Abstract
Background: In a recent executive summary, the National Heart Lung and Blood Institute concluded that right heart failure is distinctly different from left heart failure and remains an understudied but important component of cardiovascular collapse. Right heart failure from both acute and chronically elevated right ventricular afterload has been well studied. However, the effect of acute volume overload to the untrained right ventricle is still not well understood. We hypothesized that increasing acute volume overload of the right ventricle affects ventricular functional recovery after ischemia reperfusion (I/R) injury. Methods: Sprague-Dawley rats (weight 250-300 g) were used with a modified Langedorff isolated heart perfusion model with the latex balloon in the right ventricle. The isolated rat hearts were perfused for fifteen minutes after which the hearts were subjected to 25 minutes of global ischemia at 37 degrees C. The hearts were divided into two groups (N = 8 per group). The first group had a physiologic right ventricular balloon pressure (EDP) of 5 mmHg. The second group had a pathologic EDP of 40 mmHg. Function was continuously recorded throughout the experiments. Recovery of right ventricular developed pressure (RVDP), +dP/dt and -dP/dt were assessed. Data are represented as means +/− SEM and differences were considered significant if P < 0.001 (two way ANOVA). Results: Recovery of RVDP, +dP/dt and -dP/dt was significantly higher in the group with lower EDP as compared to the group with 40 mmHg EDP. RVDP: 79.53 +/− 6.34 versus 54.28 +/− 10.76 mmHg; +dP/dt: 76.54 +/− 8.79 versus 38.75 +/− 19.74 mmHg; -dP/dt: 72.29 +/− 7.02 versus 30.54 +/− 12.44 mmHg. Conclusions: Ischemia reperfusion injury produces right ventricular myocardial functional depression that is compounded by preload. The degree of functional depression is greater when the right heart is exposed to higher volume overload. This study is a step forward in elucidating the mechanism and severity of the failing right ventricle that sustains an ischemic insult.
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