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Open Access Research article

Ventricular-arterial uncoupling in heart failure with preserved ejection fraction after myocardial infarction in dogs - invasive versus echocardiographic evaluation

Myrielle Mathieu1*, Bachar El Oumeiri12, Karim Touihri1, Ielham Hadad1, Maryam Mahmoudabady1, Philippe Thoma3, Thierry Metens3, Jozef Bartunek45, Guy R Heyndrickx4, Serge Brimioulle1, Robert Naeije1 and Kathleen Mc Entee1

Author Affiliations

1 Department of Physiology and Pathophysiology, Faculty of Medicine, ULB, Brussels, Belgium

2 Cardio-Thoracic Surgery Department, Mont Godinne Hospital, UCL, Yvoir, Belgium

3 Department of Radiology and Medical Imaging, ULB, Brussels, Belgium

4 Cardiovascular Center, OLV Hospital, Aalst, Belgium

5 Faculty of Biomedical engineering, TU Eindhoven, The Netherlands

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BMC Cardiovascular Disorders 2010, 10:32  doi:10.1186/1471-2261-10-32

Published: 29 June 2010

Abstract

Background

Heart failure with preserved left ventricular ejection fraction and abnormal diastolic function is commonly observed after recovery from an acute myocardial infarction. The aim of this study was to investigate the physiopathology of heart failure with preserved ejection fraction in a model of healed myocardial infarction in dogs.

Methods

Echocardiography, levels of neurohormones and conductance catheter measurements of left ventricular pressure-volume relationships were obtained in 17 beagle dogs 2 months after a coronary artery ligation, and in 6 controls.

Results

Healed myocardial infarction was associated with preserved echocardiographic left ventricular ejection fraction (0.57 ± 0.01, mean ± SEM) and altered Doppler mitral indices of diastolic function. NT-proBNP was increased, aldosterone was decreased, and norepinephrine was unchanged. Invasive measurements showed a markedly decreased end-systolic elastance (2.1 ± 0.2 vs 6.1 ± 0.8, mmHg/ml, p < 0.001) and end-systolic elastance to effective arterial elastance ratio (0.6 ± 0.1 vs 1.4 ± 0.2, p < 0.001), with altered active relaxation (dP/dtmin -1992 ± 71 vs -2821 ± 305, mmHg/s, p < 0.01) but preserved left ventricular capacitance (70 ± 6 vs 61 ± 3, ml at 20 mmHg, p = NS) and stiffness constant. Among echocardiographic variables, the wall motion score index was the most reliable indicator of cardiac contractility while E', E/A and E'/A' were correlated to dP/dtmin.

Conclusions

In the canine model of healed myocardial infarction induced by coronary ligation, heart failure is essentially characterized by an altered contractility with left ventricular-arterial uncoupling despite vascular compensation rather than by abnormal diastolic function