We thank Fred Roberts for exemplary technical support and also appreciate the help from the histology core in Beth Israel Hospital. We thank Brigham Women&#8217;s Hospital Cardiovascular Physiology Core for providing with the instrumentation and the funds for this work. This work was supported in part by a Department of Medicine Sundry Fund.

참고 : 모든 절차는 미국 수의학 협회 (AVMA) 지침에 따라 마우스의 수행 기관 동물 관리 및 사용위원회 (IACUC) 프로토콜을 승인했다. 1. 연구 설계 <ol><li> 연구 8-10 주 오래 된 남성 C57BL / 6 마​​우스 (BW ~ 25g)를 사용합니다. </li><li> 두 그룹으로 마우스 (N = 11), 대동맥 밴딩 선정 연구 군을 랜덤 (N = 8)과 대조군 (n = 3) 개흉술을 통해 모의 동작을 받도록. </li><li> 의료 학년 제모 크림을 사용하여 가슴에서 머리를 제거하여 영상의 동물을 준비합니다. </li><li> (노즈콘을 통해 100 % O 2와 혼합) 1 %와 2.5 % 이소 플루 란 유도 마취의 범위 사이 일 -1 기본 매개 변수를 결정하기 위해 대동맥 밴딩에 24 시간 이전에 먼저 초음파 (2 절)을 수행합니다. </li><li> 의학적으로 승인 된 마취제를 선택 (즉, 이소 플루 란)과 전일비에 마취 (2-3 %를 정도를 모니터링CE, 1.0 % 유지). 참고 : 적절한 마취는 생리 학적으로 정상 요금 (약 500 비트 / 분)에서 심장 박동의 유지에 매우 중요하다. </li><li> 페달 움츠림 반사에 응답하여 상기 동물에서의 움직임의 손실에 의해 마취 깊이를 확인한다. 마취 동안 건조를 방지하기 위해 눈에 paralube 수의사 연고를 사용합니다. </li><li> 0 일 (20, 21)에서 수술을 수행합니다. </li><li> 대동맥 밴딩, 아치에 배치 테이퍼 26 G 바늘 주위 7-0 실크 봉합사를 이용하여 대동맥을 결찰. 주 : 대동맥 수술 절차를 포함 밴딩 실험 프로토콜에 관한 세부 사항은, 이전에 기재되어있다 (20, 21). </li><li> 주 (S) 2, 6, 13에서 수술 후 초음파 영상 (2 절)을​​ 수행합니다. </li><li> 14 일째에 마우스를 안락사 및 조직 학적 평가를위한 마음을 수확. 같은 마음과 같은 중요한 장기 제거하여 펜 토바 비탈의 과다 복용을 이용하여 동물을 안락사. diasto의 마음을 체포제작 및 포르말린으로 고정한다. 이전 22 설명 된 마음 수확의 절차를 사용합니다. </li><li> 버퍼링 10 % 포르말린 용액으로 모든 심장 조직을 수정합니다. 트리 크롬 염색의 경우, 단면 전에 파라핀 조직을 포함합니다. 물론 이전에 14,23 설명 된 트리 크롬 염색의 세부 사항을 사용합니다. </li><li> 오프라인 소프트웨어 (3 부)를 사용하여 데이터를 분석한다. </li></ol> 2. 이미징 프로토콜 <ol><li> 중격 관상 동맥의 길고 짧은 축 이미지 (SCA) (B- 모드) <ol><li> 액티브 포트에 연결된 40 MHz의 중심 주파수로 MS550D 프로브를 사용하여, &quot;심장 이미징&quot;에 애플리케이션 설정을 설정. </li><li> 가열 된 플랫폼 및 노즈콘을 통해 제어 마취하에 동물 부정사으로 흉골 장축 뷰 (PSLAX) (도 1A)를 획득하기 위해 레일 시스템을 사용하여 프로브를 위치. 