Duchenne Jürgen, Claus Piet, Pagourelias Efstathios D, Mada Razvan O, Van Puyvelde Joeri, Vunckx Kathleen, Verbeken Eric, Gheysens Olivier, Rega Filip, Voigt Jens-Uwe
Department of Cardiovascular Sciences and Department of Cardiovascular Diseases, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium.
Department of Cardiovascular Sciences and Department of Cardiothoracic Surgery, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium.
Cardiol J. 2019;26(4):375-384. doi: 10.5603/CJ.a2018.0007. Epub 2018 Mar 23.
Pacing the right heart has been shown to induce reversible conduction delay and subse-quent asymmetric remodeling of the left ventricle (LV) in dogs and pigs. Both species have disadvantages in animal experiments. Therefore the aim of this study was to develop a more feasible and easy-to-use animal model in sheep.
Dual-chamber (DDD) pacemakers with epicardial leads on the right atrium and right ven-tricular free wall were implanted in 13 sheep. All animals underwent 8 weeks of chronic rapid pacing at 180 bpm. Reported observations were made at 110 bpm.
DDD pacing acutely induced a left bundle branch block (LBBB) - like pattern with almost doubling in QRS width and the appearance of a septal flash, indicating mechanical dyssynchrony. Atrial pacing (AAI) resulted in normal ventricular conduction and function. During 8 weeks of rapid DDD pacing, animals developed LV remodeling (confirmed with histology) with septal wall thinning (-30%, p < 0.05), lateral wall thickening (+22%, p < 0.05), LV volume increase (+32%, p < 0.05), decrease of LV ejection fraction (-31%, p < 0.05), and functional mitral regurgitation. After 8 weeks, segmental pressure-strain-loops, representing regional myocardial work, were recorded. Switching from AAI to DDD pacing decreased immediately work in the septum and increased it in the lateral wall (-69 and +41%, respectively, p < 0.05). Global LV stroke work and dP/dtmax decreased (-27% and -25%, respectively, p < 0.05).
This study presents the development a new sheep model with an asymmetrically remod-eled LV. Simple pacemaker programing allows direct modulation of regional myocardial function and work. This animal model provides a new and valuable alternative for canine or porcine models and has the potential to become instrumental for investigating regional function and loading conditions on regional LV remodeling.
在犬类和猪类动物中,右心室起搏已被证明会诱发可逆性传导延迟以及随后左心室(LV)的不对称重塑。这两个物种在动物实验中都存在缺点。因此,本研究的目的是开发一种在绵羊中更可行且易于使用的动物模型。
将带有心外膜导线分别置于右心房和右心室游离壁的双腔(DDD)起搏器植入13只绵羊体内。所有动物均接受了8周180次/分钟的慢性快速起搏。报告的观察数据是在110次/分钟时记录的。
DDD起搏急性诱发了类似左束支传导阻滞(LBBB)的模式,QRS波宽度几乎翻倍,并出现间隔闪烁,表明存在机械性不同步。心房起搏(AAI)导致心室传导和功能正常。在8周的快速DDD起搏期间,动物出现了左心室重塑(经组织学证实),间隔壁变薄(-30%,p<0.05),侧壁增厚(+22%,p<0.05),左心室容积增加(+32%,p<0.05),左心室射血分数降低(-31%,p<0.05),以及功能性二尖瓣反流。8周后,记录了代表局部心肌做功的节段压力-应变环。从AAI起搏切换到DDD起搏后,间隔的做功立即减少,而侧壁的做功增加(分别为-69%和+41%,p<0.05)。左心室整体每搏功和dP/dtmax降低(分别为-27%和-25%,p<0.05)。
本研究展示了一种新的具有不对称重塑左心室的绵羊模型的开发。简单的起搏器编程允许直接调节局部心肌功能和做功。这种动物模型为犬类或猪类模型提供了一种新且有价值的替代方案,并且有可能成为研究局部左心室重塑的局部功能和负荷条件的重要工具。