Dose-Dependent Cardioprotection of Moderate (32°C) Versus Mild (35°C) Therapeutic Hypothermia in Porcine Acute Myocardial Infarction.
Dose-Dependent Cardioprotection of Moderate (32°C) Versus Mild (35°C) Therapeutic Hypothermia in Porcine Acute Myocardial Infarction.
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猪急性心肌梗塞中中度（32°C）与轻度（35°C）治疗性低温的剂量依赖性心脏保护。
DOI：
10.1016/j.jcin.2017.08.056
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发表时间：
2018-01-22
期刊：
影响因子：
--
通讯作者：
Yeung A
中科院分区：
文献类型：
--
作者：
Dash R;Mitsutake Y;Pyun WB;Dawoud F;Lyons J;Tachibana A;Yahagi K;Matsuura Y;Kolodgie FD;Virmani R;McConnell MV;Illindala U;Ikeno F;Yeung A
该研究调查了心肌挽救和治疗性低温深度之间是否存在剂量反应。急性心肌梗死（AMI）期间亚低温对心脏的保护作用已经产生了不确定的临床试验结果。快速、深度低温可改善心肌挽救。将经历AMI的猪（n = 24）分配到3个再灌注组：常温（38°C）、轻度（35°C）和中度（32°C）低温。1小时前壁心肌缺血后，血管内快速冷却至目标再灌注温度。再灌注前30 min开始冷却。再灌注前达到目标温度，并维持60分钟。在第6天使用心脏磁共振，氯化三苯基四氮唑和组织病理学评估冠状动脉大小（IS）。所有组中氯化三苯基四氮唑的风险面积（AAR）相等（p = 0.2），但与35°C和38°C相比，32°C分别显示出每个AAR的IS尺寸减少77%和91%，（AAR：38°C，45 ± 12%; 35°C，17 ± 10%; 32°C，4 ± 4%; p < 0.001）并且每LV质量的减少幅度相当（LV质量：38°C，14 ± 5%; 35°C，5 ± 3%; 32°C，1 ± 1%; p < 0.001）。重要的是，与35°C相比，32°C显示出较低的IS AAR（p = 0.013）和增加的免疫组织化学肉芽组织，表明较高的组织挽救。延迟增强心脏磁共振IS LV在32°C下也显示出显著降低（38°C：10 ± 4%，p < 0.001; 35°C：8 ± 3%; 32°C：3 ± 2%，p < 0.001）。第6天的心输出量仅在32°C下保持不变（心输出量减少：38°C，−29 ± 19%，p = 0.041; 35°C：−17 ± 33%; 32°C：−1 ± 28%，p = 0.041）。使用线性回归，预测的IS降低为每1°C再灌注温度降低6.7%（AAR）和2.1%（LV）。与35°C和对照组相比，中度（32°C）治疗性低温显示出上级和接近完全的心脏保护作用，从而促进了对临床应用的进一步研究。
The study investigated whether a dose response exists between myocardial salvage and the depth of therapeutic hypothermia. Cardiac protection from mild hypothermia during acute myocardial infarction (AMI) has yielded equivocal clinical trial results. Rapid, deeper hypothermia may improve myocardial salvage. Swine (n = 24) undergoing AMI were assigned to 3 reperfusion groups: normothermia (38°C) and mild (35°C) and moderate (32°C) hypothermia. One-hour anterior myocardial ischemia was followed by rapid endovascular cooling to target reperfusion temperature. Cooling began 30 min before reperfusion. Target temperature was reached before reperfusion and was maintained for 60 min. Infarct size (IS) was assessed on day 6 using cardiac magnetic resonance, triphenyl tetrazolium chloride, and histopathology. Triphenyl tetrazolium chloride area at risk (AAR) was equivalent in all groups (p = 0.2), but 32°C exhibited 77% and 91% reductions in IS size per AAR compared with 35°C and 38°C, respectively (AAR: 38°C, 45 ± 12%; 35°C, 17 ± 10%; 32°C, 4 ± 4%; p < 0.001) and comparable reductions per LV mass (LV mass: 38°C, 14 ± 5%; 35°C, 5 ± 3%; 32°C 1 ± 1%; p < 0.001). Importantly, 32°C showed a lower IS AAR (p = 0.013) and increased immunohistochemical granulation tissue versus 35°C, indicating higher tissue salvage. Delayed-enhancement cardiac magnetic resonance IS LV also showed marked reduction at 32°C (38°C: 10 ± 4%, p < 0.001; 35°C: 8 ± 3%; 32°C: 3 ± 2%, p < 0.001). Cardiac output on day 6 was only preserved at 32°C (reduction in cardiac output: 38°C, −29 ± 19%, p = 0.041; 35°C: −17 ± 33%; 32°C: −1 ± 28%, p = 0.041). Using linear regression, the predicted IS reduction was 6.7% (AAR) and 2.1% (LV) per every 1°C reperfusion temperature decrease. Moderate (32°C) therapeutic hypothermia demonstrated superior and near-complete cardioprotection compared with 35°C and control, warranting further investigation into clinical applications.
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影响因子：
9.5
作者：
Gotberg, Matthias;van der Pals, Jesper;Erlinge, David
通讯作者：
Erlinge, David
影响因子：
19.7
作者：
Heiberg, Einar;Ugander, Martin;Arheden, Hakan
通讯作者：
Arheden, Hakan
影响因子：
20.1
作者：
BADEER, H
通讯作者：
BADEER, H
DOI：
10.1161/circinterventions.110.957902
发表时间：
2010-10-01
影响因子：
5.6
作者：
Gotberg, Matthias;Olivecrona, Goran K.;Erlinge, David
通讯作者：
Erlinge, David
DOI：
10.1152/ajpheart.00776.2004
发表时间：
2006-03-01
影响因子：
4.8
作者：
Anderson, SE;Liu, H;Cala, PM
通讯作者：
Cala, PM