Zacà Valerio, Brewer Robert, Khanal Sanjaya, Imai Makoto, Jiang Alice, Wang Mengjun, Goldstein Sidney, Sabbah Hani N
Department of Medicine, Division of Cardiovascular Medicine, Henry Ford Heart & Vascular Institute, Detroit, Michigan 48202, USA.
J Card Fail. 2007 May;13(4):312-7. doi: 10.1016/j.cardfail.2007.01.006.
Assessment of global left ventricular (LV) remodeling is important in evaluating the efficacy of pharmacologic and device therapies for the treatment of chronic heart failure (HF). The effects of pharmacologic or device therapies on global left atrial (LA) remodeling in HF, although also important, are not often examined. We showed that long-term therapy with the Acorn Cardiac Support Device (CSD), a passive mechanical ventricular containment device, prevents or reverses LV remodeling in dogs with HF. This study examined the effects of the CSD on global LA remodeling in dogs with moderate and advanced HF.
Studies were performed in 24 dogs with coronary microembolization-induced HF. Of these, 12 had moderate HF (ejection fraction, EF 30% to 40%) and 12 advanced HF (EF < or = 25%). In each group, the CSD was implanted in 6 dogs and the other 6 served as controls. Dogs were followed for 3 months in the moderate group and 6 months in the advanced HF group. LA maximal volume (LAVmax), LA volume at the onset of the p-wave (LAVp), LA minimal volume (LAVmin), LA active emptying volume (LAAEV), and LA active emptying fraction (LAAEF) were measured from 2-dimensional echocardiograms obtained before CSD implantation and at the end of the treatment period. Treatment effect (delta) comparisons between CSD-treated dogs and controls showed that CSD therapy significantly decreased LA volumes (deltaLAVmax: 3.33 +/- 0.70 vs. -2.87 +/- 1.31 mL, P = .002; 7.77 +/- 1.76 versus -0.37 +/- 0.87 mL, P = .002) and improved LA function (deltaLAAEF: -6.00 +/- 1.53 versus 1.85 +/- 1.32%, P = .003; -2.39 +/- 1.10 versus 3.13 +/- 1.66%, P = .02) in the moderate HF and advanced HF groups, respectively.
Progressive LA enlargement and LA functional deterioration occurs in untreated dogs with HF. Monotherapy with the CSD prevents LA enlargement and improves LA mechanical function in dogs with moderate and advanced HF indicating prevention or reversal of adverse LA remodeling.
评估左心室（LV）整体重构对于评估慢性心力衰竭（HF）药物和器械治疗的疗效非常重要。尽管药物或器械治疗对HF患者左心房（LA）整体重构的影响也很重要，但却不常被研究。我们发现，长期使用橡果心脏支持装置（CSD，一种被动式机械心室容纳装置）治疗可预防或逆转HF犬的LV重构。本研究探讨了CSD对中度和重度HF犬LA整体重构的影响。
对24只冠状动脉微栓塞诱导HF的犬进行研究。其中，12只患有中度HF（射血分数，EF 30%至40%），12只患有重度HF（EF≤25%）。每组中，6只犬植入CSD，另外6只作为对照。中度HF组犬随访3个月，重度HF组犬随访6个月。从CSD植入前及治疗期末获得的二维超声心动图测量LA最大容积（LAVmax）、P波起始时的LA容积（LAVp）、LA最小容积（LAVmin）、LA主动排空容积（LAAEV）和LA主动排空分数（LAAEF）。CSD治疗犬与对照之间的治疗效果（差值）比较显示，CSD治疗分别显著降低了中度HF组和重度HF组的LA容积（ΔLAVmax：3.33±0.70对-2.87±1.31 mL，P = 0.002；7.77±1.76对-0.37±0.87 mL，P = 0.002），并改善了LA功能（ΔLAAEF：-6.00±1.53对1.85±1.32%，P = 0.003；-2.39±1.10对3.13±1.66%，P = 0.02）。
未经治疗的HF犬会出现LA逐渐扩大和LA功能恶化。CSD单一疗法可预防中度和重度HF犬的LA扩大并改善LA机械功能，表明可预防或逆转不良LA重构。
