Research for Improving Effects of Clinical after Left Ventricle Repair Surgery on Chronic Cardiac Failure

背景：我们报道了左心室修复术（LVR）治疗缺血性心肌病的初始效果并不持久。血管紧张素转换酶抑制剂（ACE-I）和血管紧张素II受体阻滞剂（ARB）可减轻心肌梗死后的重塑。此外，评估了减轻MI后人心钠素（hANP）重构的作用。方法：（1）血管紧张素转换酶I（ACE- I）干预：结扎左前降支（LAD）建立缺血性心肌病大鼠模型.结扎后4周将大鼠分为2组，分别用ACE-I组（ACE组）和安慰剂组（LVR组）行LVR。通过超声心动图和心导管检查评价左室功能。(2)ABR给药：将大鼠分为2组，LVR + ARB组（ARB组）和LVR+安慰剂组（LVR组）。其他方法同上。(3)结扎大鼠前降支（LAD）后，随机分为两组，ANP组静脉注射hANP，对照组静脉注射生理盐水。给药后1或2周通过超声心动图和导管评估LV功能。结果：（1）（2）ACE组和ARB组左室舒张末期面积明显小于LVR组。LVR后4周，ACE组E-max明显高于LVR组。(3)心肌梗死后1周和2周hANP组LVEDA明显小于对照组，FAC明显高于对照组。结论：1. LVR后给予ACE或ARB可防止再扩张并维持LV功能。2.静脉注射ANP可缩小梗死面积，维持左室功能。

Background: We reported that the initial effects of left ventricular repair surgery (LVR) for ischemic cardiomyopathy were not long lasting. Angiotensin-converting enzyme inhibitor (ACE-I) and Angiotensin-II receptor blocker (ARB) are known to attenuate remodeling after MI. Addition, the effect to attenuate remodeling of human atrial natriuretic peptide (hANP) after MI was estimated. Method: (1) ACE- I administration: Ischemic cardiomyopathy rats were developed after LAD ligation. Rats were divided 2groups, LVR with ACE-I (ACE Group) and LVR with placebo (LVR Group) at 4weeks after LAD ligation, and rats in 2 groups were underwent LVR by plication. LV function was evaluated by echocardiography and catheterization. (2) ABR administration: Rats were divided 2groups, LVR with ARB (ARB Group) and LVR with placebo (LVR Group). Other methods were underwent same as above. (3) Rats were divided into 2 groups after LAD ligation, an ANP group were intravenously administrated with hANP, Control group were with saline. LV function was estimated by echocardiography and catheter 1 or 2 week after administration. Results: (1)(2) LV end diastolic area in ACE Group and ARB Group was smaller than LVR Group, significantly. E-max in ACE Group was significant higher than LVR Group 4 weeks after LVR. (3) LVEDA in hANP Group was small than Control Group and FAC in hANP Group was significant higher 1 and 2 weeks after MI. Conclusion: 1. Administration of ACE or ARB after LVR was preventing re-dilation and maintaining LV function. 2. Intravenous administration of ANP reduced infarct size and maintained LV function.