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长期β1肾上腺素能受体阻断降低心率可促进梗死心脏中小动脉生长并保留冠状动脉灌注储备。

Reduction of heart rate by chronic beta1-adrenoceptor blockade promotes growth of arterioles and preserves coronary perfusion reserve in postinfarcted heart.

作者信息

Dedkov Eduard I, Christensen Lance P, Weiss Robert M, Tomanek Robert J

机构信息

Dept. of Anatomy and Cell Biology, Carver College of Medicine, 1-402 Bowen Science Bldg., Univ. of Iowa, Iowa City, IA 52242, USA.

出版信息

Am J Physiol Heart Circ Physiol. 2005 Jun;288(6):H2684-93. doi: 10.1152/ajpheart.01047.2004. Epub 2005 Jan 28.

Abstract

Adequate growth of coronary vasculature in the remaining left ventricular (LV) myocardium after myocardial infarction (post-MI) is a crucial factor for myocyte survival and performance. We previously demonstrated that post-MI coronary angiogenesis can be stimulated by bradycardia induced with the ATP-sensitive K(+) channel antagonist alinidine. In this study, we tested the hypothesis that heart rate reduction with beta-blockade may also induce coronary growth in the post-MI heart. Transmural MI was induced in 12-mo-old male Sprague-Dawley rats by occlusion of the left anterior descending coronary artery. Bradycardia was induced by administration of the beta-adrenoceptor blocker atenolol (AT) via drinking water (30 mg/day). Three groups of rats were compared: 1) control/sham (C/SH), 2) MI, and 3) MI + AT. In the MI + AT rats, heart rate was consistently reduced by 25-28% compared with C/SH rats. At 4 wk after left anterior descending coronary ligation, infarct size was similar in MI and MI + AT rats (67.1 and 61.5%, respectively), whereas a greater ventricular hypertrophy occurred in bradycardic rats, as indicated by a higher ventricular weight-to-body weight ratio (3.4 +/- 0.1 vs. 2.8 +/- 0.1 mg/g in MI rats). Analysis of LV function revealed a smaller drop in ejection fraction in the MI + AT than in the MI group ( approximately 24 vs. approximately 35%). Furthermore, in MI + AT rats, maximal coronary conductance and coronary perfusion reserve were significantly improved compared with the MI group. The better myocardial perfusion indexes in MI + AT rats were associated with a greater increase in arteriolar length density than in the MI group. Thus chronic reduction of heart rate induced with beta-selective blockade promotes growth of coronary arterioles and, thereby, facilitates regional myocardial perfusion in post-MI hearts.

摘要

心肌梗死后,左心室(LV)剩余心肌中冠状动脉血管的充分生长是心肌细胞存活和功能的关键因素。我们之前证明,ATP敏感性钾(K +)通道拮抗剂阿利尼定诱导的心动过缓可刺激心肌梗死后的冠状动脉血管生成。在本研究中,我们测试了以下假设:β受体阻滞剂降低心率也可能诱导心肌梗死后心脏的冠状动脉生长。通过闭塞左前降支冠状动脉,在12月龄雄性Sprague-Dawley大鼠中诱导透壁性心肌梗死。通过饮用水(30毫克/天)给予β肾上腺素能受体阻滞剂阿替洛尔(AT)诱导心动过缓。比较三组大鼠:1)对照/假手术(C/SH),2)心肌梗死(MI),3)MI + AT。与C/SH大鼠相比,MI + AT大鼠的心率持续降低25-28%。在左前降支冠状动脉结扎后4周,MI和MI + AT大鼠的梗死面积相似(分别为67.1%和61.5%),而心动过缓大鼠出现更大的心室肥厚,表现为心室重量与体重比更高(MI大鼠为3.4±0.1 vs. 2.8±0.1毫克/克)。左心室功能分析显示,MI + AT组的射血分数下降幅度小于MI组(约24% vs. 约35%)。此外,与MI组相比,MI + AT大鼠的最大冠状动脉传导和冠状动脉灌注储备显著改善。MI + AT大鼠更好的心肌灌注指标与小动脉长度密度的增加幅度大于MI组有关。因此,β选择性阻滞剂诱导的心率长期降低促进了冠状动脉小动脉的生长,从而促进了心肌梗死后心脏的局部心肌灌注。

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