Time course of reverse remodelling of the left ventricle during support with a left ventricular assist device
Time course of reverse remodelling of the left ventricle during support with a left ventricular assist device
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DOI：
10.1067/mtc.2001.112632
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发表时间：
2001-05-01
影响因子：
6
通讯作者：
Burkhoff, D
中科院分区：
文献类型：
--
作者：
Madigan, JD;Barbone, A;Burkhoff, D
背景：在心力衰竭患者中，左心室辅助装置的支持导致左心室几何形状的正常化，左心室胶原含量的肌细胞肥厚改变的回归，以及与兴奋-收缩耦合相关的基因的正常化表达。本研究的目的是探讨这些过程的时间进程。19例心衰患者接受无左心室辅助装置支持的移植，25例移植前支持的心衰患者（支持持续时间为S ~ 155天），5例不适合移植的正常人心脏，获得被动左心室压力-容量关系，左心室大小以左心室压力达到30 mm Mg时的体积为指标。检测左心室组织样本肌浆内膜钙腺苷三磷酸酶2a的表达，分析心肌细胞直径和相对心肌胶原含量。结果:无辅助装置支持和有辅助装置支持小于40天的心脏左室压达到30 mm Hg的体积差异不显著，但有辅助装置支持超过40天的患者左室压达到30 mm Ha的体积明显小于无辅助装置支持的心脏，但大于正常心脏。肌细胞直径也观察到类似的模式，肌浆内膜钙腺苷三磷酸酶2a的表达在辅助装置支持约20天后增加到正常水平。结论：左心室辅助装置最大限度的结构逆转重构在40天左右完成，肌浆内膜钙腺苷三磷酸酶2a表达的分子逆转重构更快。20天左右完成。
Background: Support with a left ventricular assist device leads to normalization of left ventricular chamber geometry, regression of myocyte hypertrophy alterations in left ventricular collagen content, and normalized expression of genes involved with excitation-contraction coupling in patients with heart failure. The objective of this study was to investigate the time course of these processes,Methods: Passive left ventricular pressure-volume relationships were obtained from explanted hearts of 19 patients with heart failure undergoing transplantation without left ventricular assist device support, 25 patients with heart failure supported before transplantation (duration Of support ranging between S and 155 days), and 5 normal human hearts not suitable for transplantation, left ventricular size was indexed by the volume at which left ventricular pressure reached 30 mm Mg, Left ventricular tissue samples were probed for sarcoplasmic endoreticular calcium adenosine triphosphatase 2a expression and processed for analysis of myocyte diameter and relative myocardial collagen content.Results: The volume at which left ventricular pressure reached 30 mm Hg was not significantly different between hearts without and with assist device support for less than 40 days, However, the volume at which left ventricular pressure reached 30 mm Ha in patients with assist devices supported for more than 40 days was significantly smaller than that of the hoar ts without assist devices but was larger than that of normal hearts, A similar pattern was observed for myocyte diameter Sarcoplasmic endoreticular calcium adenosine triphosphatase 2a expression increased to normal levels by about 20 days of support with an assist device. Relative collagen content was significantly increased in hearts supported for more than 40 days,Conclusion: Maximum structural reverse remodeling by left ventricular assist devices is complete by about 40 days, Molecular reverse remodeling of sarcoplasmic endoreticular calcium adenosine triphosphatase 2a expression is quicker? being complete by about 20 days.