实时心肌声学造影评价体外心脏震波对急性心肌梗死猪的促血管生成作用

Extracorporeal cardiac shock wave therapy promotes angiogenesis after acute myocardial infarction in pigs evaluated by real-time myocardial contrast echocardiography

目的:用实时心肌声学造影的方法观察体外心脏震波对急性心肌梗死猪冠状动脉微循环的作用。方法:健康成年家猪10头,随机分为震波治疗A组(n=5)和对照B组(n=5),以自制球囊的方法介入堵闭冠状动脉前降支制造急性前壁心梗模型。应用GE Vivid 7彩色超声诊断仪和SonoVue超声造影剂,分别在急性心肌梗死前、梗死后1d和梗死后1月行实时心肌声学造影检查。按照美国超声心动图学会推荐的16节段划分法,将前降支供血区域锁定为间隔中段、间隔心尖段、前壁中段、前壁心尖段。应用瑞士Storz Medical公司生产的震波治疗仪,A组猪在梗死后第3d行震波治疗,每个缺血区进行9点治疗(-1～0～+1两两组合),每点释放200次脉冲,每次脉冲能量为0.09mJ/mm2,每周治疗3次,持续3周共9次。结果:10头猪急性心肌梗死模型均顺利建成。随访期间A组死亡1头,死亡率20%;B组死亡2头,死亡率40%。震波过程中无心律失常和猝死等并发症发生。A组(n=4)和B组(n=3)梗死前靶心肌血流灌注良好,A.K值差异无统计学意义。梗死后1d,4个节段血流量明显下降,2组各个节段梗死前后自身对照,A.K值差异有统计学意义(P<0.05)。梗死后1月与梗死后1d相比,A组4个节段A.K值较B组明显增高(P<0.05),其中,室壁中段的改善程度优于室壁心尖段(86.57%vs 65.54%),而B组各个节段改变甚微。结论:体外心脏震波是一项无创、安全的血管再生疗法,可促进急性心肌梗死猪缺血区域的侧支循环建立,提高局部心肌血流灌注。

Objective:To evaluate the effect of neovascularization of extracorporeal cardiac shock wave therapy in a porcine model in vivo.Methods:Acute myocardial infarction was created by balloon occlusion of left anterior descending coronary artery and two different groups were divided(n=5 each).Real-time myocardial contrast echocardiography was performed before infarction and 1 day,1 month after infarction.In group A,the shock wave therapy was started 3 days after acute myocardial infarction and applied 9 sessions on 4 segments with low energy(0.09mJ/mm2) at 200 shoots/spot for 9 spots(-1~0^+1 combination) within 1 month and group B was the control group.Results:Within 1 month follow-up,the death rate was 20% and 40% in 2 groups respectively.Neither arrhythmias nor other complications were observed during or after the shock wave therapy.Before infarction,there was no significant differences of regional blood flow valued by A·K on target segments between 2 groups.After infarction,followed at 1 day and 1 month,A·K decreased significantly before and after self control in both groups(P<0.05).In group A,A·K was higher on 4 segments compared with the group B(P<0.05).And the blood perfusion of the middle region improved better than that of the apex region(86.57% vs 65.54%).Whereas group B had little change.Conclusion:These results suggest that our extracorporeal cardiac shock wave therapy is a safe,non-invasive treatment in promoting angiogenesis that was associated by a substantial increasing of regional blood perfusion in a porcine model of acute myocardial infarction.