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Intrapulmonary shear stress enhancement: A new therapeutic approach in acute myocardial ischemia.
MedLine Citation:
PMID:  23932859     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: Ischemic heart disease (IHD) is a leading cause of mortality with insufficient results of current therapies, most probably due to maintained endothelial dysfunction conditions. Alternatively, we propose a new treatment that promotes endothelial shear stress (ESS) enhancement using an intrapulmonary pulsatile catheter.
METHODS: Twelve piglets, divided in equal groups of 6: pulsatile (P) and non-pulsatile (NP), underwent permanent left anterior descending coronary artery ligation through sternotomy. After 1h of ischemia and heparin injection (150IU/kg): in P group, a pulsatile catheter was introduced into the pulmonary trunk and pulsated intermittently over 1h, and irrespective of heart rate (110bpm). In NP group, nitrates were given (7±2mg/kg/min) for 1h.
RESULTS: In P group all 6 animals survived ischemia for 120min, but in NP group only 2 animals survived. The 4 animals that died during the experiment in NP group survived for 93±14min. Hemodynamics and cardiac output (CO) were significantly improved in P group compared with NP group: CO was 0.92±0.15 vs. 0.52±0.08 in NP group (L/min; p<0.05), respectively. Vascular resistances (dynes.s.cm(-5)/kg) were significantly (p<0.05) lower in P group versus NP group: pulmonary resistance was 119±13 vs. 400±42 and systemic resistance was 319±43 vs. 1857±326, respectively. Myocardial apoptosis was significantly (p<0.01) lower in P group (0.66±0.07) vs. (4.18±0.27) in NP group. Myocardial endothelial NO synthase mRNA expression was significantly (p<0.01) greater in P group (0.90±0.09) vs. (0.25±0.04) in NP group.
CONCLUSIONS: Intrapulmonary pulsatile catheter could improve hemodynamics and myocardial contractility in acute myocardial ischemia. This represents a cost-effective method, suitable for emergency setting as a first priority, regardless of classical coronary reperfusion.
Authors:
Sayed Nour; Daya Yang; Gong Dai; Qinmei Wang; Minze Feng; Nermine Lila; Juan Carlos Chachques; Guifu Wu
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-8-8
Journal Detail:
Title:  International journal of cardiology     Volume:  -     ISSN:  1874-1754     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2013 Aug 
Date Detail:
Created Date:  2013-8-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2013.
Affiliation:
Laboratory of Biosurgical Research (Alain Carpentier Foundation), Pompidou Hospital, University Paris Descartes, 75015 Paris, France; Division of Cardiology and the Key Laboratory on Assisted Circulation, Ministry of Health of China, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. Electronic address: nourmd@mac.com.
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