reversed showed no changes in the initial mechanical or electrical responses, but t50-repolarization increased to 162% of control values. 6. Immunochemical studies showed networks of neurones which react with SP antibodies. 7. These findings suggest that stretch induces SP release from capsaicin-sensitive C fibres, and that released SP affects smooth muscle ionic mechanisms which control and delay the reversal of stretch-induced membrane depolarization and shortening.     

Development of esophageal epithelium in the fetal and neonatal mouse

Development of the fetal mouse esophageal epithelium was followed using light microscopy, transmission electron microscopy (TEM), scanning electron microscopy (SEM) and radioautography. At 15 days of gestation in the cervical (C), mediastinal (M), and abdominal (A) segments of the esophagus, the epithelium was two or three cells thick, and only cells located in the basal (germinal) layer incorporated tritiated thymidine. Ciliated cells were sparse in all three segments. At 17 days of gestation, longitudinal mesenchymal ridges became more differentiated in the distal segment. Labeling indices were lower than at preceding stages in each segment. Ciliated cells had increased in number and appeared to be evenly distributed along the whole esophagus. In periodic acid-Schiff (PAS)-stained sections, an increasing proximodistal distribution of glycogen stores was observed, with greatest concentrations found in segment A. At 18 days of gestation, labeling indices were comparable in segments C and M (11.7% +/- 2.9% and 12.8% +/- 1.9%, respectively) but remained higher in segment A (17.9% +/- 2.0%). Ciliated cells were still present. At this stage, transverse circular furrows and ridges started to appear. They increased in number at 4 days after birth and were very closely distributed in the adult. In longitudinal sections, these ridges corresponded to projections of stratum granulosum and of the overlying stratum corneum. After birth, ciliated cells desquamated rapidly but some patches were still present at 4 days. At 8 days, the esophageal epithelium was not yet keratinized.     

Is postsystolic shortening area always a marker of myocardial ischaemia?

Postsystolic shortening area has been shown to be a sensitive marker of myocardial ischaemia in a one-vessel model. We tested whether postsystolic shortening provoked by interaction between ischaemic and nonischaemic regions is reduced in a two-vessel model, one vessel occluded and one subjected to coronary artery stenosis. Regional function in the left ventricular anterior wall was studied by orthogonal sonomicrometry during left coronary underperfusion in 14 pentobarbital-anaesthetized cats with an acute circumflex coronary artery occlusion. Left coronary underperfusion in two discrete steps decreased subendocardial blood flow in the left ventricular anterior wall to on average 60% (P < 0.001) and 20% (P < 0.001) of control value, while subepicardial flow did not change. End-diastolic lengths of longitudinal segments increased markedly even during mild subendocardial underperfusion, whereas end-diastolic lengths of circumferential segments only increased during severe subendocardial underperfusion with concomitant increase of left ventricular end-diastolic pressure. Systolic shortening, pressure-length loop area and shortening velocity of circumferential segments did not change. In contrast, systolic shortening and total pressure-length loop area of longitudinal segments decreased progressively approaching zero values during severe coronary underperfusion. Shortening velocity of longitudinal segments also decreased progressively during experimental protocol whereas postsystolic shortening area did not change. Conclusions: postsystolic shortening area is not a marker of subendocardial ischaemia in a two-vessel model which indicates that postsystolic shortening is primarily a phenomenon related to model of ischaemia. End-diastolic lengthening is predominant in the longitudinal axis of the heart during subendocardial ischaemia.     

Analysis and modeling of the multisegmental coordination of shortening behavior in the medicinal leech. I. Motor output pattern.

1. To understand how a multisegmental animal coordinates motor activity over more than one segment, we studied shortening behavior in the medicinal leech, in which several segments contract longitudinally in response to a moderately strong mechanical stimulus. 2. We first demonstrated that the neuronal activity responsible for shortening behavior occurred in semi-intact and isolated nerve cord preparations, and then characterized the responses of motor neurons in isolated preparations. The motor output during shortening was simultaneous excitation of motor neurons innervating dorsal longitudinal muscle and of motor neurons innervating ventral longitudinal muscle. 3. The stronger the stimulus, the more segments produced the shortening motor output, with the segments nearest the stimulus recruited first. 4. Although the shortening response was produced in several segments near the site of stimulation, it was never produced in the stimulated segment, where the local bending motor output pattern was produced. The motor pattern suggests that shortening, initially considered a very simple behavior, requires the involvement of at least few segmentally iterated interneurons.     

