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適度な不血性ミトラル逆流の早期修復は,左心室の改造を逆転させる:機能的および分子学的研究
Ronen Beeri1, Chaim Yosefy, J Luis Guerrero
1Cardiac Ultrasound Laboratory, Cardiovascular Research Center, and Cardiothoracic Surgery Department, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
Circulation
|September 14, 2007
まとめ
心臓発作 (心筋梗塞) の後,中程度の心筋回 (MR) を修復することで,不良心筋の再構築が逆転する. 早期修復は心臓の機能を改善し,負の分子変化を減少させ,患者に潜在的な利益をもたらします.
科学分野:
- 心血管科学の研究について
- 心臓外科手術について
- 再生医学は,再生医療である.
背景:
- 心筋梗塞 (MI) の後のミトラル吐 (MR) は死亡率を倍増させる.
- 適度なMRIは,アピカルMI後の心臓のリモデリングを増加させます.
- 以前の研究で,MRと心筋梗塞後の不良心改造との関連が確認された.
研究 の 目的:
- アピカルMIの1ヶ月後に中程度のMRを修復することで,心臓のリモデリングを逆転させることができるかどうかを調査する.
- 左心室の体積と心臓の収縮性に対するMR修復の影響を評価する.
- MR修復が細胞内信号伝達経路とマトリックスメタルプロテインアース活性に及ぼす影響を分析する.
主な方法:
- 羊の群れでは,抗うつ薬のMIが誘発された.
- 左心室から左心房へのシャントが埋め込まれ,中等度のMR (30%の逆流分数) を生み出しました.
- シャントはMI後1ヶ月で修復グループで閉鎖され,対照グループには,修復されていないMRとMIのみのMIが含まれていました.
主要な成果:
- 修復群は3ヶ月で逆転した再建を示し,左心室の末期ダイアストリック容量と末期シストリック容量は,修復されていないMRと比較して基値に有意に近い.
- 心臓の収縮性 (dP/dt,プレロード・リクルート可能な脳卒中作業) は,修復されたグループと修復されていないグループでより良く維持されました.
- 主要なプロハイパートロフィックおよびアンチアポプトティック細胞内信号は,修復されたグループでは上昇し続け,マトリックスタンパク質分解活性は低下しました.
結論:
- アピカルMIに続く中程度のMRの早期修復は,漸進的な心臓の改造を大幅に逆転させます.
- 修復により,左心室の体積が減少し,収縮性が維持され,細胞内信号伝達が好調になる.
- これらの発見は,特定のポストMI患者集団における早期MR修復を検討することを支持しています.
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