Puhl Sarah-Lena, Müller Andreas, Wagner Michael, Devaux Yvan, Böhm Michael, Wagner Daniel R, Maack Christoph
Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; and
Klinik für Interventionelle Radiologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany;
Am J Physiol Heart Circ Physiol. 2015 Jul 15;309(2):H345-59. doi: 10.1152/ajpheart.00683.2014. Epub 2015 May 22.
Although exercise mediates beneficial effects in patients after myocardial infarction (MI), the underlying mechanisms as well as the question of whether an early start of exercise after MI is safe or even beneficial are incompletely resolved. The present study analyzed the effects of exercise before and reinitiated early after MI on cardiac remodeling and function. Male C57BL/6N mice were housed sedentary or with the opportunity to voluntarily exercise for 6 wk before MI induction (ligation of the left anterior descending coronary artery) or sham operation. After a 5-day exercise-free phase after MI, mice were allowed to reexercise for another 4 wk. Exercise before MI induced adaptive hypertrophy with moderate increases in heart weight, cardiomyocyte diameter, and left ventricular (LV) end-diastolic volume, but without fibrosis. In sedentary mice, MI induced eccentric LV hypertrophy with massive fibrosis but maintained systolic LV function. While in exercised mice gross LV end-diastolic volumes and systolic function did not differ from sedentary mice after MI, LV collagen content and thinning of the infarcted area were reduced. This was associated with ameliorated activation of inflammation, mediated by TNF-α, IL-1β, and IL-6, as well as reduced activation of matrix metalloproteinase 9. In contrast, no differences in the activation patterns of various MAPKs or adenosine receptor expressions were observed 5 wk after MI in sedentary or exercised mice. In conclusion, continuous exercise training before and with an early reonset after MI ameliorates adverse LV remodeling by attenuating inflammation, fibrosis, and scar thinning. Therefore, an early reonset of exercise after MI can be encouraged.
尽管运动对心肌梗死(MI)后患者具有有益作用,但其潜在机制以及MI后早期开始运动是否安全甚至有益的问题尚未完全解决。本研究分析了MI前及MI后早期重新开始运动对心脏重塑和功能的影响。将雄性C57BL/6N小鼠分为久坐组或在MI诱导(结扎左冠状动脉前降支)或假手术前有机会自愿运动6周的组。MI后经过5天无运动期后,允许小鼠再运动4周。MI前运动诱导适应性肥大,心脏重量、心肌细胞直径和左心室(LV)舒张末期容积适度增加,但无纤维化。在久坐的小鼠中,MI诱导离心性LV肥大并伴有大量纤维化,但维持LV收缩功能。虽然运动小鼠MI后的LV舒张末期总体积和收缩功能与久坐小鼠无差异,但LV胶原含量和梗死区域变薄减少。这与由TNF-α、IL-1β和IL-6介导的炎症激活改善以及基质金属蛋白酶9的激活减少有关。相比之下,MI后5周,久坐或运动小鼠中各种MAPK的激活模式或腺苷受体表达没有差异。总之,MI前持续运动训练以及MI后早期重新开始运动可通过减轻炎症、纤维化和瘢痕变薄来改善不良LV重塑。因此,可鼓励MI后早期重新开始运动。