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Department of Pharmacology, Merck Research Laboratories, West Point, Pennsylvania 19486
A heart failure model was developed using
conscious pigs subjected to serial myocardial infarctions followed by
intermittent rapid ventricular pacing. Aortic and atrial catheters,
left ventricular (LV) pressure gauge, LV dimension crystals, ascending
aortic flow probe, pacing leads, and two coronary artery occluders were
implanted in 15 pigs. The initial distal left circumflex coronary
artery (LCX) occlusion produced a modest infarct, i.e., 18 ± 3% of LV, and the second proximal LCX occlusion, performed
48 h later, enlarged the infarct to 33 ± 2% of the LV with only
modest changes in LV function. Thereafter, the pigs were subjected to
ventricular pacing at 220 beats/min, which was maintained for 7 days
and terminated for 3 days. This pacing cycle was repeated two more
times and resulted in significantly impaired LV function and systemic
hemodynamics. For example, after the second cycle of pacing, LV rate of
pressure change (dP/dt,
41 ± 4% from 2,778 ± 112 mmHg/s), velocity of circumferential
fiber shortening
(Vcf:
53 ± 6% from 1.1 ± 0.1 s
1), and cardiac index
(CI:
42 ± 5% from 122 ± 4 ml · min
1 · kg
1)
were reduced significantly, whereas LV end-diastolic diameter (EDD:
+34 ± 6% from 39 ± 2 mm), total peripheral
resistance (TPR: +75 ± 16% from 0.79 ± 0.05 U), and mean left
atrial pressure (LAP) (+21 ± 1 mmHg from 5 ± 1 mmHg) were
increased significantly. Importantly, 3 wk after cessation of the final
pacing cycle, LV dP/dt (
40 ± 5%), Vcf
(
48 ± 9%), and CI (
30 ± 4%) remained depressed,
whereas LV EDD (+39 ± 5%), TPR (+43 ± 9%), and LAP (+13 ± 4 mmHg) were still increased. In contrast, hemodynamic impairment in
six conscious pigs subjected to pacing only did not persist when pacing
was terminated. Thus this model could provide a unique opportunity to
study both the effects of preclinical therapeutic interventions and the
mechanisms involved in the development of heart failure.
myocardial infarction; rapid ventricular pacing; left ventricular function; systemic hemodynamics
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