Mechanism of cardiac functional improvement by biventricular pacing

双心室起搏改善心功能的机制

• 批准号: 13670730
• 负责人: OTSUJI Yutaka
• 金额: $ 0.26万
• 依托单位: Kagoshima University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 2001
• 资助国家: 日本
• 起止时间: 2001 至 2002
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-13670730/
• 关键词: Biventricular pacing; Functional mitral regurgitation; 虚血性僧帽弁逆流; 両室ペーシング; 心エコー法; functional mitral regurgitation

Left ventricular (LV) dysfunction was induced in an anesthetized and open chest pig by infusion of esmolol (400 - 500 μg/kg/min) and phenylephrine (200 - 300 μg/kg/min), and mild but significant functional mitral regurgitation (MR) was created. The heart rate was kept constant (100 beats/min) by atrial pacing. LV function was evaluated by LV peak + and -dP/dt. MR was quantified by proximal isovelocity surface area (PISA) method. Addition of right ventricular pacing (atrio-ventricular sequential pacing) resulted in significant decrease in LV peak + dP/dt (1192±30 to 874±178, p<0.01) and LV peak - dP/dt (- 829±78 to - 744±148, p<0.01), which was accompanied by significant increase in MR volume (4.2±2.4 to 12.0±2.7 ml/beat, p<0.01). Addition of LV pacing (biventricular pacing) failed to improve LV function (LV + dP/dt: 874±178 to 798±64, n.s., LV-dP/dt: -744±148 to - 681±91, n.s.) and MR volume did not significantly changed either (12.0±2.7 to 13.0±5.1 ml/beat, n.s.). These results suggest that LV dysfunction by asynchrony with reduced peak LV + and - dP/dt results in worsening of functional MR. Cardiac re-synchronization therapy with biventricular pacing is expected to improve LV dysfunction and worsened functional MR by asynchrony, however, it was not effective in this animal model, requiring further investigations.

麻醉开胸猪静脉注射艾司洛尔(4 0 0~5 0 0μg/kg/m in)和苯肾上腺素(2 0 0~30 0μg/kg/m in)诱导左心功能不全，出现轻度但明显的功能性二尖瓣反流(MR)。通过心房起搏保持心率恒定(100次/分钟)。用LV峰值+和-dp/dt评价左心功能，用近端等速表面积(PISA)法定量评价MR。加用右室起搏后，LV峰值+dp/dt(1192±30)、LV峰值-dp/dt(-829±78)、LV峰值-dp/dt(-744±148)显著降低(P<0.01)，MR容积显著增加(4.2±2.4至12.0±2.7ml/次，P&lt；0.01)。加用左室起搏(双室起搏)不能改善左心功能(LV+dp/dt：874±178至798±，N.S.，LV-dp/dt：-744±148至-681±91，N.S.)MR血流量无明显变化(12.0±2.7至13.0±5.1ml/次，N.S.)。这些结果表明，异步性左心功能不全与LV+和-dp/dt峰值降低导致功能性MR的恶化。双室起搏心脏再同步治疗有望改善LV功能障碍，并使非同步性功能MR恶化，但在该动物模型中效果不佳，有待进一步研究。

项目成果

Otsuji Y, et al.: "Isolated annular dilatation does not usually cause important functional mitral regurgitation : comparison between patients with lone atrial fibrillation and those with idiopathic or ischemic cardiomyopathy"Journal of the American Colleg

Otsuji Y 等人：“孤立性瓣环扩张通常不会引起重要的功能性二尖瓣反流：孤立性心房颤动患者与特发性或缺血性心肌病患者之间的比较”美国大学杂志

Otsuji Y, et al.: "Isolated annular dilatation does not usually cause important functional mitral regurgitation"Journal of the American College of Cardiology. 39. 1651-1656 (2002)

Otsuji Y 等人：“孤立性瓣环扩张通常不会引起重要的功能性二尖瓣反流”美国心脏病学会杂志。

Otsuji Y, Minagoe S, Tei C, et al.: "Isolated annular dilatation does not usually cause important functional mitral regurgitation: comparison between patients with lone atrial fibrillation and those with idiopathic or ischemic cardiomyopathy"Journal of th

Otsuji Y、Minagoe S、Tei C 等人：“孤立性瓣环扩张通常不会引起重要的功能性二尖瓣关闭不全：孤立性心房颤动患者与特发性或缺血性心肌病患者之间的比较”杂志

Kumanohoso T, Otsuji Y, et al.: "Mechanism of higher incidence of ischemic mitral regurgitation in patients with inferior myocardial infarction"The Journal of Thoracic and Cardiovascular Surgery. 125. 135-143 (2003)

Kumanohoso T、Otsuji Y 等：“下壁心肌梗死患者缺血性二尖瓣反流发生率较高的机制”《胸心血管外科杂志》。