항상 동물이 데워진 플랫폼, 따뜻한 유지되어 있는지 확인m 및 체온은 생리적 수준에서 유지된다. </li><li> (노치는 꼬리 쪽을 가리키는) 프로브를 시계 방향으로 회전 이러한 프로브 각도가 왼쪽 흉골 라인 (긴 축보기) (그림 1B)에 15 °이다. </li><li> 화면 (도 1b)의 중심에 SCA의 전체 길이와 세로보기를 얻기 위해 프로브의 Y 축 방향으로 약간 기울여 프로브 각도를 조정한다. </li><li> 적절한 랜드 마크 (대동맥 판막과 폐동맥이), 시네 저장소에게 가장 높은 프레임 속도를 사용하여 이미지를 볼 수 있습니다되면. </li><li> &quot;XY&quot;를 사용하여 마이크로 매니퓰레이터 (그림 1D)를 축, SCA의 선명한 이미지를 얻을 수있는 프로브 위치를 조정합니다. </li><li> 프로브의 홈 부분을이 중간 선 (짧은 축)의 왼쪽에되도록 시계 방향으로 (그림 1C)을 (노치는 꼬리 쪽을 가리키는) 프로브 90 ° 회전합니다. </li></ol></li><li> SCA의 길고 짧은 축 이미지 (컬러 도플러 모전자) <ol><li> B 모드 이미지를 캡처 또는 시네가 저장된되면, 색 도플러 음향 창 (그림 2)를 켜 키보드의 색 도플러 키를 누릅니다. 참고 :이 (흰색 화살표가 SCA를 표시 포함)는 긴 (그림 2A) 또는 짧은 축 (그림 2C) 관상 동맥을 분리하는 데 도움이됩니다. 빨간색은 실시간으로 볼 수 있으며 (거리 대동맥판)에서 흐름 방향을 나타낸다된다. </li><li> (이미지 화면의 오른쪽에 노란색 화살표로 표시) 초점 심도가, 관상 동맥의 중심에 놓여 있는지 확인합니다. </li><li> 데이터가 가장 높은 프레임 속도 (&gt; 100 프레임 / 초)에서, 시네 매장 키를 사용하여 기록되어 있는지 확인합니다. </li></ol></li><li> SCA의 PW 도플러 이미징 (펄스 웨이브 또는 PW 모드) <ol><li> 컬러 도플러 모드에있는 동안, (빨간색으로 표시 그림 2) 관상 동맥에 노란색 표시 줄을 가지고 PW 키를 누릅니다. </li><li> 노란색 배치흐름의 방향성을 평행 각도로보기 관상 동맥의 중간 PW 라인. 그 속도 측정은 이미지 수집의 각도에 크게 의존합니다. </li><li> 60 ° 이하이며, 샘플 량은 SCA의 중앙에 바로 유동 포착 유동 각도 (PW 앵글 키) 및 PW 각 키가되도록 샘플 볼륨 (SV 키)를 조정한다. </li><li> 1 % 및 2.5 %의 이소 플루 란을 이용하여, 피크 수축기 (S) 및 심장 확장 (D) (도 3a 및 3b)에서 혈류의 속도를 나타내는 파형 형태를 캡처 시네 저장소를 사용한다. </li></ol></li></ol> 3. 데이터 계산 및 분석 <ol><li> 속도 타임도 3a 및도 3b에 도시 된 이미지에서 피크 수축기 및 확장기 속도를 얻기 위해 적분 (VTI) 도구를 선택. </li><li> 충혈 (2.5 % 이소 플루 란) 피크 이완기 (F)의 비율로 관상 동맥 흐름 예비 지수 (CFR)을 계산기준에 낮은 속도 (1 % 이소 플루 란) 피크 이완기 혈류 속도. </li><li> 최고 수축기 혈류 속도 / 최대 이완기 혈류 속도 등의 S / D 비율을 계산합니다. 베이스 라인에서의 비율 (1 % 이소 플루 란)과 충혈에서 (2.5 % 이소 플루 란)을 결정합니다. </li><li> 이러한 FS, FAC, LVM 등의 표준 심장 기능의 매개 변수에 대한 독점 소프트웨어를 사용하여 데이터 분석을 수행하거나 쳉의 조브 용지 2 참조하기 위해 제조업체의 설명서를 참조하십시오. </li></ol>

