Intrapulmonary shear stress enhancement: A new therapeutic approach in acute myocardial ischemia
Intrapulmonary shear stress enhancement: A new therapeutic approach in acute myocardial ischemia
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DOI：
10.1016/j.ijcard.2013.07.107
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发表时间：
2013-10-09
影响因子：
3.5
通讯作者：
Wu, Guifu
中科院分区：
文献类型：
--
作者：
Nour, Sayed;Yang, Daya;Wu, Guifu
目的：缺血性心脏病（IHD）是导致死亡的主要原因，目前的治疗效果不足，很可能是由于持续的内皮功能障碍所致。或者，我们提出了一种使用肺内脉动导管促进内皮剪切应力 (ESS) 增强的新治疗方法。 方法：将 12 只仔猪分成相等的组，每组 6 只：脉动 (P) 和非脉动 (NP)，通过胸骨切开术接受永久性左冠状动脉前降支结扎。缺血1小时并注射肝素（150 IU/kg）后：在P组中，将脉动导管引入肺干并间歇性脉动超过1小时，且与心率无关（110 bpm）。 NP组给予硝酸盐（7±2mg/kg/min）1小时。结果：P组6只动物均在缺血120分钟后存活，而NP组仅2只动物存活。 NP组实验期间死亡的4只动物存活了93+/-14分钟。与 NP 组相比，P 组的血流动力学和心输出量 (CO) 显着改善：CO 分别为 0.92 +/- 0.15 和 NP 组的 0.52 +/- 0.08（L/min；p < 0.05）。与 NP 组相比，P 组的血管阻力 (dynes.s.cm(-5)/kg) 显着降低 (p < 0.05)：肺阻力分别为 119 +/- 13 与 400 +/- 42，全身阻力分别为 319 +/- 43 与 1857 +/- 326。 P 组 (0.66 +/- 0.07) 的心肌细胞凋亡显着 (p < 0.01) 低于 NP 组 (4.18 +/- 0.27)。 P组心肌内皮NO合酶mRNA表达量（0.90+/-0.09）显着高于NP组（0.25+/-0.04）（p<0.01）。结论：肺内搏动导管可以改善急性心肌缺血时的血流动力学和心肌收缩力。这是一种经济高效的方法，适合优先考虑紧急情况，无论经典冠状动脉再灌注如何。 (C) 2013 Elsevier Ireland Ltd. 保留所有权利。
Objective: Ischemic heart disease (IHD) is a leading cause of mortality with insufficient results of current therapies, most probably due to maintained endothelial dysfunction conditions. Alternatively, we propose a new treatment that promotes endothelial shear stress (ESS) enhancement using an intrapulmonary pulsatile catheter.Methods: Twelve piglets, divided in equal groups of 6: pulsatile (P) and non-pulsatile (NP), underwent permanent left anterior descending coronary artery ligation through sternotomy. After 1 h of ischemia and heparin injection (150 IU/kg): in P group, a pulsatile catheter was introduced into the pulmonary trunk and pulsated intermittently over 1 h, and irrespective of heart rate (110 bpm). In NP group, nitrates were given (7 +/- 2 mg/kg/min) for 1 h.Results: In P group all 6 animals survived ischemia for 120 min, but in NP group only 2 animals survived. The 4 animals that died during the experiment in NP group survived for 93 +/- 14 min. Hemodynamics and cardiac output (CO) were significantly improved in P group compared with NP group: CO was 0.92 +/- 0.15 vs. 0.52 +/- 0.08 in NP group (L/min; p < 0.05), respectively. Vascular resistances (dynes.s.cm(-5)/kg) were significantly (p < 0.05) lower in P group versus NP group: pulmonary resistance was 119 +/- 13 vs. 400 +/- 42 and systemic resistance was 319 +/- 43 vs. 1857 +/- 326, respectively. Myocardial apoptosis was significantly (p < 0.01) lower in P group (0.66 +/- 0.07) vs. (4.18 +/- 0.27) in NP group. Myocardial endothelial NO synthase mRNA expression was significantly (p < 0.01) greater in P group (0.90 +/- 0.09) vs. (0.25 +/- 0.04) in NP group.Conclusions: Intrapulmonary pulsatile catheter could improve hemodynamics and myocardial contractility in acute myocardial ischemia. This represents a cost-effective method, suitable for emergency setting as a first priority, regardless of classical coronary reperfusion. (C) 2013 Elsevier Ireland Ltd. All rights reserved.