EXPERIMENTAL STUDY
Extension of borderzone myocardium in postinfarction dilated cardiomyopathy
Benjamin M. Jackson, MD*,
Joseph H. Gorman, III, MD*,
Sina L. Moainie, MD*,
T. Sloane Guy, MD*,
Navneet Narula, MD ,
Jagat Narula, MD, DM, PhD, FACC ,
Martin G. St. John-Sutton, FRCP, FACC ,
L. Henry Edmunds, Jr, MD* and
Robert C. Gorman, MD*,*
* Harrison Department of Surgical Research, Philadelphia, Pennsylvania, USA
Department of Pathology, Philadelphia, Pennsylvania, USA
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
Center for Molecular Cardiology–MCP/Hahnemann University School of Medicine, Philadelphia, Pennsylvania, USA
Manuscript received May 7, 2001;
revised manuscript received April 8, 2002,
accepted June 12, 2002.
* Reprint requests and correspondence: Dr. Robert C. Gorman, Department of Surgery, 6 Silverstein, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
gormanr{at}uphs.upenn.edu
OBJECTIVES: This study tests the hypothesis that hypocontractile, borderzone myocardium adjacent to an expanding infarct becomes progressively larger and more hypocontractile as remodeling continues.
BACKGROUND: Early infarct expansion following anteroapical myocardial infarction (MI) is associated with progressive ventricular dilation and heart failure. The contribution of perfused, hypocontractile, borderzone myocardium to this process is unknown.
METHODS: Using a sheep model of anteroapical infarction, sonomicrometry array localization and serial microsphere injections were used to track changes in regional myocardial contractility, geometry, and perfusion. Eight sheep were studied before and after infarction and two, five, and eight weeks later. Thirty intertransducer chord lengths were analyzed to measure regional contractility and serial changes in regional geometry at end systole.
RESULTS: Beginning as a narrow band of fully perfused hypocontractile myocardium adjacent to the infarction, borderzone myocardium extends to involve additional contiguous myocardium that progressively loses contractile function as the heart remodels. Three distinct myocardial zones develop as a result of transmural MI: infarct, borderzone (perfused but hypocontractile), and remote (perfused and normally functioning).
CONCLUSIONS: This study demonstrates that hypocontractile, fully perfused borderzone myocardium extends to involve contiguous normal myocardium during postinfarction remodeling. This borderzone myocardium is a unique type of perfused, hypocontractile myocardium, which is distinct from hibernating or stunned myocardium. Preventing extension of borderzone myocardium by medical or surgical means offers the prospect of preventing late-onset heart failure following transmural expanding MIs.
|
Abbreviations and Acronyms
| | ANOVA | | analysis of variance | | ECG | | electrocardiogram | | ED | | end diastole | | ES | | end systole | % ES | | percent change in end systolic chord length | | %FS | | percent change in fractional shortening | | IV | | intravenous | | LV | | left ventricle | | LVP | | left ventricular pressure | | MDS | | multidimensional scaling | | MI | | myocardial infarction | | SAL | | sonomicrometry array localization | | SW | | stroke work |
|
This article has been cited by other articles:
|
|
|
|
 
J. A. Dixon and F. G. Spinale
Large Animal Models of Heart Failure: A Critical Link in the Translation of Basic Science to Clinical Practice
Circ Heart Fail,
May 1, 2009;
2(3):
262 - 271.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H.-Y. Yu, Y.-S. Chen, W.-Y. Tseng, N.-S. Chi, C.-H. Wang, S.-S. Wang, and F.-Y. Lin
Why is the surgical ventricular restoration operation effective for ischemic cardiomyopathy? Geometric analysis with magnetic resonance imaging of changes in regional ventricular function after surgical ventricular restoration
J. Thorac. Cardiovasc. Surg.,
April 1, 2009;
137(4):
887 - 894.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C.-C. Yeh, D. Malhotra, H. Li, S. Nicholas, R. Tu, and M. J. Mann
Surgical ventricular reconstruction in mice: Elucidating potential targets for combined molecular/surgical intervention
J. Thorac. Cardiovasc. Surg.,
April 1, 2009;
137(4):
942 - 949.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Hamamoto, J. H. Gorman III, L. P. Ryan, R. Hinmon, T. P. Martens, M. D. Schuster, T. Plappert, M. Kiupel, M. G. St. John-Sutton, S. Itescu, et al.
Allogeneic mesenchymal precursor cell therapy to limit remodeling after myocardial infarction: the effect of cell dosage.
Ann. Thorac. Surg.,
March 1, 2009;
87(3):
794 - 801.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. J. Pilla, J. H. Gorman III, and R. C. Gorman
Theoretic impact of infarct compliance on left ventricular function.
