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缺血性心力衰竭临床前模型的特征:左前降支和左旋支梗死之间的差异。

Characterizing preclinical models of ischemic heart failure: differences between LAD and LCx infarctions.

作者信息

Ishikawa Kiyotake, Aguero Jaume, Tilemann Lisa, Ladage Dennis, Hammoudi Nadjib, Kawase Yoshiaki, Santos-Gallego Carlos G, Fish Kenneth, Levine Robert A, Hajjar Roger J

机构信息

Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York; and

Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York; and.

出版信息

Am J Physiol Heart Circ Physiol. 2014 Nov 15;307(10):H1478-86. doi: 10.1152/ajpheart.00797.2013. Epub 2014 Sep 12.

Abstract

Large animal studies are an important step toward clinical translation of novel therapeutic approaches. We aimed to establish an ischemic heart failure (HF) model with a larger myocardial infarction (MI) relative to previous studies, and characterize the functional and structural features of this model. An MI was induced by occluding the proximal left anterior descending artery (LAD; n = 15) or the proximal left circumflex artery (LCx; n = 6) in Yorkshire pigs. Three pigs with sham procedures were also included. All pigs underwent hemodynamic and echocardiographic assessments before MI, at 1 mo, and 3 mo after MI. Analyses of left ventricular (LV) myocardial mechanics by means of strains and torsion were performed using speckle-tracking echocardiography and compared between the groups. The proximal LAD MI approach induced larger infarct sizes (14.2 ± 3.2% vs. 10.6 ± 1.9%, P = 0.03), depressed systolic function (LV ejection fraction; 39.8 ± 7.5% vs. 54.1 ± 4.6%, P < 0.001), and more LV remodeling (end-systolic volume index; 82 ± 25 ml/m(2) vs. 51 ± 18 ml/m(2), P = 0.02, LAD vs. LCx, respectively) compared with the LCx MI approach without compromising the survival rate. At the papillary muscle level, echocardiographic strain analysis revealed no differences in radial and circumferential strain between LAD and LCx MIs. However, in contrast with the LCx MI, the LAD MI resulted in significantly decreased longitudinal strain. The proximal LAD MI model induces more LV remodeling and depressed LV function relative to the LCx MI model. Location of MI significantly impacts the severity of HF, thus careful consideration is required when choosing an MI model for preclinical HF studies.

摘要

大型动物研究是新型治疗方法临床转化的重要一步。我们旨在建立一个相对于先前研究而言具有更大面积心肌梗死(MI)的缺血性心力衰竭(HF)模型,并描述该模型的功能和结构特征。通过结扎约克夏猪的左前降支近端(LAD;n = 15)或左旋支近端(LCx;n = 6)诱导心肌梗死。还纳入了3只接受假手术的猪。所有猪在心肌梗死前、心肌梗死后1个月和3个月均接受了血流动力学和超声心动图评估。使用斑点追踪超声心动图对左心室(LV)心肌力学进行应变和扭转分析,并在组间进行比较。与LCx心肌梗死方法相比,近端LAD心肌梗死方法导致更大的梗死面积(14.2±3.2%对10.6±1.9%,P = 0.03)、收缩功能降低(左心室射血分数;39.8±7.5%对54.1±4.6%,P < 0.001)以及更多的左心室重构(收缩末期容积指数;82±25 ml/m²对51±18 ml/m²,P = 0.02,分别为LAD与LCx),且不影响生存率。在乳头肌水平,超声心动图应变分析显示LAD和LCx心肌梗死之间的径向和周向应变无差异。然而,与LCx心肌梗死相反,LAD心肌梗死导致纵向应变显著降低。相对于LCx心肌梗死模型,近端LAD心肌梗死模型诱导更多的左心室重构和左心室功能降低。心肌梗死的位置显著影响心力衰竭的严重程度,因此在为临床前心力衰竭研究选择心肌梗死模型时需要仔细考虑。

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