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The authors report no disclosures.

이 초음파 기초 연구에서, 관상 동맥 유량의 비 침습적 평가는 라이브 재현성 실험 쥐에서, 일 동안 실시간으로 수행 하였다; 또한, 프로토콜은 초기에 존재하고 심근 관류 결핍 연관되었다 관상 동맥 장애를 검출 할 가능성을 보여 주었다. 이 방법은 궁극적으로 심혈관 질환의 위험 계층화 및 / 또는 치료 적 개입에 대한 평가 대응을위한 임상 도구로 활용 될 수있다. 먼저, ?...

임상 대동맥 협착 (AS)가 잘 좌심실 후 부하의 점진적 증가를 촉진하는 것으로 알려져있다. 이 만성적으로 상승 혈역학 적 부하를 보상하기 위해, 좌심실 비대 (LVH)는 적응 응답 1,2로 계속된다. LVH의 개발은 종종 관상 미세 순환에 이상과 연관된다. 그것은 미세 혈관 기능 장애 환자 5 만성 허혈에 기여하는 것으로 생각된다. 관상 동맥 유량 3,4- 외에도 혈류 보호구 (CFR)는 관상 동맥 1,3 기능적 변화를 나타내고, 기준 유속 또는 휴식 유속 4,6,7에 충혈에서 최대 유동 속도의 비율로 정의된다. CFR은 LV 리모델링 1-3,5-9 동안 감소 관상 1,10,17의 기능적 장애 심각성의 정도의 지표로서 사용된다. 이는 팽창 된 심근증 (10)의 다양한 형태 및 관상 (S)에 손상되는 것으로 알려진tenosis 6. CFR은 가난한 임상 결과 12 예후 마커입니다. 이러한 허혈 또는 ​​좌심실 비대로 심장 기능 장애의 설정에서 LV 리모델링은 광범위한 섬유화, 관상 동맥 1,2의 관상 동맥 미세와 농축의 변화를 동반한다. 관상 생리학 이러한 변화의 결과로서, 관상 동맥의 리모델링 가능성이있다. 이것은 낮은 산소 확산 및 심근 허혈 1,2,13 감수성이 발생할 수 좌심실 이완기 기능 장애의 영향을 완화하는 데 도움이됩니다. 유전자 변형 마우스는 관상 동맥 경화 5,7,10,12,17로 지금 인간의 질병 상태를 모방하는 데 널리 널리 임상 도구입니다. 특히, 마우스에서의 압력 과부하 모델을 14,17 널리 연구되고있다. 트랜스 대동맥 협착 모델 (TAC)는 광범위한 섬유증 및 coronar과 연관된 것으로 밝혀졌다Y 협착 관상 동맥의 내측 두껍게에서 인간의 좌심실 비대의 설정에서 본 것과 유사한 관상 동맥 흐름 패턴 1,11,17,19의 변화를 동반, 부분적으로, 결과. 이 장시간 압력 과부하 4-8 주간 부전 심부전에 이르게하는 것이 알려져 있지만, 밴딩 후 혈류 역학 및 조기 질병 진행 과정에서 이러한 모델 플로우 보호구에 그리고 다른 단계에서 효과가 아직 명확하게 묘사한다. 마우스의 수많은 변종이 잘 특성화 LDLR을 포함하여 연구 사용하기 위해 현재 사용할 수있는 - / - 또는 아포 - / - 마우스 10-12, 이들은 살아있는 쥐 11-15 심혈관 기능과 형태를 평가하기위한 중요한 기술의 개발을하라는 메시지가있다. 이러한 기술은 침습적 유망한 대안을 제공 모두 MRI, PET, 콘트라스트 CT, 초음파, 고주파, 전자빔 단층 2,9,17,19 포함이러한 심장 catheterizations 및 관상 동맥 조영술 (12) 등의 방법. 그러나, 관상 동맥의 매우 작은 크기와 높은 심박수 (HR)와 쥐, 관상 동맥 순환의 이미지는 여전히 많은 현재 기술 4,12에 대한 기술적 인 도전을 구성한다. 흥미롭게도, 15에서 약 30 ~ 100 μm의 축 방향 해상도를 허용하는 50 MHz의 중심 주파수와 높은 주파수 배열 스캔 헤드의 개발을 포함한 흉부 심 초음파 (TTDE) 분야의 기술 발전, 기하 급수적으로 증가되고있다, 8-40mm의 깊이 및 프레임 속도보다 큰 400 / 초 프레임 - 캡처. 차례로, TTDE 기반 기술은 관상 동맥 5,12-으로이 더 크거나 더 작은 혈관을 영상화 잠재적으로 강력한 도구로 등장했다. 연구자들은 작은에서 혈관의 진단 영상 연구를 수행 할 수 또 다른 중요한 사전nimals 11 이미징 동안 마음과 동물의 호흡 속도를 유지 마취제의주의 깊게 제어를 사용하는 것이다. 제어 마취 유지 마우스에서 혈관 확장에 관련된 연구에 특히 중요하며, 마취 효과도 더욱 이러한 맥락 10,11 탐구 할 필요가있다. 인간에서, 반면에, TTDE 유래 CFR 측정은 주로 좌전 하행 (LAD) 관상 동맥 5,16에서 협착 및 비 - 방해 외막 관상 동맥의 평가보다 일반적으로 사용되는 도구가되었다. 그러나, CFR 무증상 환자 또는 휴식 보존 좌심실 수축기 기능과 마우스에서 관상 동맥 흐름 변화의 예후 역할은 훨씬 덜되어 (16)을 탐험했다. 따라서, 연구의 목적은 첫 ​​번째 압력 과부하 마우스 모델을 이용 TTDE 관류 량의 변화를 평가하기 위해, 명확한 단계별 프로토콜을 확립되었다; 둘째,이 연구는 예후 기호를 조사CFR 및 응답에서 관상 동맥 흐름의 변화 ificance이 마우스에 과부하 스트레스를 압박한다. 우리는 CFR 및 관상 동맥 흐름의 TTDE 기반 평가는 좌심실 기능 장애에 선행 할 수있다 관상 동맥 장애의 조기 발견에 유용 할 수 있다는 가설을 세웠다.