Ann. Thorac. Surg.,
March 1, 2009;
87(3):
803 - 810.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Di Donato, S. Castelvecchio, T. Kukulski, C. Bussadori, F. Giacomazzi, A. Frigiola, and L. Menicanti
Surgical ventricular restoration: left ventricular shape influence on cardiac function, clinical status, and survival.
Ann. Thorac. Surg.,
February 1, 2009;
87(2):
455 - 461.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. P. Ryan, K. Matsuzaki, M. Noma, B. M. Jackson, T. J. Eperjesi, T. J. Plappert, M. G. St. John-Sutton, J. H. Gorman III, and R. C. Gorman
Dermal Filler Injection: A Novel Approach for Limiting Infarct Expansion
Ann. Thorac. Surg.,
January 1, 2009;
87(1):
148 - 155.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. C. Walker, M. B. Ratcliffe, P. Zhang, A. W. Wallace, E. W. Hsu, D. A. Saloner, and J. M. Guccione
Magnetic resonance imaging-based finite element stress analysis after linear repair of left ventricular aneurysm.
J. Thorac. Cardiovasc. Surg.,
May 1, 2008;
135(5):
1094 - 1102.e2.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. Y. Szeto, R. C. Gorman, J. H. Gorman III, and M. A. Acker
Ischemic Mitral Regurgitation
Card. Surg. Adult,
January 1, 2008;
3(2008):
785 - 802.
[Full Text]
|
|
|
|
|
|
|
A. S. Blom, J. J. Pilla, J. Arkles, L. Dougherty, L. P. Ryan, J. H. Gorman III, M. A. Acker, and R. C. Gorman
Ventricular Restraint Prevents Infarct Expansion and Improves Borderzone Function After Myocardial Infarction: A Study Using Magnetic Resonance Imaging, Three-Dimensional Surface Modeling, and Myocardial Tagging
Ann. Thorac. Surg.,
December 1, 2007;
84(6):
2004 - 2010.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. M. Shipulin, V. A. Kazakov, I. V. Suhodolo, E. V. Krivoshekov, A. A. Lezhnev, B. N. Kozlov, V. Ch. Vaizov, and A. A. Miller
Causes of repeated remodeling of left ventricle after Dor procedure
Interactive CardioVascular and Thoracic Surgery,
December 1, 2007;
6(6):
772 - 777.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Sakamoto, L. M. Parish, H. Hamamoto, L. P. Ryan, T. J. Eperjesi, T. J. Plappert, B. M. Jackson, M. G. St John-Sutton, J. H. Gorman III, and R. C. Gorman
Effect of Reperfusion on Left Ventricular Regional Remodeling Strains After Myocardial Infarction
Ann. Thorac. Surg.,
November 1, 2007;
84(5):
1528 - 1536.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. D. Gilson, F. H. Epstein, Z. Yang, Y. Xu, K.-M. R. Prasad, M.-C. Toufektsian, V. E. Laubach, and B. A. French
Borderzone Contractile Dysfunction Is Transiently Attenuated and Left Ventricular Structural Remodeling Is Markedly Reduced Following Reperfused Myocardial Infarction in Inducible Nitric Oxide Synthase Knockout Mice
J. Am. Coll. Cardiol.,
October 30, 2007;
50(18):
1799 - 1807.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Zhang, J. M. Guccione, S. I. Nicholas, J. C. Walker, P. C. Crawford, A. Shamal, G. Acevedo-Bolton, M. A. Guttman, C. Ozturk, E. R. McVeigh, et al.
Endoventricular patch plasty for dyskinetic anteroapical left ventricular aneurysm increases systolic circumferential shortening in sheep.
J. Thorac. Cardiovasc. Surg.,
October 1, 2007;
134(4):
1017 - 1024.e1.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. C. Shuros, R. W. Salo, V. G. Florea, J. Pastore, M. A. Kuskowski, Y. Chandrashekhar, and I. S. Anand
Ventricular Preexcitation Modulates Strain and Attenuates Cardiac Remodeling in a Swine Model of Myocardial Infarction
Circulation,
September 4, 2007;
116(10):
1162 - 1169.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Langer, F. Rodriguez, A. Cheng, S. Ortiz, K. B. Harrington, M. K. Zasio, G. T. Daughters, J. C. Criscione, N. B. Ingels, and D. C. Miller
Alterations in Lateral Left Ventricular Wall Transmural Strains During Acute Circumflex and Anterior Descending Coronary Occlusion
Ann. Thorac. Surg.,
July 1, 2007;
84(1):
51 - 60.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. C. Nguyen, A. Cheng, F. A. Tibayan, D. Liang, G. T. Daughters, N. B. Ingels Jr., and D. C. Miller
Septal-lateral annnular cinching perturbs basal left ventricular transmural strains
Eur. J. Cardiothorac. Surg.,
March 1, 2007;
31(3):
423 - 429.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. C. Nguyen, A. Cheng, F. Langer, F. Rodriguez, R. A. Oakes, A. Itoh, D. B. Ennis, D. Liang, G. T. Daughters, N. B. Ingels Jr, et al.
