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Division of Research, Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina 28232-2861
Cardiac dysfunction has been documented in
vivo after acute massive pulmonary embolism (AMPE). The present study
tests whether intrinsic ventricular dysfunction occurs in rat hearts
isolated after AMPE. AMPE was induced in spontaneously breathing
ketamine-xylazine-anesthetized rats by thrombus infusion until mean
arterial blood pressure (MAP) was ~40% of basal measurement. A
hypotensive control group underwent controlled blood withdrawal to
produce MAP ~40% of basal levels. Shams underwent identical surgical
and anesthesia preparation but without pulmonary embolization. Hearts
were perfused in isovolumetric mode, and simultaneous right ventricular
(RV) and left ventricular (LV) pressures were measured. AMPE caused
arterial hypotension with hypoxemia (PO2 = 50 ± 14 Torr), acidemia (pH = 7.26 ± 0.11), and high
lactate concentration (6.9 ± 1.7 mM). Starling curves from both
ventricles demonstrated that AMPE significantly reduced ex vivo
systolic contractile function in the RV (P = 0.031) and LV (P = 0.008) compared with both the hypotensive
control and sham hearts. AMPE did not alter coronary flow or compliance
in either ventricle. Soluble tumor necrosis factor-
decreased in the
RV (P = 0.043) and LV (P = 0.005)
tissue. These data support the hypothesis that AMPE produces intrinsic
biventricular dysfunction and suggest that arterial hypotension is not
the principal mechanism of this dysfunction.
pulmonary heart disease; tumor necrosis factor-
; myocardial
contraction; shock; animal model; fibrinolysis
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