Correlation of autologous skeletal myoblast survival with changes in left ventricular remodeling in dilated ischemic heart failure.

OBJECTIVES: The effect of autologous skeletal myoblast transplantation has not been rigorously studied in the setting of end-stage ischemic heart failure free of concomitant coronary revascularization. The aims of the present study were to determine autologous skeletal myoblast survival and its effects on left ventricular function and remodeling in sheep with dilated ischemic heart failure. METHODS: Ischemic heart failure (left ventricular ejection fraction, 30% +/- 2%; left ventricular end-systolic volume index, 82 +/- 9 mL/m2) was created in sheep (n = 11) with serial left circumflex coronary artery microembolizations. Instruments were inserted for the long-term determination of left ventricular global and regional dimensions, hemodynamics, and pressure-volume analysis after autologous skeletal myoblast transplantation (approximately 3.0 x 10(8) myoblasts; heart failure plus autologous skeletal myoblast group, n = 5) or without (heart failure-control group, n = 6). Measurements were performed in conscious animals. RESULTS: Autologous skeletal myoblast-derived skeletal muscle was found in all injected animals at 6 weeks. In ischemic heart failure, autologous skeletal myoblast cardiomyoplasty failed to improve systolic (left ventricular ejection fraction, 29% +/- 4%; dP/dT(max), 2863 +/- 152 mm Hg/s; end-systolic elastance, 1.6 +/- 0.22) or diastolic (left ventricular end-diastolic pressure, 21 +/- 2 mm Hg; time constant of relaxation (Tau), 34 +/- 4 ms; dP/dT(min), -1880 +/- 68 mm Hg/s) function. There was, however, attenuation in the left ventricular dilatation after autologous skeletal myoblast transplantation (change in end-systolic volume index, 14% +/- 4% vs 32% +/- 6%; P < .05). The effects of autologous skeletal myoblast-derived skeletal muscle were exclusive to the left ventricular short-axis dimension and dependent on autologous skeletal myoblast survival (R2 = 0.59, P = .006, n = 11). CONCLUSIONS: Autologous skeletal cardiomyoplasty was able to attenuate left ventricular remodeling in sheep with end-stage ischemic heart failure.

Doxorubicin-induced canine CHF: advantages and disadvantages.

BACKGROUND: The dog is the most commonly used laboratory animal for heart surgery research. It has been difficult, however, to develop a canine chronic heart failure model, particularly without associated significant tachycardia. Our objective is to utilize intracoronary doxorubicin at various doses to evaluate a chronic model of left ventricular dysfunction and develop a dose-response relationship. METHODS: In 18 dogs, we evaluated their hemodynamic function, placed an in-dwelling intracoronary catheter, and then administered four weekly infusions of doxorubicin at 5 mg (n = 6), 10 mg (n = 6), or 15 mg (n = 6). Hemodynamic measurements were taken again at 4-5 weeks after infusion, and a final measurement at 14-18 weeks. RESULTS (See table): In the low dose group, all six animals survived the post-infusion period. Cardiac output changed from 2.9 +/- 0.2 to 2.2 +/- 0.5. The medium dose group had a mortality of 33% (2/6 dogs), with a moderate decrease in cardiac output (3.1 +/- 0.4 to 2.3 +/- 0.3 L/min). The high dose group had a mortality of 67% (4/6 dogs), with a dramatic decrease in cardiac output (3.0 +/- 0.2 L/min to 1.6 +/- 0.7 L/min (p < 0.05). None of the dogs developed a significant tachycardia. CONCLUSION: This study reconfirms that doxorubicin, when given into the coronary arteries, induces cardiac dysfunction. It appears to be dose-dependent, but more importantly, in doses where the LV dysfunction yields overt heart failure; the mortality over 14 weeks is significant and likely unacceptable for most chronic heart failure studies.