Litwin S E, Raya T E, Anderson P G, Litwin C M, Bressler R, Goldman S
Department of Internal Medicine, Tucson, VAMC.
Circulation. 1991 Oct;84(4):1819-27. doi: 10.1161/01.cir.84.4.1819.
Previous studies have shown that hypertrophy of surviving myocytes after myocardial infarction (MI) is limited. Progressive ventricular dilatation after MI may occur when compensatory hypertrophy cannot restore left ventricular (LV) wall stress to normal.
To test whether induction of additional myocyte hypertrophy might prevent pathological LV remodeling after large MI, we administered 2-tetradecylglycidic acid (TDGA) 20 mg/kg/day to sham-operated (n = 12) and MI (n = 10) rats for 10 days, beginning the third day after infarction. We have previously shown that chronic inhibition of long-chain fatty acid oxidation with TDGA in rats results in myocardial hypertrophy without any apparent impairment of LV systolic function. When compared with untreated MI rats (n = 9), we found that TDGA-treated MI rats had increases in LV weight/body wt, myocyte cross-sectional area, and peak developed LV pressure during abrupt aortic occlusion. MI rats treated with TDGA had lower LV end-diastolic pressures and smaller end-diastolic volumes, whereas stroke volume was maintained. The ex vivo passive LV pressure-volume relation was shifted toward the pressure axis compared with untreated infarct rats. In sham-operated rats, TDGA caused increases in LV weight/body wt, myocyte size, peak developed LV pressure, cardiac index, and stroke volume index, and a shift of the passive LV pressure-volume relation toward the pressure axis.
Induction of myocardial hypertrophy with an inhibitor of long-chain fatty acid oxidation retarded the process of LV dilatation and produced beneficial effects on systolic function after large myocardial infarction. These data support the hypothesis that inadequate hypertrophy of residual myocardium after infarction may contribute to LV dilatation and the development of congestive heart failure.
既往研究表明,心肌梗死(MI)后存活心肌细胞的肥大是有限的。当代偿性肥大无法将左心室(LV)壁应力恢复至正常时,MI后可能会发生进行性心室扩张。
为了测试诱导额外的心肌细胞肥大是否可以预防大面积MI后的病理性LV重塑,我们从梗死第三天开始,给假手术组(n = 12)和MI组(n = 10)大鼠每天腹腔注射20 mg/kg的2-十四烷基甘油酸(TDGA),持续10天。我们之前已经表明,用TDGA长期抑制大鼠的长链脂肪酸氧化会导致心肌肥大,而LV收缩功能没有任何明显损害。与未治疗的MI大鼠(n = 9)相比,我们发现TDGA治疗的MI大鼠在主动脉突然闭塞期间LV重量/体重、心肌细胞横截面积和LV最大压力峰值增加。TDGA治疗的MI大鼠LV舒张末期压力较低,舒张末期容积较小,而每搏输出量保持不变。与未治疗的梗死大鼠相比,离体被动LV压力-容积关系向压力轴偏移。在假手术大鼠中,TDGA导致LV重量/体重、心肌细胞大小、LV最大压力峰值、心脏指数和每搏输出量指数增加,并且被动LV压力-容积关系向压力轴偏移。
用长链脂肪酸氧化抑制剂诱导心肌肥大可延缓大面积心肌梗死后LV扩张的进程,并对收缩功能产生有益影响。这些数据支持以下假设:梗死后残余心肌肥大不足可能导致LV扩张和充血性心力衰竭的发展。