心脏震波对猪心肌梗死后早期侧枝循环重建及左心功能的影响

Effects of Cardiac Shock Wave Therapy on Myocardial Collateral Circulation and Global Cardiac Function after Acute Myocardial Infarction at Early Stage in Pigs

目的观察心脏震波治疗（cardiac shock wave therapy,CSWT）对猪急性心肌梗死后的心肌局部侧枝循环血管及心脏整体功能有无影响,对比不同震波方案疗效差异,为优化CSWT方法学提供进一步科学依据.方法选取本地小型猪25只,3~5月龄,体重26~32 kg.实验猪随机分为3组：震波组,假震波组及及手术组.震波组按震波治疗方案不同随机分为3个亚组.通过选择性冠状动脉造影评价心肌侧枝循环分级;通过左心室造影检测不同治疗期间及不同处理组间左心室整体心功能,心腔室容积变化差异,综合评价CSWT对心肌梗死后心室重塑的影响.结果通过选择性血管造影评价侧枝循环Rentrop分级,震波组与假震波组比较差异有统计学意义[（2.05±0.11）vs（0.98±0.09）,P=0.03];假震波组心肌侧枝循环指数与假手术组间相比未见显著差异性[（0.98±0.09）vs（0.86±0.03）,P〉0.05],各震波治疗亚组间分析也显示不同治疗亚组间侧枝循环分级有一定差别,且延长治疗组侧枝循环建立明显优于标准治疗组及扩大范围组.左心室形态学指标（左室收缩末容积及舒张末容积、左室整体射血分数）的变化结果显示心肌梗死组动物（震波组及假震波组）左室收缩末容积（LVESV）和舒张末容积（LVEDV）较心肌梗死前基础值及非梗死组明显增加,左室射血分数（LVEF）降低,但与假震波组相比,CSWT明显改善了震波组的LVESV、LVEDV及LVEF.结论梗死后早期实施CSWT能明显促进局部心肌微循环结构的重建,及明显改善心肌梗死后左心室整体心功能,且延长震波疗程的方案可获得更明显益处.因此,认为及早有效的进行CSWT可在一定程度上延缓心肌梗死后左心室重塑由可逆阶段向不可逆阶段发展.

Objective To investigate the effects of CSWT on myocardial collateral circulation and global cardiac function after acute myocardial infarction at the early stage. Methods Thirty 3 ~5 months and 26 ~32kg domestic miniature pigs were enrolled in this study. The selected 30 pigs were randomly divided into three groups：CSWT group, pseudo- CSWT group and pseudo operation group. CSWT group was further divided into three subgroups according to treatment protocols. The collateral circulation vessel Rentrop score and global cardiac function were measured and evaluated by coronary artery angiography and left ventricular angiography, and then were compared among these groups, respectively. Results Compared with pseudo- CSWT group, collateral vessel Rentrop score was significantly higher in CSWT group [（ 2.05±0.11） vs（ 0.98±0.09）, P = 0.03]. There was nosignificant difference in the collateral vessel Rentrop score between pseudo- CSWT group and pseudo- operation group[（ 0.98 ±0.09） Vs（ 0.86 ±0.03）, P〉0.05]. There were significant differences in the collateral vessel Rentrop score among different subgroups in CSWT group, and the improving effects in subgroup of prolonged duration CSWT were better than other two subgroups. At the same time, the global cardiac function, including LVESV and LVEDV were significantly higher while and LVEF was lower in the CSWT group, pseudo- CSWT group than those in the sham operation. LVESV, LVEDV and LVEF in CSWT group were significantly better than those in pseudo- CSWT group.Conclusions Extracorporeal cardiac shock wave therapy could improve reconstructing micro- vascular circulation of ischemia myocardial, while result in an improvement in global cardiac function, especially, prolonged duration CSWT at early stage of acute myocardial infarction could better improve myocardial collateral vascular circulation.This may be one of the most important mechanisms for CSWT in improving of remodeling after ischemia heart disease in early stage.