Physiological Implications of Myocardial Scar Structure.
Physiological Implications of Myocardial Scar Structure.
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DOI：
10.1002/cphy.c140067
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发表时间：
2015-09-20
影响因子：
5.8
通讯作者：
Holmes JW
中科院分区：
文献类型：
--
作者：
Richardson WJ;Clarke SA;Quinn TA;Holmes JW
一旦心肌在心脏病发作期间死亡，它就会在几周内被疤痕组织取代。愈合疤痕的大小、位置、成分、结构和机械性能都是决定最初脑梗塞患者命运的关键因素。虽然疤痕结构在决定泵功能和重塑方面的核心重要性早已被认识到，但事实证明，设计通过改变疤痕结构来改善心功能或限制重塑的治疗方法非常困难。许多令人兴奋的新疗法正在开发中，但要预测它们的长期效果，需要详细了解梗死性瘢痕是如何形成的，它的性质如何影响左心功能和重塑，以及疤痕结构和性质的变化如何反馈不仅影响心脏力学，还影响电传导、反射性血流动力学补偿和正在进行的瘢痕形成本身的过程。在本文中，我们概述了心肌梗死后的瘢痕形成过程，讨论了在恢复性脑梗塞时心功能的标准测量方法的解释，然后提出了梗死后瘢痕的几何和结构对心脏机械和电功能的影响，并总结了迄今旨在改变瘢痕几何和结构的治疗干预经验。从本文综述的研究中得出的一个重要结论是，计算模型是整合了解这一复杂系统和预测新疗法对心肌梗死后瘢痕愈合、心功能和重塑的影响所需的丰富信息的重要工具。
Once myocardium dies during a heart attack, it is replaced by scar tissue over the course of several weeks. The size, location, composition, structure and mechanical properties of the healing scar are all critical determinants of the fate of patients who survive the initial infarction. While the central importance of scar structure in determining pump function and remodeling has long been recognized, it has proven remarkably difficult to design therapies that improve heart function or limit remodeling by modifying scar structure. Many exciting new therapies are under development, but predicting their long-term effects requires a detailed understanding of how infarct scar forms, how its properties impact left ventricular function and remodeling, and how changes in scar structure and properties feed back to affect not only heart mechanics but also electrical conduction, reflex hemodynamic compensations, and the ongoing process of scar formation itself. In this article, we outline the scar formation process following an MI, discuss interpretation of standard measures of heart function in the setting of a healing infarct, then present implications of infarct scar geometry and structure for both mechanical and electrical function of the heart and summarize experiences to date with therapeutic interventions that aim to modify scar geometry and structure. One important conclusion that emerges from the studies reviewed here is that computational modeling is an essential tool for integrating the wealth of information required to understand this complex system and predict the impact of novel therapies on scar healing, heart function, and remodeling following myocardial infarction.