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ultrasound based assessment of coronary artery flow and coronary flow reserve using the pressure overload model in mice

Transthoracic Doppler echocardiography (TTDE) is a clinically useful, noninvasive tool for studying coronary artery flow velocity and coronary flow reserve (CFR) in humans. Reduced CFR is accompanied by marked intramyocardial and pericoronary fibrosis and is used as an indication of the severity of dysfunction. This study explores, step-by-step, the real-time changes measured in the coronary flow velocity, CFR and systolic to diastolic peak velocity (S/D) ratio in the setting of an aortic banding model in mice. By using a Doppler transthoracic imaging technique that yields reproducible and reliable data, the method assesses changes in flow in the septal coronary artery (SCA), for a period of over two weeks in mice, that previously either underwent aortic banding or thoracotomy. 
During imaging, hyperemia in all mice was induced by isoflurane, an anesthetic that increased coronary flow velocity when compared with resting flow. All images were acquired by a single imager. Two ratios, (1) CFR, the ratio between hyperemic and baseline flow velocities, and (2) systolic (S) to diastolic (D) flow were determined, using a proprietary software and by two independent observers. Importantly, the observed changes in coronary flow preceded LV dysfunction as evidenced by normal LV mass and fractional shortening (FS). 
The method was benchmarked against the current gold standard of coronary assessment, histopathology. The latter technique showed clear pathologic changes in the coronary artery in the form of peri-coronary fibrosis that correlated to the flow changes as assessed by echocardiography. 
The study underscores the value of using a non-invasive technique to monitor coronary circulation in mouse hearts. The method minimizes redundant use of research animals and demonstrates that advanced ultrasound-based indices, such as CFR and S/D ratios, can serve as viable diagnostic tools in a variety of investigational protocols including drug studies and the study of genetically modified strains.

몇 시간에 단일 지점에서 관찰자에 의해 연구 (줄무늬, N = 8, 가짜, N = 3), 및 적절한 재현 화상을 얻었다 된 마우스의 11 : 기준선 (D-1), D2, D6 및 D13 . 또한, 협착 부위 유속 수술 (p &lt;0.05) 후 당일 가짜 마우스 277.5 ± 10.51 mm / s와 비교하여 110.9 mm / s ± 2,225으로 측정 하였다. 속도의 증가는 압력 과부하 모델의 성공적인 수립 검증했다. 또한 CF 속도, CFR 및 S / D 비율로 여기서 말하는 SCA 유속은 성공적 기?...

Watch this Scientific Journal Video about Ultrasound Based Assessment of Coronary Artery Flow and Coronary Flow Reserve Using the Pressure Overload Model in Mice at JoVE.com

Ultrasound Based Assessment of Coronary Artery Flow and Coronary Flow Reserve Using the Pressure Overload Model in Mice

Coronary flow reserve (CFR) is useful for assessment of myocardial oxygen demand and evaluation of cardiovascular risk. This study establishes a step-by-step transthoracic Doppler echocardiographic (TTDE) method for longitudinal monitoring of the changes in CFR, as measured from coronary artery in mice, under the experimental pressure overload of aortic banding.

마우스의 압력 과부하 모델을 사용하여 관상 동맥 흐름 및 관상 동맥 흐름 준비 제도 이사회의 초음파를 바탕으로 평가

Transthoracic Doppler echocardiography (TTDE) is a clinically useful, noninvasive tool for studying coronary artery flow velocity and coronary flow ...

ultrasound-based-assessment-coronary-artery-flow-coronary-flow

Research

JoVE Journal

Medicine

14.8K 조회수.  Brigham and Women's Hospital, Harvard Medical School. Coronary flow reserve (CFR) is useful for assessment of myocardial oxygen demand and evaluation of cardiovascular risk. This study establishes a step-by-step transthoracic Doppler echocardiographic (TTDE) method for longitudinal monitoring of the changes in CFR, as measured from coronary artery in mice, under the experimental pressure overload of aortic banding.

