Does Laser Type Impact Myocardial Function Following Transmyocardial Laser Revascularization?
Does Laser Type Impact Myocardial Function Following Transmyocardial Laser Revascularization?
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DOI：
10.1002/lsm.21012
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发表时间：
2010-12-01
影响因子：
2.4
通讯作者：
Horvath, Keith A.
中科院分区：
文献类型：
--
作者：
Estvold, Soren K.;Mordini, Frederico;Horvath, Keith A.
背景资料：激光血管重建术（TMR）目前临床上使用CO2或Ho：YAG激光进行，用于治疗严重心绞痛。虽然这两种激光器提供症状缓解，有显着差异的激光组织的相互作用，具体到每个设备，可能会影响他们的能力，以提高心肌灌注，从而改善收缩功能的缺血heart.Methods：猪模型慢性心肌缺血。在通过电影磁共振成像（MRI）和多巴酚丁胺负荷超声（DSE）收集基线功能数据后，14只动物接受了CO2或Ho：YAG激光TMR。每种激光在缺血区以1/cm（2）的分布创建脑血管通道。给药后6周重复MRI以及DSE，然后处死动物。结果：CO2 TMR治疗后，缺血区室壁增厚改善，电影MRI（40.3%，P < 0.05）和DSE（20.2%，P < 0.05）均较治疗前明显改善。通过MRI（-11.6% vs.基线，P = 0.67）和DSE（16.7% vs.基线，P = 0.08），Ho：YAG治疗组动物的室壁增厚没有改善。相关半定量组织学检查显示Ho：YAG治疗组心肌纤维化指数明显高于CO2治疗组（1.81 vs.0.083，P < 0.05）。结论：在并行比较中，CO2 TMR可改善缺血心肌的功能。Ho：YAG TMR未导致局部功能改善，可能是由于激光区域的纤维化伴随增加。激光外科医学42：746-751，2010年。(C)2010 Wiley-Liss，Inc.
Background: Transmyocardial laser revascularization (TMR) is currently clinically performed with either a CO2 or Ho:YAG laser for the treatment of severe angina. While both lasers provide symptomatic relief, there are significant differences in the laser-tissue interactions specific to each device that may impact their ability to enhance the perfusion of myocardium and thereby improve contractile function of the ischemic heart.Methods: A porcine model of chronic myocardial ischemia was employed. After collecting baseline functional data with cine magnetic resonance imaging (MRI) and dobutamine stress echo (DSE), 14 animals underwent TMR with either a CO2 or Ho: YAG laser. Transmural channels were created with each laser in a distribution of 1/cm(2) in the ischemic zone. Six weeks post-treatment repeat MRI as well as DSE were obtained after which the animals were sacrificed. Histology was preformed to characterize the laser-tissue interaction.Results: CO2 TMRled to improvement in wall thickening in the ischemic area as seen with cine MRI(40.3% vs. baseline, P < 0.05) and DSE (20.2% increase vs. baseline, P < 0.05). Ho: YAG treated animals had no improvement in wall thickening by MRI (-11.6% vs. baseline, P = .67) and DSE ( 16.7% vs. baseline, P = 0.08). Correlative semi-quantitative histology revealed a significantly higher fibrosis index in Ho: YAG treated myocardium versus CO2 (1.81 vs. 0.083, P < 0.05).Conclusions: In a side-by-side comparison CO2 TMR resulted in improved function of ischemic myocardium as assessed by MRI and echocardiography. Ho:YAG TMRled to no improvement in regional function likely due to concomitant increase in fibrosis in the lasered area. Lasers Surg. Med. 42:746-751, 2010. (C) 2010 Wiley-Liss, Inc.