1. Hypothermia elongates the contraction-relaxation cycle in explanted human failing heart decreasing the time for ventricular filling during diastole
- Author
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Christen P. Dahl, Kurt A. Krobert, Marie-Victoire Cosson, Finn Olav Levy, Arnt E. Fiane, Geir Øystein Andersen, and Halvard Gautefall Hiis
- Subjects
Adult ,Cardiomyopathy, Dilated ,Male ,Inotrope ,medicine.medical_specialty ,Time Factors ,Contraction (grammar) ,Adolescent ,Systole ,Physiology ,medicine.medical_treatment ,Diastole ,In Vitro Techniques ,030204 cardiovascular system & hematology ,Targeted temperature management ,Ventricular Function, Left ,Contractility ,03 medical and health sciences ,0302 clinical medicine ,Heart Rate ,Hypothermia, Induced ,Physiology (medical) ,Internal medicine ,Humans ,Medicine ,Heart Failure ,business.industry ,Cardiac Pacing, Artificial ,Isoproterenol ,030208 emergency & critical care medicine ,Adrenergic beta-Agonists ,Middle Aged ,Hypothermia ,Myocardial Contraction ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Ventricular filling ,Relaxation cycle - Abstract
Targeted temperature management is part of the standardized treatment for patients in cardiac arrest. Hypothermia decreases cerebral oxygen consumption and induces bradycardia; thus, increasing the heart rate may be considered to maintain cardiac output. We hypothesized that increasing heart rate during hypothermia would impair diastolic function. Human left ventricular trabeculae obtained from explanted hearts of patients with terminal heart failure were stimulated at 0.5 Hz, and contraction-relaxation cycles were recorded. Maximal developed force (Fmax), maximal rate of development of force [(dF/d t)max], time to peak force (TPF), time to 80% relaxation (TR80), and relaxation time (RT = TR80 − TPF) were measured at 37, 33, 31, and 29°C. At these temperatures, stimulation frequency was increased from 0.5 to 1.0 and to 1.5 Hz. At 1.5 Hz, concentration-response curves for the β-adrenergic receptor (β-AR) agonist isoproterenol were performed. Fmax, TPF, and RT increased when temperature was lowered, whereas (dF/d t)max decreased. At all temperatures, increasing stimulation frequency increased Fmax and (dF/d t)max, whereas TPF and RT decreased. At 31 and 29°C, resting tension increased at 1.5 Hz, which was ameliorated by β-AR stimulation. At all temperatures, maximal β-AR stimulation increased Fmax, (dF/d t)max, and maximal systolic force, whereas resting tension decreased progressively with lowering temperature. β-AR stimulation reduced TPF and RT to the same extent at all temperatures, despite the more elongated contraction-relaxation cycle at lower temperatures. Diastolic dysfunction during hypothermia results from an elongation of the contraction-relaxation cycle, which decreases the time for ventricular filling. Hypothermic bradycardia protects the heart from diastolic dysfunction and increasing the heart rate during hypothermia should be avoided. NEW & NOTEWORTHY Decreasing temperature increases the duration of the contraction-relaxation cycle in the human ventricular myocardium, significantly reducing the time for ventricular filling during diastole. During hypothermia, increasing heart rate further reduces the time for ventricular filling and in some situations increases resting tension further impairing diastolic function. Modest β-adrenergic receptor stimulation can ameliorate these potentially detrimental changes during diastole while improving contractile force generation during targeted temperature management.
- Published
- 2018
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