ALTERATIONS IN LEFT-VENTRICULAR DIASTOLIC FUNCTION IN CONSCIOUS DOGS WITH PACING-INDUCED HEART-FAILURE

We investigated in conscious dogs (a) the effects of heart failure induced by chronic rapid ventricular pacing on the sequence of development of left ventricular (LV) diastolic versus systolic dysfunction and (b) whether the changes were load dependent or secondary to alterations in structure. LV systolic and diastolic dysfunction were evident within 24 h after initiation of pacing and occurred in parallel over 3 wk. LV systolic function was reduced at 3 wk, i.e., peak LV dP/dt fell by -1,327+/-105 mmHg/s and ejection fraction by -22+/-2%. LV diastolic dysfunction also progressed over 3 wk of pacing, i.e., tau increased by +14.0+/-2.8 ms and the myocardial stiffness constant by +6.5+/-1.4, whereas LV chamber stiffness did not change. These alterations were associated with increases in LV end-systolic (+28.6+/-5.7 g/cm2) and LV end-diastolic stresses (+40.4+/-5.3 g/cm2). When stresses and heart rate were matched at the same levels in the control and failure states, the increases in tau and myocardial stiffness were no longer observed, whereas LV systolic function remained depressed. There were no increases in connective tissue content in heart failure. Thus, pacing-induced heart failure in conscious dogs is characterized by major alterations in diastolic function which are reversible with normalization of increased loading condition.