Heart failure is the leading cause of hospitalization and a major cause of mortality. A model of permanent ligation of the left anterior descending coronary artery in mice is applied to investigate ventricular remodelling and cardiac dysfunction post-myocardial infarction. The technique of invasive hemodynamic measurements in mice is presented.
Hartfalen is een syndroom waarbij het hart faalt om bloed te pompen met een snelheid evenredig met mobiele zuurstofbehoefte in rust of tijdens stress. Het wordt gekenmerkt door het vasthouden van vocht, kortademigheid en vermoeidheid, met name bij inspanning. Hartfalen is een groeiend probleem voor de volksgezondheid, de belangrijkste oorzaak van ziekenhuisopname, en een belangrijke oorzaak van sterfte. Ischemische hartziekten is de belangrijkste oorzaak van hartfalen.
Kamerdilatatie verwijst naar veranderingen in structuur, grootte en vorm van de linker ventrikel. Deze architecturale hermodellering van de linker ventrikel wordt geïnduceerd door verwonding (bijvoorbeeld myocardinfarct) door drukoverbelasting (bijvoorbeeld systemische arteriële hypertensie en aortastenose), of volume overbelasting. Sinds ventriculaire remodeling beïnvloedt muur stress, het heeft een grote invloed op de hartfunctie en op de ontwikkeling van hartfalen. Een model van permanente ligatie van de linker anterior descending kransslagader bij muizen wordt gebruikt om de ventriculaire remodeling en hartfunctie post-myocardinfarct onderzoeken. Dit model is fundamenteel anders dan in termen van doelstellingen en pathofysiologische relevantie ten opzichte van het model van voorbijgaande ligatie van de linker voorste dalende kransslagader. In dit laatste model van ischemie / reperfusie schade, de aanvankelijke omvang van het infarct worden gemoduleerd door factoren die myocardiale salvage na reperfusie beïnvloeden. Daarentegen wordt het infarct gebied op 24 uur na permanente ligatie van de linker voorste dalende kransslagader vast. Hartfunctie bij dit model zal worden beïnvloed door 1) het proces van uitbreiding van het infarct, infarct genezing en littekenvorming; en 2) de gelijktijdige ontwikkeling van de linker ventrikel dilatatie, hypertrofie van het hart, en ventriculaire remodeling.
Naast het model van permanente ligatie van de linker voorste dalende kransslagader, de techniek van invasieve hemodynamische meaopnieuw metingen bij muizen wordt in detail gepresenteerd.
Heart failure is a syndrome in which the heart fails to pump blood at a rate commensurate with the cellular oxygen requirements at rest or during stress. It is characterized by fluid retention, shortness of breath, and fatigue, in particular on exertion. Heart failure is a growing public health problem, the leading cause of hospitalization, and a major cause of mortality. Ischemic heart disease is the main cause of heart failure1.
Ventricular remodelling refers to changes in structure, size, and shape of the left ventricle. In other words, ventricular remodelling concerns an alteration of the left ventricular architecture. This architectural remodelling of the left ventricle is induced by injury (e.g., myocardial infarction), by pressure overload (e.g., systemic arterial hypertension or aortic stenosis), or by volume overload (e.g., mitral insufficiency). Since ventricular remodelling affects wall stress, it has a profound impact on cardiac function and on the development of heart failure.
Loss of myocardial tissue following acute myocardial infarction results in a decreased systolic ejection and an increased left ventricular end-diastolic volume and pressure. The Frank-Starling mechanism, implying that an increased end-diastolic volume results in an increased pressure developed during systole, may help to restore cardiac output. However, the concomitant increased wall stress may induce regional hypertrophy in the non-infarcted segment, whereas in the infarcted area expansion and thinning may occur. Experimental animal studies show that the infarcted ventricle hypertrophies and that the degree of hypertrophy is dependent on the infarct size2.
The loss of myocardial tissue following acute myocardial infarction results in a sudden increase in loading conditions. Post-infarct remodelling occurs in the setting of volume overload, since the stretched and dilated infarcted tissue increases the left ventricular volume. An increased ventricular volume not only implies increased preload (passive ventricular wall stress at the end of diastole) but also increased afterload (total myocardial wall stress during systolic ejection). Afterload is increased since the systolic radius is increased. Therefore, ventricular remodelling post-myocardial infarction is characterized by mixed features of volume overload and pressure overload.
The myocardium consists of 3 integrated components: cardiomyocytes, extracellular matrix, and the capillary microcirculation. All 3 components are involved in the remodelling process. Matrix metalloproteinases produced by inflammatory cells induce degradation of intermyocyte collagen struts and cardiomyocyte slippage. This leads to infarct expansion characterized by the disproportionate thinning and dilatation of the infarct segment3. In later stages of remodelling, interstitial fibrosis is induced, which negatively affects the diastolic properties of the heart.
The vascular and cardiomyocyte compartment in the myocardium should remain balanced in the process of ventricular remodelling to avoid tissue hypoxia4,5. Whether hypertrophy progresses to heart failure or not may be critically dependent on this balance between the vascular and cardiomyocyte compartment in the myocardium.
A model of permanent ligation of the left anterior descending coronary artery in mice is used to investigate ventricular remodelling and cardiac function post-myocardial infarction. This model is fundamentally different in terms of objectives and pathophysiological relevance compared to the model of transient ligation of the left anterior descending coronary artery. In this latter model of ischemia/reperfusion injury, the initial extent of the infarct may be modulated by factors that affect myocardial salvage following reperfusion6. In contrast, the infarct area at 24 hours after permanent ligation of the left anterior descending coronary artery is fixed. Cardiac function in this model will be affected by 1) the process of infarct expansion, infarct healing, and scar formation; and 2) the concomitant development of left ventricular dilatation, cardiac hypertrophy, and ventricular remodelling.
Chronische veranderingen in myocardiale structuur en functie, kan de ontwikkeling van de linker ventriculaire disfunctie, en progressie van hartfalen te onderzoeken in verschillende muizenmodellen 12. Remodellering en disfunctie kan worden geïnduceerd door myocardinfarct of drukoverbelasting secundaire aorta vernauwing dwarse, of kunnen worden onderzocht in genetische modellen van gedilateerde cardiomyopathie 12. Uiteraard is het meest uitgesproken voordeel van muismodellen is de beschikbaarheid v…
The authors have nothing to disclose.
This work was supported by Onderzoekstoelagen grant OT/13/090 of the KU Leuven and by grant G0A3114N of the FWO-Vlaanderen.
Reagents | |||
Buprenorphine (Buprenex®) | Bedford Laboratories | ||
Sodium Pentobarbital (Nembutal®) | Ceva | ||
Betadine® | VWR internationals | 200065-400 | |
5 – 0 silk suture | Ethicon, Johnson & Johnson Medical | K890H | |
6 – 0 prolene suture | Ethicon, Johnson & Johnson Medical | F1832 | |
6 – 0 Ti- Cron suture | Ethicon, Johnson & Johnson Medical | F1823 | |
Urethane | Sigma | 94300 | |
Alconox | Alconox Inc. | ||
Equipment | |||
Ventilator, MiniVent Model 845 | Hugo Sachs | 73-0043 | |
Chest retractor or Thorax retractor | Kent Scientific corporation | INS600240 | ALM Self-retaining, serrated, 7cm long, 4 x 4 "L" shaped prongs, 3mm x 3mm |
1.0 French Millar pressure catheter | Millar Instruments | SPR – 1000/NR | |
Powerlab | ADInstruments Pty Ltd. | ||
LabChart® software | ADInstruments Pty Ltd. | ||
Rectal probe | ADInstruments Pty Ltd. |