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The effect of hemodilution on regional myocardial function in the presence of coronary stenosis

Isovolumische Hämodilution bei eingeschränkter Koronarreserve: Wirkung auf die globale und regionale Myokardfunktion

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Summary

Hemodilution decreases blood viscosity and circulatory input impedance and thus reduces afterload. Its use in treatment of LV power failure has been advocated, but the safe limits of isovolemic hemodilution are not known. Compensation of the reduced O2-capacity of the blood was therefore studied with normal and impaired coronary reserve.

In 20 dogs the LAD was stenosed to a degree just not affecting the supplied region and central and coronary hemodynamics were studied. Regional myocardial function was assessed by ultrasound transit time between transducers implanted in the LV wall. Lowering the hematocrit to 15% by isovolumic exchange of blood for Dextran 60 increased CVP (18%), PAP (47%), LAP (64%), LVedP (46%), CO (67%), and flow to the intact area (LCA: 211%). Flow in the stenosed LAD increased slightly. Enddiastolic length (EDL) of LAD dependent, muscle segments rose to 120% and their contraction amplitude ΔL was decreased by 46%. Whereas non-ischemic segments showed compensatory rise in ΔL (38%) at almost constant EDL (+9%). After release of the LAD stenosis EDL and ΔL returned to normal.

During progressive anemia myocardial O2-demand is not adequately met if coronary reserve capacity is depleted. Reversion of hypokinesia after removal of the stenosis shows unimpaired myocardial function at a hematocrit as low as 15% provided the coronary circulation is intact.

Zusammenfassung

Während Hämodilution nimmt die Blutviskosität ab, und die aortale Eingangsimpedanz sinkt. Die klinische Anwendung bei Linksherzversagen with vorgeschlagen, jedoch sind die zu steckenden Grenzen der isovolämischen Hämodilution weitgehend unbekannt. In dieser Arbeit wurde untersucht, inwieweit die reduzierte O2-Transportkapazität des Blutes unter normaler und eingeschränkter Koronarreserve die Funktion des linken Ventrikels beeinflußt.

Im akuten Experiment an 20 Hunden wurde die LAD subkritisch stenosiert und sowohl die Pumpfunktion des linken Ventrikels als auch die Koronarversorgung untersucht. Die regionale Myokardfunktion wurde nach dem Ultraschall-Laufzeitprinzip bestimmt. Dazu wurden piezoelektrische Wandler in die Wand des linken Ventrikels implantiert. Eine schrittweise Senkung des Hämatokrit bis auf 15% erfolgte durch isovolumischen Blutaustausch mit Dextran 60. Als Folge konnte ein Anstieg des CVP (+18%), des PAP (+47%), des LAP (+64%), des LVedP (+46%) und des CO (+67%) verzeichnet werden. Der Blutflu\ in die normal versorgten Myokardbezirke stieg um das dreifache (QLCA: +211%), während in der LAD nur eine geringfügige Flußzunahme registriert wurde. Die enddiastolische Länge EDL in den minderversorgten Myokardbezirken erhöhte sich auf 120%; deren Kontraktionsamplitude ΔL fiel jedoch um 46% ab. Zugleich wurde in den nichtischämischen Myokardarealen ein kompensatorischer Anstieg der ΔL um +38% bei nur minimal vergrößerter EDL (+9%) deutlich. Nach Entfernung der Stenose kehrten die EDL und ΔL auf ihren Ausgangswert zurück.

Bei zunehmender Anämie kann der Sauerstoffbedarf in Myokardbezirken mit erschöpfter Koronarreserve nicht mehr in ausreichendem Maße gedeckt werden. In diesen Bereichen entstehl eine ischämische Dysfunktion. Die Gesamtventrikelfunktion kann jedoch durch kompensatorische Hyperkinesie des Restventrikels erhalten bleiben. Selbst bei einem Hämatokrit von 15% ist die Hypokinesie nach Eröffnung der Stenose in den bisland ischämischen Arealen reversibel.

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Author notes

  1. S. Hagl

    Present address: Deutsches Herzzentrum München, Lothstraße 11, 8000, München 2, Germany

Authors and Affiliations

  1. Deutsches Herzzentrum München, Lothstraße 11, 8000, München 2, Germany

    W. Heimisch, H. Meisner, R. Erben, M. Baum, N. Mendler, W. Eisel-Eiselsberg, D. Helms & Ch. Schülgen

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With 11 figures and 1 table

Mit Unterstützung des Sonderforschungsbereichs 37.

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Hagl, S., Heimisch, W., Meisner, H. et al. The effect of hemodilution on regional myocardial function in the presence of coronary stenosis. Basic Res Cardiol 72, 344–364 (1977). https://doi.org/10.1007/BF02023594

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