Change in (dP/dt)max as an index of myocardial microvascular permeability.

We frequently study processes that alter microvascular permeability in the heart. Myocardial microvascular permeability has been estimated by determining the filtration independent reflection coefficient for beta-lipoprotein (sigma beta-LIPO). This technique requires the measurement of myocardial lymph flow rate and the lymph-to-plasma protein concentration ratio. Unfortunately, it is a nonsurvival procedure. An index of myocardial microvascular permeability was needed that could be determined in experimental preparations without sacrificing valuable chronically instrumented animals. We attempted to relate changes in myocardial microvascular permeability and myocardial edema formation to some index of myocardial performance. In 33 acute, anesthetized dogs (with normal or disrupted myocardial microvasculatures), we measured systemic arterial pressure, systemic venous pressure, coronary sinus pressure, left ventricular pressure, the maximum rate of change in left ventricular pressure (dP/dt)max, myocardial lymph flow rate, and myocardial extravascular fluid volume. Following an increase in coronary sinus pressure, the amount of edema fluid entering the myocardium varied as a function of myocardial microvascular permeability. Further, as the heart became edematous, (dP/dt)max changed with respect to time [delta(dP/dt)max/delta t]. Finally, a significant relation was found between sigma beta-LIPO and delta(dP/dt)max/delta t. Since coronary sinus pressure can be elevated and delta(dP/dt)max/delta t can be measured in chronic animals, this technique may be useful for evaluating myocardial microvascular permeability on a long-term survival basis.