Myocardial infarction in the baboon: regional function and the collateral circulation.

Occlusion of the anterior descending coronary artery was produced in sedated baboons 7-15 days after implantation of a micromanometer and ultrasonic crystals for measurement of regional left ventricular dimensions in ischemic, marginal, and control segments. One minute after coronary occlusion (CO), ischemic segments exhibited a marked systolic bulge with wall thinning, and percent systolic shortening of marginal segments decreased. Over the ensuing weeks, there was a progressive increase of end-diastolic lengths in marginal and ischemic segments, whereas systolic shortening in these segments did not improve significantly. Control segments did not change. In control baboons, the coronary collateral index was 55 +/-25 (SE) compared to 560 +/- 74 in normal dogs. One month after CO, the collateral index was 543 +/- 144 in baboons compared to 6,685 +/- 716 in dogs, regions of normal tissue were seen in the infarct (14.2 +/- 2% of left ventricular mass). Minimal coronary collateral development in the baboon provides a likely explanation for differences from the dog in regional functional responses and in the character of the infarct.     

Effects of endurance training on left ventricular performance: a study in anaesthetized rabbits

Endurance training is known to increase ventricular performance during exercise and to decrease resting heart rate. The aim of this study was to evaluate a model for endurance training in rabbits and to study the effects of endurance training on local myocardial performance in the left ventricle during resting conditions. One group of rabbits underwent a 10-week exercise training programme. The rabbits trained 5 days a week on a treadmill. Training periods increased gradually from 15 min to 1 h with increments in speed from 0.5 to 1.2 km h¹. After the training programme the rabbits were anaesthetized and studied as acute open-chest preparations. A micro-tip pressure transducer was introduced via apex to the left ventricle and two pairs of ultrasonic crystals were implanted in the left anterior wall to measure segment lengths. One pair measured shortening in the circumferential direction whereas the other pair measured shortening in the longitudinal direction. Heart rate was lower in the trained group (n = 5), 172 + 9 beats min“‘ (mean±SEM), compared with 235 ± 19 beats min ’ in the control group (n = 8) (P < 0.02). Stroke volume, measured by radio-nuclidelabelled microspheres, was greater in the trained rabbits compared with controls (P < 0.03). Shortening in both segments was of similar magnitude for the trained and control groups. End-systolic pressure-length relations (ESPLR) obtained by occlusion of the descending aorta (balloon catheter) showed reduced slopes for longitudinal segments in the trained group compared with the control group (P < 0.05). We conclude that this endurance training programme in rabbits can be used to study myocardial effects of endurance training. Furthermore, the less steep slope of ESPLRs for the longitudinal segment in the trained animals might indicate a structural myocardial remodelling and increased contractile reserve that might be recruited during adrenergic stimulation in the trained group.     

Local auxotonic systolic force and work in canine right ventricular free wall

Regional auxotonic force (F) and segment length (SL) were measured in the right ventricular (RV) free wall of 10 anesthetized dogs. F was obtained with a Feigl force gauge and SL with ultrasonic crystals positioned in the inflow or outflow region and in the longitudinal or transverse direction. Although the time courses of right ventricular pressure and force were almost identical, the timing of right ventricular ejection had little relationship to specific parts of the force-segment-length loop. Thus local F vs. SL loops were of irregular form signifying local lengthening or shortening in isovolumic periods. Local work, i.e., F vs. SL loop area, increased linearly with cardiac output (CO), which was varied by volume expansion or reduction. A predominant contribution to total RV work from any particular region and direction was not observed. A "local contribution factor" [eta, defined as (local work/local area)/(total RV work/free wall area)] fell with increased CO from 2.1 +/- 0.5 at 1.1 l/min to 0.7 +/- 0.2 at 4.8 l/min. This observation suggests that transformation of local into total work became more efficient at higher CO or that structures other than the free wall became increasingly important for RV pump function at higher output levels.     

