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Title of Journal: Ann Biomed Eng

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Abbravation: Annals of Biomedical Engineering

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Springer US

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DOI

10.1007/bf01888831

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1573-9686

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Computationally Managed Bradycardia Improved Cardi

Authors: Kazunori Uemura Kenji Sunagawa Masaru Sugimachi
Publish Date: 2008/11/12
Volume: 37, Issue: 1, Pages: 82-
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Abstract

In acute heart failure systemic arterial pressure AP cardiac output CO and left atrial pressure P LA have to be controlled within acceptable ranges Under this condition cardiac energetic efficiency should also be improved Theoretically if heart rate HR is reduced while AP CO and P LA are maintained by preserving the functional slope of left ventricular LV Starling’s curve S L with precisely increased LV endsystolic elastance E es it is possible to improve cardiac energetic efficiency and reduce LV oxygen consumption per minute MVO 2 We investigated whether this hemodynamics can be accomplished in acute heart failure using an automated hemodynamic regulator that we developed previously In seven anesthetized dogs with acute heart failure CO  70 mL min−1 kg−1 P LA  15 mmHg the regulator simultaneously controlled S L with dobutamine systemic vascular resistance with nitroprusside and stressed blood volume with dextran or furosemide thereby controlling AP CO and P LA Normal hemodynamics were restored and maintained CO 88 ± 3 mL min−1 kg−1 P LA 109 ± 04 mmHg even when zatebradine significantly reduced HR −27 ± 3 Following HR reduction E es increased +34 ± 14 LV mechanical efficiency stroke work/oxygen consumption increased +22 ± 6 and MVO 2 decreased −17 ± 4 significantly In conclusion in a canine acute heart failure model computationally managed bradycardia improved cardiac energetic efficiency while restoring normal hemodynamic conditionsThis study was supported by GrantinAid for Scientific Research C 18500358 20500404 from the Ministry of Education Culture Sports Science and Technology by a research grant from Nakatani Foundation of Electronic Measuring Technology Advancement and by Health and Labour Sciences Research Grants H19nanoippan009 from the Ministry of Health Labour and Welfare of JapanBlock diagram of the PI controller in the automated hemodynamic regulator ΔS L and ΔR denote the difference between target and subject’s S L and between target and subject’s R respectively K i and K p represent the integral and proportional gain constants respectively s is a Laplace operator

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