Hayward, Martin Paul; (1997) Improving skeletal muscle performance for cardiac assistance - A clinical and laboratory study. Masters thesis (M.S), UCL (University College London).

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Abstract

This thesis aims to contribute to an improved understanding of the potential use of skeletal muscle for cardiac assistance as well as seeking to increase the working capacity of skeletal muscle whilst transforming it into a fatigue resistant phenotype. In the laboratory a test rig capable of evaluating the physiological properties of control and chronically stimulated mammalian muscle was designed and built and it's performance validated. A series of physiological experiments were completed to study, at precise power levels, the isometric, isotonic and isokinetic characteristics of the muscles under test. A series of computer programmes were written to control each test and display the data for analysis. A new animal model was designed in order to investigate the effects of specific stimulation protocols on the transformation of the intact latissimus dorsi muscle in the rabbit with appropriate controls. Patterns of chronic electrical stimulation were identified which produced skeletal muscle which is both resistant to fatigue and which is faster-contracting and more powerful than the completely transformed types produced hitherto. New ways of providing prompt, more effective circulatory support in clinical skeletal muscle circulatory support programmes are suggested. In the clinical setting a protocol with Department of Health and Ethics Committee approval was designed to investigate in a randomised, prospective manner the clinical benefits of Dynamic Cardiomyoplasty as a therapeutic option for the treatment of NYHA Grade III to IV heart failure compared with maximal medical therapy in man, and the trial was commenced. Within the format of the randomised trial this thesis particularly concentrates on assessing the contribution of the skeletal muscle graft in actively squeezing the myocardium and improving stroke volume and causing intrinsic improvement in the native myocardial function. Links between the laboratory results and clinical findings are discussed fully as is the potential future role of skeletal muscle in this setting.

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