비디오: Ultrasound Based Assessment of Coronary Artery Flow and Coronary Flow Reserve Using the Pressure Overload Model in Mice

Use of a Hanging Weight System for Coronary Artery Occlusion in Mice

Murine studies of acute injury are an area of intense investigation, as knockout mice for different genes are becoming increasingly available 1-38. Cardioprotection by ischemic preconditioning (IP) remains an area of intense investigation. To further elucidate its molecular basis, the use of knockout mouse studies is particularly important 7, 14, 30, 39. Despite the fact that previous studies have already successfully performed cardiac ischemia and reperfusion in mice, this model is technically very challenging. Particularly, visual identification of the coronary artery, placement of the suture around the vessel and coronary occlusion by tying off the vessel with a supported knot is technically difficult. In addition, re-opening the knot for intermittent reperfusion of the coronary artery during IP without causing surgical trauma adds additional challenge. Moreover, if the knot is not tied down strong enough, inadvertent reperfusion due to imperfect occlusion of the coronary may affect the results. In fact, this can easily occur due to the movement of the beating heart.
Based on potential problems associated with using a knotted coronary occlusion system, we adopted a previously published model of chronic cardiomyopathy based on a hanging weight system for intermittent coronary artery occlusion during IP 39. In fact, coronary artery occlusion can thus be achieved without having to occlude the coronary by a knot. Moreover, reperfusion of the vessel can be easily achieved by supporting the hanging weights which are in a remote localization from cardiac tissues.
We tested this system systematically, including variation of ischemia and reperfusion times, preconditioning regiments, body temperature and genetic backgrounds39. In addition to infarct staining, we tested cardiac troponin I (cTnI)
as a marker of myocardial infarction in this model. In fact, plasma levels of cTnI correlated with infarct sizes (R2=0.8). Finally, we could show in several studies that this technique yields highly reproducible infarct sizes during murine IP and myocardial infarction6, 8, 30, 40, 41. Therefore, this technique may be helpful for researchers who pursue molecular mechanisms involved in cardioprotection by IP using a genetic approach in mice with targeted gene deletion. Further studies on cardiac IP using transgenic mice may consider this technique.

A murine model for myocardial ischemia and ischemic preconditioning is an important tool study cardioprotective mechanisms in vivo. Here, we report an easy applicable in situ model for cardiac IP using a hanging-weight system for coronary artery occlusion.

마우스의 관상 동맥 폐색에 대한 한깅 무게 시스템의 사용

Murine studies of acute injury are an area of intense investigation, as knockout mice for different genes are becoming increasingly available 1-38. ...

연구

의학

Coronary Artery Ligation and Intramyocardial Injection in a Murine Model of Infarction

Mouse models are a valuable tool for studying acute injury and chronic remodeling of the myocardium in vivo. With the advent of genetic modifications to the whole organism or the myocardium and an array of biological and/or synthetic materials, there is great potential for any combination of these to assuage the extent of acute ischemic injury and impede the onset of heart failure pursuant to myocardial remodeling. 
Here we present the methods and materials used to reliably perform this microsurgery and the modifications involved for temporary (with reperfusion) or permanent coronary artery occlusion studies as well as intramyocardial injections. The effects on the heart that can be seen during the procedure and at the termination of the experiment in addition to histological evaluation will verify efficacy. 
Briefly, surgical preparation involves anesthetizing the mice, removing the fur on the chest, and then disinfecting the surgical area. Intratracheal intubation is achieved by transesophageal illumination using a fiber optic light. The tubing is then connected to a ventilator. An incision made on the chest exposes the pectoral muscles which will be cut to view the ribs. For ischemia/reperfusion studies, a 1 cm piece of PE tubing placed over the heart is used to tie the ligature to so that occlusion/reperfusion can be customized. For intramyocardial injections, a Hamilton syringe with sterile 30gauge beveled needle is used. When the myocardial manipulations are complete, the rib cage, the pectoral muscles, and the skin are closed sequentially. Line block analgesia is effected by 0.25% marcaine in sterile saline which is applied to muscle layer prior to closure of the skin. The mice are given a subcutaneous injection of saline and placed in a warming chamber until they are sternally recumbent. They are then returned to the vivarium and housed under standard conditions until the time of tissue collection. At the time of sacrifice, the mice are anesthetized, the heart is arrested in diastole with KCl or BDM, rinsed with saline, and immersed in fixative. Subsequently, routine procedures for processing, embedding, sectioning, and histological staining are performed. 
Nonsurgical intubation of a mouse and the microsurgical manipulations described make this a technically challenging model to learn and achieve reproducibility. These procedures, combined with the difficulty in performing consistent manipulations of the ligature for timed occlusion(s) and reperfusion or intramyocardial injections, can also affect the survival rate so optimization and consistency are critical.

Numerous genetic manipulations and/or intramyocardial injections of genes, proteins, cells, and/or biomaterials are superimposed upon the dimension of time in studies of acute ischemia/ reperfusion injury and chronic remodeling in mice. This video illustrates the microsurgical procedures for ischemia/reperfusion, permanent coronary artery ligation, and intramyocardial injection studies.

경색의 Murine 모델에서 관상 동맥 내고과 Intramyocardial 사출

Mouse models are a valuable tool for studying acute injury and chronic remodeling of the myocardium in vivo.  With the advent of genetic modifications to ...