Segment stroke work and metabolism depend on coronary blood flow in the pig

We determined the mechanical and metabolic effects of graded myocardial ischemia in 23 open-chest, anesthetized pigs. By connecting the midportion of the left anterior descending artery (LAD) to the carotid artery via a constant volume, calibrated pump, we reduced the flow in the LAD to 0, 25, 50, and 75% of control rates for periods of 1 h. Flows of 100% and 150% were also examined. Using pairs of ultrasonic crystals to measure segment dimensions, we calculated segment shortening and thickening, and total and systolic stroke work in the ischemic and normally perfused segments. Blood gases, pH, and lactate and inosine balances were determined from the regional coronary venous blood. At coronary blood flows of 0, 25, 50, and 75% of normal resting flow, total segment work was 8 +/- 8, 25 +/- 4, 51 +/- 5, and 80 +/- 6% of control, respectively, while systolic segment work was -2 +/- 5, -10 +/- 5, 40 +/- 5, and 86 +/- 7% of control, respectively (means +/- SE). Thus, the decrease in total segment stroke work is proportional to the decrease in flow over the range 0-100%. However, no useful work (i.e., systolic work) is done until flow exceeds 25%. Segment shortening and thickening are significantly depressed with flows diminished by only 25%. Segmental inosine production correlates with lactate production and parallels decreased mechanical performance.     

Regional diastolic mechanics of the left ventricle in the conscious dog.

In eight chronically instrumented conscious dogs, apical and middle left ventricular transverse diameters were measured with pulse-transit ultrasonic dimension transducers. Intracavitary apical and midventricular pressures and intrapleural pressure were measured with micromanometers. Both diameters were normalized as a percent extension from the dimension at zero transmural pressure, determined during a transient vena caval occlusion. During the rapid phase of diastolic filling, there was a 2--5 mmHg pressure gradient from the midventricle to the apex. During late rapid filling, the apical transmural pressure and diameter increased more rapidly and reached diastasis 17 +/- 4 ms earlier than the corresponding midventricular measurements (P less than 0.01). The static diastolic pressure-dimension characteristics at the apical and midventricular levels were not significantly different (P greater than 0.30). The dynamic diastolic pressure-dimension relationship was also similar at the two levels and could be represented by a model incorporating parallel viscous properties. Because of regional differences in pressures and dimensions, however, the dynamic relationship could not be modeled when pressure was compared to the dimension at a different level. Thus, diastolic pressures should be measured at the same level as dimensions when assessing left ventricular diastolic mechanics.     

Regional myocardial function at the papillary muscle insertion site

The importance of the mitral apparatus to the global left ventricular (LV) function has been suggested in several clinical studies. One recent study reported that chordal transsection induced an unloading of myocardium at the papillary muscle insertion site. We hypothesized that the regional response for afterloading at this site with intact mitral apparatus was different from that at the free wall. We investigated the end-systolic pressure-regional segment length relations (ESPLR) in two anterior LV sites, free wall (FREE) and the papillary muscle insertion site (PAP), during an increasing afterload by aortic occlusion in 7 anesthetized open-chest dogs. To measure the regional segment length at FREE and PAP, two sets of the pair of sonomicrometer crystals were implanted in the same midwall depth at the same circumferential hoop by using an echocardiographic guide. ESPLR both at FREE and PAP were always highly linear in a physiological range (r > or = 0.9). The slope of this relation at FREE (274 +/- 164 mmHg/mm) was significantly steeper than that at PAP (157 +/- 118 mmHg/mm) for each dog (p < 0.05). These data indicate that the regional response for afterloading at PAP loaded by chordal tension is different from that at FREE in the same heart.     

Analysis and modeling of the multisegmental coordination of shortening behavior in the medicinal leech. II. Role of identified interneurons.

