Liao Ruoxi, Li Zhihong, Wang Qiancheng, Lin Hairuo, Sun Huijun
Department of Clinical Medicine, Dalian Medical University, Dalian, China.
State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Front Cardiovasc Med. 2022 Aug 25;9:940808. doi: 10.3389/fcvm.2022.940808. eCollection 2022.
Coronary chronic total occlusion (CTO) contributes to the progression of heart failure in patients with ischemic cardiomyopathy. Randomized controlled trials demonstrated that percutaneous coronary intervention (PCI) for CTO significantly improves angina symptoms and quality of life but fails to reduce clinical events compared with optimal medical therapy. Even so, intervening physicians strongly support CTO-PCI. Cardiac regeneration therapy after CTO-PCI should be a promising approach to improving the prognosis of ischemic cardiomyopathy. However, the relationship between CTO revascularization and cardiac regeneration has rarely been studied, and experimental studies on cardiac regeneration usually employ rodent models with permanent ligation of the coronary artery rather than reopening of the occlusive artery. Limited early-stage clinical trials demonstrated that cell therapy for cardiac regeneration in ischemic cardiomyopathy reduces scar size, reverses cardiac remodeling, and promotes angiogenesis. This review focuses on the of CTO-PCI in ischemic cardiomyopathy and the clinical prospect of cardiac regeneration in this setting.
冠状动脉慢性完全闭塞（CTO）会促使缺血性心肌病患者心力衰竭的进展。随机对照试验表明，与最佳药物治疗相比，针对CTO的经皮冠状动脉介入治疗（PCI）能显著改善心绞痛症状和生活质量，但无法减少临床事件。即便如此，介入治疗医生仍强烈支持CTO-PCI。CTO-PCI后的心脏再生治疗应该是改善缺血性心肌病预后的一种有前景的方法。然而，CTO血运重建与心脏再生之间的关系鲜有研究，而且心脏再生的实验研究通常采用永久性结扎冠状动脉的啮齿动物模型，而非重新开通闭塞动脉。有限的早期临床试验表明，针对缺血性心肌病进行心脏再生的细胞治疗可减小瘢痕大小、逆转心脏重塑并促进血管生成。本综述重点关注CTO-PCI在缺血性心肌病中的作用以及在此背景下心脏再生的临床前景。
