大鼠心肌缺血再灌注后冠状动脉流动储备评价
Summary
冠状动脉流动储备(CFR),定义为最大冠状动脉血流与休息冠状动脉血流的比例。我们提出了通过超声波评估大鼠CFR的协议,这为在没有阻塞性冠心病的情况下预测心血管危险因素提供了机会。
Abstract
冠状动脉疾病是全世界的主要死因。急性心肌梗死后,通过冠状动脉的再造进行早期和成功的心肌干预是减少缺血性心肌大小的最有效的策略。冠状微血管在体内无法可视化和成像,但有几个侵入性和非侵入性技术可用于评估直接依赖于冠状微血管功能的参数。缺血再灌注后的内皮功能也可通过冠状动脉流动储备(CFR)在冠状动脉循环水平上进行评估。在这项研究中,在休息和压力挑战(多布他明诱导)期间,通过跨胸多普勒超声心动图在大鼠体内测量左前下降(LAD)冠状动脉的峰值速度。正常心脏在压力诱导期间,其冠状动脉血液流量可增加至静息值的四倍以上。继缺血再灌注后,我们发现CFR显著减少,可作为冠状微血管功能障碍的标志。CFR打开了一扇关于微血管功能障碍重要性的窗口,并已证明可以预测心血管风险,而与是否存在严重的阻塞性疾病无关。
Introduction
心肌缺血再灌注(IR)是血液供应仅限于心脏,然后恢复灌注和同时再氧1的条件。冠状动脉的闭塞可由栓塞或胆固醇斑块破裂引起,导致代谢供求严重失衡,导致组织缺氧。通过再灌注疗法,抢救危害性心肌,改善左心室功能,提高急性心肌梗死患者的存活率。然而,在冠状动脉重新血管化后,小冠状血管的功能异常可能发生2、3、4、5。尽管冠状动脉流动已经恢复,但相当一部分患者(可能多达40%)不会恢复微血管和心肌灌注。冠状微血管的可视化和评估在体内可能很困难,但有许多侵入性和非侵入性技术可以直接根据冠状微血管功能评估参数6 ,7.此外,内皮功能可以通过CFR5在冠状环流水平上进行评估。
跨胸多普勒超声心动图是一种非侵入性工具,它使我们能够研究冠状动脉流速和CFR 5。CFR表示最大冠状动脉血流与休息冠状动脉血流比8。在压力挑战期间,正常心脏增加冠状动脉血流量,比休息值高四倍。当CFR减少9时,心血管风险增加。石原等人显示,CFR在冠状血管造形5后立即严重受损。在没有冠状动脉狭窄的情况下,CFR在冠状微血管功能障碍期间减少,在大约一半的冠状动脉疾病10患者中存在。
该方法的总体目标是通过超声心动图对大鼠左前下冠状动脉(LAD)功能进行非侵入性可视化,用于计算CFR。这为诊断微血管功能障碍和评估潜在的治疗提供了重要的评估工具。
Protocol
Representative Results
Discussion
本研究的主要发现是,即使在没有任何残留血管狭窄的情况下,IR也会增加休息的LAD冠状动脉速度,并损害CFR。
了解冠状动脉生理学是心脏病学家治疗冠状动脉疾病的临床决策的重要组成部分。CFR是了解冠状微循环病理生理学的重要功能参数之一。CFR是一种评估冠状动脉狭窄和冠状动脉微血管循环的非侵入性方法,是心肌供血指标,明确?…
Disclosures
The authors have nothing to disclose.
Acknowledgements
我们要感谢赫尔姆斯利基金会提供超声波设备来进行我们的实验。这项工作得到了NIA R01 053585赠款的支持。
Materials
| 10 mL syringe | BD Syringe | 302995 | |
| 250S 13–24 MHz linear probe | FUJIFILM VisualSonics Inc | ||
| Dobutamine hydrochloride | Sigma | D0676-10mg | |
| Isoflurane | RRC | 27376 | |
| Legato 100 Syringe pump | KD Scientific | 788100 | |
| Vevo 3100 | FUJIFILM VisualSonics Inc | ||
| Winged infusion set, 27G x 1/2", | Medline.com | TMOSV27ELZ |
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