Altered Myocardial Shear Strains Are Associated With Chronic Ischemic Mitral Regurgitation
Ann. Thorac. Surg.,
January 1, 2007;
83(1):
47 - 54.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Saeed, O. Weber, R. Lee, L. Do, A. Martin, D. Saloner, P. Ursell, P. Robert, C. Corot, and C. B. Higgins
Discrimination of Myocardial Acute and Chronic (Scar) Infarctions on Delayed Contrast Enhanced Magnetic Resonance Imaging With Intravascular Magnetic Resonance Contrast Media
J. Am. Coll. Cardiol.,
November 21, 2006;
48(10):
1961 - 1968.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Q. Hu, X. Wang, J. Lee, A. Mansoor, J. Liu, L. Zeng, C. Swingen, G. Zhang, J. Feygin, K. Ochiai, et al.
Profound bioenergetic abnormalities in peri-infarct myocardial regions
Am J Physiol Heart Circ Physiol,
August 1, 2006;
291(2):
H648 - H657.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Cheng, T. C. Nguyen, M. Malinowski, F. Langer, D. Liang, G. T. Daughters, N. B. Ingels Jr, and D. C. Miller
Passive Ventricular Constraint Prevents Transmural Shear Strain Progression in Left Ventricle Remodeling
Circulation,
July 4, 2006;
114(1_suppl):
I-79 - I-86.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Cheng, T. C. Nguyen, M. Malinowski, D. Liang, G. T. Daughters, N. B. Ingels Jr, and D. C. Miller
Effects of Undersized Mitral Annuloplasty on Regional Transmural Left Ventricular Wall Strains and Wall Thickening Mechanisms
Circulation,
July 4, 2006;
114(1_suppl):
I-600 - I-609.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Carluccio, P. Biagioli, G. Alunni, A. Murrone, C. Giombolini, T. Ragni, P. N. Marino, G. Reboldi, and G. Ambrosio
Patients With Hibernating Myocardium Show Altered Left Ventricular Volumes and Shape, Which Revert After Revascularization: Evidence That Dyssynergy Might Directly Induce Cardiac Remodeling
J. Am. Coll. Cardiol.,
March 7, 2006;
47(5):
969 - 977.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A. Borger, A. Alam, P. M. Murphy, T. Doenst, and T. E. David
Chronic Ischemic Mitral Regurgitation: Repair, Replace or Rethink?
Ann. Thorac. Surg.,
March 1, 2006;
81(3):
1153 - 1161.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. A. Ribeiro, C. E. da Costa, M. M. Lopes, A. N. Albuquerque, F. Antoniali, G. A. A. Reinert, and K. G. Franchini
Left ventricular reconstruction benefits patients with ischemic cardiomyopathy and non-viable myocardium
Eur. J. Cardiothorac. Surg.,
February 1, 2006;
29(2):
196 - 201.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. M. Jackson, L. M. Parish, J. H. Gorman III, Y. Enomoto, H. Sakamoto, T. Plappert, M. G. St. John Sutton, I. Salgo, and R. C. Gorman
Borderzone Geometry After Acute Myocardial Infarction: A Three-Dimensional Contrast Enhanced Echocardiographic Study
Ann. Thorac. Surg.,
December 1, 2005;
80(6):
2250 - 2255.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. J. Pilla, A. S. Blom, J. H. Gorman III, D. J. Brockman, J. Affuso, L. M. Parish, H. Sakamoto, B. M. Jackson, M. A. Acker, and R. C. Gorman
Early Postinfarction Ventricular Restraint Improves Borderzone Wall Thickening Dynamics During Remodeling
Ann. Thorac. Surg.,
December 1, 2005;
80(6):
2257 - 2262.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Zhang, J. M. Guccione, S. I. Nicholas, J. C. Walker, P. C. Crawford, A. Shamal, D. A. Saloner, A. W. Wallace, and M. B. Ratcliffe
Left ventricular volume and function after endoventricular patch plasty for dyskinetic anteroapical left ventricular aneurysm in sheep
J. Thorac. Cardiovasc. Surg.,
October 1, 2005;
130(4):
1032 - 1038.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Ashikaga, S. R. Mickelsen, D. B. Ennis, I. Rodriguez, P. Kellman, H. Wen, and E. R. McVeigh
Electromechanical analysis of infarct border zone in chronic myocardial infarction
Am J Physiol Heart Circ Physiol,
September 1, 2005;
289(3):
