Early repair of moderate ischemic mitral regurgitation reverses left ventricular remodeling
Early repair of moderate ischemic mitral regurgitation reverses left ventricular remodeling
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DOI：
10.1161/circulationaha.106.681114
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发表时间：
2007-09-11
期刊：
影响因子：
37.8
通讯作者：
Levine, Robert A.
中科院分区：
文献类型：
--
作者：
Beeri, Ronen;Yosefy, Chaim;Levine, Robert A.
Background - Mitral regurgitation (MR) doubles postmyocardial infarction (MI) mortality. We have shown that moderate MR augments remodeling in an apical MI model ( no intrinsic MR) with independent left ventricle-to-left atrial MR-type flow. We hypothesized that repairing moderate MR 1 month after MI reverses this remodeling.Methods and Results - Anteroapical MIs were created in 18 sheep, and a left ventricle-to-left atrial shunt implanted in 12 (regurgitant fraction, 30%). Six sheep had the shunt closed at 1 month ( repair group). Sheep were compared at baseline, and at 1 and 3 months. Sheep in the MI + MR (unrepaired) and repaired groups remodeled during the first month (120% increased left ventricular end-systolic volume [ESV; P < 0.01]), but shunt closure reversed remodeling at 3 months, with end-diastolic volume (EDV) and ESV 135% and 128% of baseline versus 220% and 280% without repair (P < 0.001). At 3 months, dP/dt and preload-recruitable stroke work were relatively maintained in the repaired and MI-only groups versus nearly 50% decreases without repair. Prohypertrophic gp130 and antiapoptotic pAkt increased followed by exhaustion below baseline without repair, but remained elevated at 3 months with repair or MI only. With repair, matrix metalloproteinase-2 decreased to
