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左心室负荷长期减轻对心肌重塑的作用:对两项异位心脏移植技术的多参数评估

Effect of chronic left ventricular unloading on myocardial remodeling: Multimodal assessment of two heterotopic heart transplantation techniques

来源:Scopus 发布时间:2016-5-23
作者:Liu Y, Maureira P, Gauchotte G, Falanga A, Marie V, Olivier A, Groubatch F, Gu C, Marie PY, Tran N.
机构: 法国南希,南希大学医学中心心血管外科及心脏移植科;法国南希,洛林大学外科系;中国武汉,武汉大学中南医院胸心血管外科
期刊: J HEART LUNG TRANSPL 2016年4月4期34卷

Background Cardiac recovery is possible by means of mechanical unloading yet remains rare. Excessive unloading-associated myocardial atrophy and fibrosis may adversely affect the process of reverse remodeling. In this study, we sought to evaluate the effect of different intensities of chronic left ventricular (LV) unloading on myocardial remodeling. Methods Twenty-five isogenic Lewis rats underwent complete LV unloading (CU, n = 15) induced by heterotopic heart transplantation or partial LV unloading (PU, n = 10) by heterotopic heart-lung transplantation. Information obtained from serial echocardiography, 2-deoxy-2[18F]fluoro-d-glucose (18F-FDG)-positron emission tomography, and an LV pressure-volume catheter were used to evaluate the morphology, glucose metabolism, and hemodynamic performance of the orthotopic hearts and heterotopic transplants over 4 weeks. Cell size, collagen content, tissue cytokines (interleukin [IL]-1α, IL-2, IL-6, IL-10, tumor necrosis factor-α, and vascular endothelial growth factor), and matrix metalloproteinase-2 and -9 were also determined. The recorded parameters included LV end-systolic dimension, LV end-diastolic dimension, posterior wall thickness, diastolic interventricular septum thickness, LV fractional shortening, and LV ejection fraction. Results We demonstrated an LV load-dependent relationship using echo-based structural (left posterior wall thickness, diastolic interventricular septum thickness, and left ventricular end-diastolic dimension) and functional (LV fractional shortening and LV ejection fraction) parameters, as well as an 18F-FDG uptake (all p < 0.05). This load-dependent relationship was also evidenced in measurements from the pressure-volume conductance catheter (stroke volume, stroke work, cardiac output, dP/dTmax, and -dP/dTmin; all p < 0.05). Significant myocardial atrophy and fibrosis were observed in unloaded hearts, whereas concentrations of cytokines and matrix metalloproteinases were comparable in both unloading conditions. Conclusions Partial and complete unloading affected the remodeling of non-failing hearts in a rodent model to different extents on myocardial atrophy, fibrosis, glucose metabolism, and mechanical work. Cardiac atrophy is the prominent change after mechanical unloading, which exaggerates the proportion of total collagen that is responsible for diastolic dysfunction. © 2015 International Society for Heart and Lung Transplantation. All rights reserved.

 

通讯作者:Department of Cardiovascular Surgery And Heart Transplantation, Centre Hospitalier Universitaire-Nancy, Nancy, France; School of Surgery, Unité Institut National de la Santé et de la Recherche Médicale 1116, Université de Lorraine, Nancy, France; Department of Cardiothoracic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China.
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