Modified Technique for Coronary Artery Ligation in Mice

Myocardial infarction (MI) is one of the most important causes of mortality in humans1-3. In order to improve morbidity and mortality in patients with MI we need better knowledge about pathophysiology of myocardial ischemia. This knowledge may be valuable to define new therapeutic targets for innovative cardiovascular therapies4. Experimental MI model in mice is an increasingly popular small-animal model in preclinical research in which MI is induced by means of permanent or temporary ligation of left coronary artery (LCA)5. In this video, we describe the step-by-step method of how to induce experimental MI in mice.
The animal is first anesthetized with 2% isoflurane. The unconscious mouse is then intubated and connected to a ventilator for artificial ventilation. The left chest is shaved and 1.5 cm incision along mid-axillary line is made in the skin. The left pectoralis major muscle is bluntly dissociated until the ribs are exposed. The muscle layers are pulled aside and fixed with an eyelid-retractor. After these preparations, left thoracotomy is performed between the third and fourth ribs in order to visualize the anterior surface of the heart and left lung. The proximal segment of LCA artery is then ligated with a 7-0 ethilon suture which typically induces an infarct size ~40% of left ventricle. At the end, the chest is closed and the animals receive postoperative analgesia (Temgesic, 0.3 mg/50 ml, ip). The animals are kept in a warm cage until spontaneous recovery.

The surgical procedure used to induce experimental myocardial infarction in mice begins with left thoracotomy between the third and the fourth ribs in order to visualize the anterior surface of the heart and left lung. The left coronary artery is ligated, the chest is closed and the mouse is allowed to recover spontaneously.

마우스의 관상 동맥 결합에 대한 수정 기술

Myocardial infarction (MI) is one of the most important causes of mortality in humans1-3. In order to improve morbidity and mortality in patients with MI ...

Ultrasound Assessment of Endothelial-Dependent Flow-Mediated Vasodilation of the Brachial Artery in Clinical Research

The vascular endothelium is a monolayer of cells that cover the interior of blood vessels and provide both structural and functional roles. The endothelium acts as a barrier, preventing leukocyte adhesion and aggregation, as well as controlling permeability to plasma components. Functionally, the endothelium affects vessel tone.
Endothelial dysfunction is an imbalance between the chemical species which regulate vessel tone, thombroresistance, cellular proliferation and mitosis. It is the first step in atherosclerosis and is associated with coronary artery disease, peripheral artery disease, heart failure, hypertension, and hyperlipidemia.
The first demonstration of endothelial dysfunction involved direct infusion of acetylcholine and quantitative coronary angiography. Acetylcholine binds to muscarinic receptors on the endothelial cell surface, leading to an increase of intracellular calcium and increased nitric oxide (NO) production. In subjects with an intact endothelium, vasodilation was observed while subjects with endothelial damage experienced paradoxical vasoconstriction.
There exists a non-invasive, in vivo method for measuring endothelial function in peripheral arteries using high-resolution B-mode ultrasound. The endothelial function of peripheral arteries is closely related to coronary artery function. This technique measures the percent diameter change in the brachial artery during a period of reactive hyperemia following limb ischemia.
This technique, known as endothelium-dependent, flow-mediated vasodilation (FMD) has value in clinical research settings. However, a number of physiological and technical issues can affect the accuracy of the results and appropriate guidelines for the technique have been published. Despite the guidelines, FMD remains heavily operator dependent and presents a steep learning curve. This article presents a standardized method for measuring FMD in the brachial artery on the upper arm and offers suggestions to reduce intra-operator variability.

Endothelial dysfunction is associated with numerous disease states and is predictive of adverse cardiovascular events in humans. Flow-mediated vasodilation (FMD) is a non-invasive ultrasound method of evaluating endothelial function. Methodological choices and operator experience may affect results. A systematic approach to FMD in human studies is discussed here.

임상 연구에서 상완 동맥의 초음파 평가 내피 의존 흐름 매개 혈관 확장

The vascular endothelium is a monolayer of cells that cover the interior of blood vessels and provide both structural and functional roles. The ...