H1099 - H1105.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. C. Walker, M. B. Ratcliffe, P. Zhang, A. W. Wallace, B. Fata, E. W. Hsu, D. Saloner, and J. M. Guccione
MRI-based finite-element analysis of left ventricular aneurysm
Am J Physiol Heart Circ Physiol,
August 1, 2005;
289(2):
H692 - H700.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Rodriguez, F. Langer, K. B. Harrington, A. Cheng, G. T. Daughters, J. C. Criscione, N. B. Ingels, and D. C. Miller
Alterations in transmural strains adjacent to ischemic myocardium during acute midcircumflex occlusion
J. Thorac. Cardiovasc. Surg.,
April 1, 2005;
129(4):
791 - 803.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. Enomoto, J. H. Gorman III, S. L. Moainie, B. M. Jackson, L. M. Parish, T. Plappert, A. Zeeshan, M. G. St. John-Sutton, and R. C. Gorman
Early Ventricular Restraint After Myocardial Infarction: Extent of the Wrap Determines the Outcome of Remodeling
Ann. Thorac. Surg.,
March 1, 2005;
79(3):
881 - 887.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. Enomoto, J. H. Gorman III, S. L. Moainie, T. S. Guy, B. M. Jackson, L. M. Parish, T. Plappert, A. Zeeshan, M. G. St. John-Sutton, and R. C. Gorman
Surgical treatment of ischemic mitral regurgitation might not influence ventricular remodeling
J. Thorac. Cardiovasc. Surg.,
March 1, 2005;
129(3):
504 - 511.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. B.C. Dang, J. M. Guccione, P. Zhang, A. W. Wallace, R. C. Gorman, J. H. Gorman III, and M. B. Ratcliffe
Effect of Ventricular Size and Patch Stiffness in Surgical Anterior Ventricular Restoration: A Finite Element Model Study
Ann. Thorac. Surg.,
January 1, 2005;
79(1):
185 - 193.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Tsuneyoshi, T. Nishina, T. Nomoto, H. Kanemitsu, R. Kawakami, O. Unimonh, K. Nishimura, and M. Komeda
Atrial Natriuretic Peptide Helps Prevent Late Remodeling After Left Ventricular Aneurysm Repair
Circulation,
September 14, 2004;
110(11_suppl_1):
II-174 - II-179.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. M. Jackson, J. H. Gorman III, and R. C. Gorman
Increased border-zone stress in bulging ventricular aneurysm
Ann. Thorac. Surg.,
May 1, 2004;
77(5):
1876 - 1876.
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. S. Guy IV, S. L. Moainie, J. H. Gorman III, B. M. Jackson, T. Plappert, Y. Enomoto, M. G. St. John-Sutton, L. H. Edmunds Jr, and R. C. Gorman
Prevention of ischemic mitral regurgitation does not influence the outcome of remodeling after posterolateral myocardial infarction
J. Am. Coll. Cardiol.,
February 4, 2004;
43(3):
377 - 383.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. H. Gorman III, R. C. Gorman, B. M. Jackson, Y. Enomoto, M. G. St. John-Sutton, and L. H. Edmunds Jr
Annuloplasty ring selection for chronic ischemic mitral regurgitation: lessons from the ovine model
Ann. Thorac. Surg.,
November 1, 2003;
76(5):
1556 - 1563.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. M. Wilson, S. L. Moainie, J. M. Baskin, A. S. Lowry, A. M. Deschamps, R. Mukherjee, T. S. Guy, M. G. St John-Sutton, J. H. Gorman III, L. H. Edmunds Jr, et al.
Region- and Type-Specific Induction of Matrix Metalloproteinases in Post-Myocardial Infarction Remodeling
Circulation,
June 10, 2003;
107(22):
2857 - 2863.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. M. Jackson, J. H. Gorman III, I. S. Salgo, S. L. Moainie, T. Plappert, M. St. John-Sutton, L. H. Edmunds Jr., and R. C. Gorman
Border zone geometry increases wall stress after myocardial infarction: contrast echocardiographic assessment
Am J Physiol Heart Circ Physiol,
February 1, 2003;
284(2):
H475 - H479.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. C. Gorman, J. H. Gorman III, and L. H. Edmunds Jr.
Ischemic Mitral Regurgitation
Card. Surg. Adult,
January 1, 2003;
2(2003):
751 - 769.
[Full Text]
|
|
|
|