1. Mechanical stimulation of the leech, Hirudo medicinalis, elicits withdrawal behavior that has two components: local bending in the segment stimulated and shortening in outlying segments. Local bending is characterized by excitation of longitudinal muscle on one side of the segment and inhibition on the other side. In shortening, all longitudinal muscles are excited. We wished to understand how these distinct motor patterns are produced by a nervous system with segmentally iterated neurons, a configuration that places some limitations on the complexity of connection patterns. 2. We searched for neurons in the segmental nervous system that subserved shortening behavior, expecting to find at least one interneuron in each segment that was involved in shortening behavior exclusively. We found instead that all interneurons involved in shortening are also involved in local bending, and no individual interneuron can completely account for shortening. 3. The motor output caused by individual identified interneurons is not entirely consistent with the shortening motor output pattern. For instance, one interneuron, cell 115, has the same pattern of motor effects from segment to segment, causing excitation of dorsal excitatory motor neurons and inhibition of ventral excitatory motor neurons. These effects would cause dorsal local bending, not shortening, in a few segments. Only one interneuron, cell 125, has motor effects that would cause shortening. 4. Individual interneurons were hyperpolarized while single sensory cells were stimulated, to quantify the contributions of individual interneurons to the observed motor pattern. Interneurons 115 and 125, and the inhibitory motor neuron, cell 1, were found to have significant roles in producing the shortening motor output. 5. A quantitative estimate of the role of each interneuron type showed that the identified interneurons account for most of the excitation of dorsal motor neurons, but for very little of the excitation of ventral motor neurons. This predicts that at least one additional interneuron type remains to be identified, one that would provide excitation to ventral motor neurons in several segments. 6. A back-propagation trained neural network model was constructed to predict the connections of the as yet unidentified interneurons. To match the known properties of interneurons, it was necessary to include a segmental similarity constraint in the training algorithm for segmentally iterated model neurons. The modeled networks predicted that there are at least two kinds of interneurons yet to be found. Also, the modeling showed that interneurons can have input and output patterns that differ very little from segment to segment but yet produce major differences in the motor output.     

Effects of hemodynamic alterations on wall motion in the canine right ventricle.

Regional right ventricular (RV) wall motion was analyzed in six closed-chest, anesthetized, paced dogs by measuring distances between chronically implanted radiopaque markers on RV free wall and septum. Normally, contraction started in the sinus region 25 ms before conus region. Highest velocities of shortening occurred in the conus region (2.42 +/- 0.33 lengths/s) and in septum-to-free-wall direction (2.56 +/- 0.40 l/s). Percent shortening for all regions was between 12% and 17%. The data indicate that the RV ejects blood by a uniform reduction in its free wall surface area and septal-to-free-wall distance. Reduced venous return decreased end-diastolic length, percent shortening, maximum velocity of shortening, and time to end-systolic length. RV pressure overload increased end-diastolic length and decreased percent shortening and maximum velocity of shortening. LV pressure overload led to a nonhomogeneous contraction pattern. Percent shortening and maximum velocity of shortening increased in sinal and conal transverse directions and decreased in sinal and conal longitudinal directions; these changes indicate a mechanical interaction between RV and LV.     

Comparison of atriopeptins II and III, VIP and beta 2-adrenoceptor-evoked relaxations of the two layers of smooth muscle in the rat portal vein

The relative importance of vascular relaxations induced by atriopeptins (AP), the beta-adrenoceptor agonist isoprenaline and of the neuropeptide VIP was studied in vitro on circular and longitudinal preparations of the rat portal vein. Two members of the rat atriopeptins (AP II and III) were equipotent with respect to relaxation of the spontaneously contracting outer, longitudinal layer and of the alpha 1-contracted inner, circular layer. The potency for AP II was about 13 times lower in the inner (pD2 = 7.48 +/- 0.73, n = 6) than in the outer layer (pD2 = 8.60 +/- 0.34, n = 6). No significant difference was apparent between the intrinsic activities for AP II in the two layers. The potencies for AP II were for both layers higher than those for VIP while the intrinsic activities for AP II were significantly lower than for VIP and for the reference agonist, isoprenaline in both layers. Atriopeptin II was equally efficient in relaxing the K+-depolarized and alpha 1-contracted longitudinal segments. Neither the beta-antagonist, propranolol nor the guanylate cyclase inhibitor, methylene blue, modified the potency or the intrinsic activity of AP II. These results suggest that concentrations of circulating atriopeptins above 10 nM may contribute to reduction of vascular tone by the methylene blue insensitive receptors for AP II and III in the portal-mesenteric vein region.     