Permanent Ligation of the Left Anterior Descending Coronary Artery in Mice: A Model of Post-myocardial Infarction Remodelling and Heart Failure

Heart failure is a syndrome in which the heart fails to pump blood at a rate commensurate with cellular oxygen requirements at rest or during stress. It is characterized by fluid retention, shortness of breath, and fatigue, in particular on exertion. Heart failure is a growing public health problem, the leading cause of hospitalization, and a major cause of mortality. Ischemic heart disease is the main cause of heart failure.
Ventricular remodelling refers to changes in structure, size, and shape of the left ventricle. This architectural remodelling of the left ventricle is induced by injury (e.g., myocardial infarction), by pressure overload (e.g., systemic arterial hypertension or aortic stenosis), or by volume overload. Since ventricular remodelling affects wall stress, it has a profound impact on cardiac function and on the development of heart failure. A model of permanent ligation of the left anterior descending coronary artery in mice is used to investigate ventricular remodelling and cardiac function post-myocardial infarction. This model is fundamentally different in terms of objectives and pathophysiological relevance compared to the model of transient ligation of the left anterior descending coronary artery. In this latter model of ischemia/reperfusion injury, the initial extent of the infarct may be modulated by factors that affect myocardial salvage following reperfusion. In contrast, the infarct area at 24 hr after permanent ligation of the left anterior descending coronary artery is fixed. Cardiac function in this model will be affected by 1) the process of infarct expansion, infarct healing, and scar formation; and 2) the concomitant development of left ventricular dilatation, cardiac hypertrophy, and ventricular remodelling.
Besides the model of permanent ligation of the left anterior descending coronary artery, the technique of invasive hemodynamic measurements in mice is presented in detail.

Heart failure is the leading cause of hospitalization and a major cause of mortality. A model of permanent ligation of the left anterior descending coronary artery in mice is applied to investigate ventricular remodelling and cardiac dysfunction post-myocardial infarction. The technique of invasive hemodynamic measurements in mice is presented.

마우스의 왼쪽 전방 내림차순 관상 동맥의 영구 결찰 : 심근 경색 리모델링과 심장 마비의 모델

Heart failure is a syndrome in which the heart fails to pump blood at a rate commensurate with cellular oxygen requirements at rest or during stress. It ...

Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly which is one of leading causes of myocardial ischemia and infarction in children. If left untreated, it results in a 90% mortality rate in the first year of life. In patients who survive to the adulthood, the coronary steal phenomenon and retrograde left-sided coronary flow provide a substrate for chronic subendocardial ischemia, which may lead to left ventricular dysfunction, ischemic mitral regurgitation, malignant ventricular arrhythmias, and sudden cardiac death. The average age of life-threatening presentation is 33 years and of sudden cardiac death 31 years. Therefore, surgical correction is highly recommended as soon as the diagnosis is made, regardless of age. In adult-type ALCAPA originating from the right-facing sinus of the pulmonary artery, direct re-implantation of the ALCAPA into the aorta is the more physiologically sound repair technique to re-establish the dual-coronary perfusion system and is recommended. This protocol describes the technique of direct re-implantation of adult-type ALCAPA into the aorta.

Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA

Surgical correction of ALCAPA is highly recommended, regardless of age or the degree of intercoronary collateralization. This protocol presents a technique for the direct re-implantation of adult-type ALCAPA into the aorta to re-establish the dual-coronary perfusion. Whenever feasible, direct re-implantation is preferred to other surgical correction techniques.

폐 동맥에서 좌측 관상 동맥의 변칙 기원과 성인에서 대동맥으로 왼쪽 관상 동맥의 직접 재 주입 (좌 관상 동맥 폐동맥 이상 연결 증)

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly which is one of leading causes of myocardial ...

Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats

Coronary artery disease is the leading cause of death worldwide. After an acute myocardial infarction, early and successful myocardial intervention via recanalization of the coronary artery is the most effective strategy for reducing the size of ischemic myocardium. The coronary microvasculature cannot be visualized and imaged&#160;in vivo, but there are several invasive and noninvasive techniques that can be used to assess parameters which depend directly on coronary microvascular function. The endothelial function after ischemia reperfusion can be assessed also at the level of the coronary circulation via the coronary flow reserve (CFR).&#160;In this study, peak velocity of left anterior descending (LAD) coronary arteries was measured in rats in vivo via Transthoracic Doppler Echocardiography during resting and stress challenge (induced by Dobutamine). A normal heart can increase its coronary blood flow up to four times above the resting values during stress induction. Following ischemia reperfusion, we found a significantly diminished CFR, which can be used as a marker of coronary microvascular dysfunction. CFR has opened a window on the importance of microvascular dysfunction and has been shown to predict cardiovascular risk independent of whether the severe obstructive disease is present.

Coronary flow reserve (CFR), is defined as the ratio of maximal coronary blood flow to the resting coronary blood flow. We present a protocol for evaluating CFR in rats via ultrasound, which offers the opportunity to predict cardiovascular risk factors in the absence of obstructive coronary disease.

쥐의 심근 허혈 재관류 후 관상 동맥 흐름 예비의 평가

Coronary artery disease is the leading cause of death worldwide. After an acute myocardial infarction, early and successful myocardial intervention via ...

