Restraining infarct expansion preserves left ventricular geometry and function after acute anteroapical infarction.
Restraining infarct expansion preserves left ventricular geometry and function after acute anteroapical infarction.
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DOI：
10.1161/01.cir.100.25.e152
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发表时间：
1999-01
期刊：
影响因子：
37.8
通讯作者：
R. Edwards;M. Marber
中科院分区：
文献类型：
--
作者：
R. Edwards;M. Marber
背景--急性心肌梗死扩大预示着进行性左心室(LV)扩大、功能恶化和早期死亡。这项研究验证了抑制急性梗塞扩大可以保留左室构型和静息功能的假说。方法和结果：在23只绵羊的冠状动脉左前降支和第二对角线远端分别放置圈套。在12只绵羊中，通过在预期的心肌梗死上放置Marlex网片来防止心肌梗死变形。10~14天后结扎结扎动脉。左心室前心尖梗死0.23块后8周进行动态血流动力学检测和横隔膜定量超声心动图检查。在有网眼的绵羊中，循环血流动力学、每搏功和收缩末期弹性在梗死后1周恢复到梗死前的值，随后不会改变。心肌梗死后第一周，心室容量和射血分数无明显变化。对照组动物出现较大的前心尖室壁瘤，左室扩张增加，循环血流动力学和心功能进行性恶化。在第8周，两组间左室舒张末压、心输出量、舒张末和收缩末期容量、射血分数、每搏功和收缩末期弹性有显著差异(P<；0.01)。结论：预防急性心肌梗死扩大可保留左室构型和功能。
Background —Expansion of an acute myocardial infarction predicts progressive left ventricular (LV) dilatation, functional deterioration, and early death. This study tests the hypothesis that restraining expansion of an acute infarction preserves LV geometry and resting function. Methods and Results —In 23 sheep, snares were placed around the distal left anterior descending and second diagonal coronary arteries. In 12 sheep, infarct deformation was prevented by Marlex mesh placed over the anticipated myocardial infarct. Snared arteries were occluded 10 to 14 days later. Serial hemodynamic measurements and transdiaphragmatic quantitative echocardiograms were obtained up to 8 weeks after anteroapical infarction of 0.23 of LV mass. In sheep with mesh, circulatory hemodynamics, stroke work, and end-systolic elastance return to preinfarction values 1 week after infarction and do not change subsequently. Ventricular volumes and ejection fraction do not change after the first week postinfarction. Control animals develop large anteroapical ventricular aneurysms, increasing LV dilatation, and progressive deterioration in circulatory hemodynamics and ventricular function. At week 8, differences in LV end-diastolic pressure, cardiac output, end-diastolic and end-systolic volumes, ejection fraction, stroke work, and end-systolic elastance are significant ( P <0.01) between groups. Conclusions —Preventing expansion of acute myocardial infarctions preserves LV geometry and function.