Left ventricular cellular hypertrophy in pressure- and volume-overload valvular heart disease

To determine the dependence of myocyte hypertrophy in chronic valvular heart disease on the site and type of lesion, the myocardium was studied from 11 patients with either pressure-overload hypertrophy (PO; four patients with aortic stenosis and two with mixed aortic stenosis/insufficiency) or pure volume-overload hypertrophy (VO; two patients with mitral regurgitation and three with aortic insufficiency). These patients, all without coronary artery disease, died zero to 34 days after valve replacement surgery. Diameters of 25 longitudinally oriented myocytes in the circular midwall myocardium were measured with a calibrated light microscope eyepiece reticle on each of five transmural, transverse, histologic sections from the apical, anterolateral, posterolateral, anteroseptal, and posteroseptal left ventricle. Statistical analysis by modified two-way analysis of variance (ANOVA) demonstrated that mean myocyte size (based on 125 measurements) varied widely among cases but was not statistically different among sites. The myocyte diameter for PO lesions (25.9 +/- 1.1 micron, mean +/- SEM) was significantly greater (P less than 0.05) than that for pure VO lesions (20.4 +/- 0.7 micron), despite equal relative heart weights (measured/predicted from body weight: 2.5 +/- 0.2 [mean +/- SD] versus 2.5 +/- 0.5). This study suggests that 1) cellular hypertrophy in valvular heart disease occurs uniformly throughout the left ventricular myocardium; and 2) mean myocyte diameters are greater in PO than in VO hypertrophy for equivalent cardiac enlargement.     

Right ventricular distension alters monophasic action potential duration during pulmonary arterial occlusion in anaesthetised lambs: evidence for arrhythmogenic right ventricular mechanoelectrical feedback

Abnormal loading and distension of the right ventricle may induce arrhythmia through the process of mechanoelectrical feedback. Nonetheless, the electrophysiological effects of right ventricular distension are ill-defined and the mechanisms which underpin mechanoelectrical feedback in the right ventricle are unknown. We examined the effects of changes in right ventricular load (complete occlusion of both caval veins or the main pulmonary artery) in 14 anaesthetised lambs, instrumented with right ventricular surface electrodes and strain gauges for recording monophasic action potential and segment length, and an integrated conductance and micromanometer-tipped catheter for measurement of right ventricular pressure and volume. Caval occlusion did not alter right ventricular segment length and monophasic action potential duration. By contrast, pulmonary arterial occlusion increased the segment length and decreased the monophasic action potential duration at 25, 50 and 70% repolarisation by 29 +/- 6, 22 +/- 4 and 17 +/- 3 ms, respectively (all P < 0.01). Of the 42 pulmonary arterial occlusions, 38 were associated with early afterdepolarisations (EADs) which increased progressively in magnitude as the occlusion was maintained until, in 32, overt arrhythmia was observed. By contrast, none of the four occlusions in which EADs were not observed resulted in arrhythmia. As a result, the proportion of occlusions which resulted in arrhythmia were greater in those associated with EADs than in those which were not (P = 0.002). Right ventricular distension alters the pattern of repolarisation, precipitates early afterdepolarisations and results in a variety of ventricular arrhythmia, including ventricular tachycardia.     

Transmural variation in the relationship between myocardial infarct size and risk area

To test the hypothesis that the relationship between infarct area (IA) and area at risk (AR) varies in different layers of the left ventricle (LV), we occluded the circumflex coronary artery for 48 h in 20 conscious dogs. AR was determined by postmortem coronary stereoarteriography, and infarct area by pathological examination. Both AR and IA were divided into four layers: posterior papillary muscle (PPM), subendocardium (Endo), midwall, and subepicardium (Epi) and quantified with planimetry. Hemodynamics and regional myocardial flow with tracer microspheres (7-10 micrometers diam) were measured before and after coronary occlusion. IA was closely correlated with AR for PPM (r = 0.96), Endo (r = 0.97), and Epi (r = 0.92). However, the slope of IA/AR for Endo (1.30 +/- 0.08) was significantly steeper (P less than 0.05) than that for Epi (0.89 +/- 0.11); furthermore, the intercepts at zero infarction for PPM (0.5 +/- 0.1% of LV), Endo (4.2 +/- 0.4%), and Epi (0.1 +/- 0.7%) were significantly different from each other. Regional blood flow measurements indicate that the differences in IA/AR in various layers reflected earlier and greater total collateral flow to the noninfarcted AR in the epicardium. Thus IA/AR for the entire LV is a composite representing separate IA/AR specific to various transmural layers of the LV. In addition, this study demonstrates that the lateral border zone between the IA and the AR is minimal (less than 3-5 mm) in the subendocardium and midwall layers of the left ventricle.