Murine Myocardial Infarction Model using Permanent Ligation of Left Anterior Descending Coronary Artery

Myocardial infarction (MI) and acute coronary diseases are among the most prominent causes of death in population with western lifestyle. The murine models of MI with permanent ligation of left-anterior descending (LAD) coronary artery closely mimics MI in humans. Murine models benefit from the extensive genetic engineering available nowadays. Here we propose a reproducible murine surgical model of myocardial infarction by permanent LAD coronary ligation. Our technique comprises anesthesia with ketamine/xylazine that can be rapidly reversed by administration of an antagonist, intubation without tracheotomy for mechanical-assisted ventilation, ventilation with application of extrinsic positive end-expiratory pressure (PEEP) to avoid alveolar collapse, a thoracotomy method limiting to the minimum surgical lesions made to skeletal muscles, and lung inflation without thoracentesis. This method is sparsely invasive, reproducible and reduces post-surgery mortality and complications.

Herein we describe a surgical procedure showing how to achieve permanent ligation of the left-anterior descending coronary artery in mice. This model is of high relevance to investigate the pathophysiology of myocardial infarction and the concomitant biological processes.

왼쪽 전방 내림차순 관상 동맥의 영구 결찰을 사용하는 뮤린 심근 경색 모델

Myocardial infarction (MI) and acute coronary diseases are among the most prominent causes of death in population with western lifestyle. The murine ...

In Vitro Model of Coronary Angiogenesis

Here, we describe an in vitro culture assay to study coronary angiogenesis. Coronary vessels feed the heart muscle and are of clinical importance. Defects in these vessels represent severe health risks such as in atherosclerosis, which can lead to myocardial infarctions and heart failures in patients. Consequently, coronary artery disease is one of the leading causes of death worldwide. Despite its clinical importance, relatively little progress has been made on how to regenerate damaged coronary arteries. Nevertheless, recent progress has been made in understanding the cellular origin and differentiation pathways of coronary vessel development. The advent of tools and technologies that allow researchers to fluorescently label progenitor cells, follow their fate, and visualize progenies in vivo have been instrumental in understanding coronary vessel development. In vivo studies are valuable, but have limitations in terms of speed, accessibility, and flexibility in experimental design. Alternatively, accurate in vitro models of coronary angiogenesis can circumvent these limitations and allow researchers to interrogate important biological questions with speed and flexibility. The lack of appropriate in vitro model systems may have hindered the progress in understanding the cellular and molecular mechanisms of coronary vessel growth. Here, we describe an in vitro culture system to grow coronary vessels from the sinus venosus (SV) and endocardium (Endo), the two progenitor tissues from which many of the coronary vessels arise. We also confirmed that the cultures accurately recapitulate some of the known in vivo mechanisms. For instance, we show that the angiogenic sprouts in culture from SV downregulate COUP-TFII expression similar to what is observed in vivo. In addition, we show that VEGF-A, a well-known angiogenic factor in vivo, robustly stimulates angiogenesis from both the SV and Endo cultures. Collectively, we have devised an accurate in vitro culture model to study coronary angiogenesis.

In vitro models of coronary angiogenesis can be utilized for the discovery of the cellular and molecular mechanisms of coronary angiogenesis. In vitro explant cultures of sinus venosus and endocardium tissues show robust growth in response to VEGF-A and display a similar pattern of COUP-TFII expression as in vivo.

관상 동맥 혈관 신생의 체외 모델

Here, we describe an in vitro culture assay to study coronary angiogenesis. Coronary vessels feed the heart muscle and are of clinical importance. Defects ...

Echocardiographic Characterization of Left Ventricular Structure, Function, and Coronary Flow in Neonate Mice

Echocardiography is a non-invasive procedure that enables the evaluation of structural and functional parameters in animal models of cardiovascular disease and is used to assess the impact of potential treatments in preclinical studies. Echocardiographic studies are usually conducted in young adult mice (i.e., 4-6 weeks of age). The evaluation of early neonatal cardiovascular function is not usually performed because of the small size of the mouse pups and the associated technical difficulties. One of the most important challenges is that the short length of the pups&#39; limbs prevents them from reaching the electrodes in the echocardiography platform. Body temperature is the other challenge, as pups are very susceptible to changes in temperature. Therefore, it is important to establish a practical guide for performing echocardiographic studies in small mouse pups to help researchers detect early pathological changes and study the progression of cardiovascular disease over time. The current work describes a protocol for performing echocardiography in mouse pups at the early age of 7 days old. The echocardiographic characterization of cardiac morphology, function, and coronary flow in neonatal mice is also described.

The present protocol describes the echocardiographic assessment of left ventricular morphology, function, and coronary blood flow in 7-day old neonate mice.

신생아 마우스의 좌심실 구조, 기능 및 관상 동맥 흐름의 심 초음파 특성

Echocardiography is a non-invasive procedure that enables the evaluation of structural and functional parameters in animal models of cardiovascular ...