Orrego Carlos M, Nasir Nadim, Oliveira Guilherme H, Flores-Arredondo Jose H, Cordero-Reyes Andrea M, Loebe Matthias, Youker Keith A, Torre-Amione Guillermo
Methodist DeBakey Heart and Vascular Center, The Methodist Hospital, Houston, TX 77030, USA.
Congest Heart Fail. 2011 May-Jun;17(3):140-6. doi: 10.1111/j.1751-7133.2011.00227.x. Epub 2011 May 23.
Left ventricular assist devices (LVADs) induce reverse cardiac remodeling by reducing myocyte size and collagen deposition. On the other hand, cardiac resynchronization therapy (CRT) induces reverse cardiac remodeling by improving electromechanical synchronization. The clinical and structural changes produced by CRT in failing myocardium are known, but whether these changes are accompanied by reverse cellular remodeling is unknown. A total of 12 patients with chronic heart failure (CHF) who underwent CRT and 15 patients who had LVAD therapy as clinically indicated and 8 healthy controls were compared. Demographics, echocardiographic data, and histologic samples from myocardial biopsies were analyzed and compared among groups. The authors found significant increases in myocyte size, myocardial fibrosis, and inflammation in both CHF groups who underwent CRT or LVAD, compared with healthy controls. After CRT or LVAD therapy, a significant decrease in myocyte size and tumor necrosis factor α (TNF-α) expression compared with healthy controls (P < .05) was found. In the CRT group, 6 of 8 patients demonstrated reduction in myocyte size and interstitial fibrosis. In addition, there was a decrease in myocyte size by 13%, total collagen by 27% and TNF-α by 49% in the CRT group vs 28%, 45%, and 45% in the LVAD group. CRT produces cellular reverse remodeling in failing human hearts that are comparable with those produced by LVAD therapy.
左心室辅助装置（LVADs）通过减小心肌细胞大小和减少胶原蛋白沉积来诱导心脏逆向重塑。另一方面，心脏再同步治疗（CRT）通过改善机电同步来诱导心脏逆向重塑。CRT在衰竭心肌中产生的临床和结构变化是已知的，但这些变化是否伴随着细胞逆向重塑尚不清楚。比较了12例接受CRT的慢性心力衰竭（CHF）患者、15例根据临床指征接受LVAD治疗的患者和8名健康对照者。分析并比较了各组的人口统计学、超声心动图数据以及心肌活检的组织学样本。作者发现，与健康对照者相比，接受CRT或LVAD治疗的两个CHF组的心肌细胞大小、心肌纤维化和炎症均显著增加。在CRT或LVAD治疗后，与健康对照者相比，心肌细胞大小和肿瘤坏死因子α（TNF-α）表达显著降低（P <.05）。在CRT组中，8例患者中有6例心肌细胞大小和间质纤维化减少。此外，CRT组心肌细胞大小减少13%，总胶原蛋白减少27%，TNF-α减少49%，而LVAD组分别为28%、45%和45%。CRT在衰竭的人类心脏中产生的细胞逆向重塑与LVAD治疗产生的相当。
