Name: transthoracic echocardiography to assess post-resuscitation left ventricular dysfunction after acute myocardial infarction and cardiac arrest in pigs
Uploaded: 2022-07-12T13:45:00
Description: Watch this Scientific Journal Video about Transthoracic Echocardiography to Assess Post-Resuscitation Left Ventricular Dysfunction After Acute Myocardial Infarction and Cardiac Arrest in Pigs at JoVE.

我们感谢Judith Bagott的语言编辑。

所有涉及动物及其护理的程序均符合国家和国际法律和政策。该研究已获得米兰大学和政府机构的机构审查委员会的批准（卫生部批准号84/2014-PR）。支持本研究结果的数据可根据合理要求从通讯作者处获得。实验模型和超声心动图方案图详见图 1 和 图2。
1. 动物制备
<ol><li>快速雄性家猪（体重39.8±0.6公斤）在实验前?...

<ol>
	<li>Kubota, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Out-of-hospital+cardiac+arrest+does+not+affect+post-discharge+survival+in+patients+with+acute+myocardial+infarction.">Out-of-hospital cardiac arrest does not affect post-discharge survival in patients with acute myocardial infarction.</a> Circulation Reports. 3 (4), 249-255 (2021).</li><li>Spaulding, C. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Immediate+coronary+angiography+in+survivors+of+out-of-hospital+cardiac+arrest.">Immediate coronary angiography in survivors of out-of-hospital cardiac arrest.</a> The New England Journal of Medicine. 336 (23), 1629-1633 (1997).</li><li>Nolan, J. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=European+Resuscitation+Council+and+European+Society+of+Intensive+Care+Medicine+guidelines+2021:+post-resuscitation+care.">European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care.</a> Intensive Care Medicine. 47 (4), 369-421 (2021).</li><li>Xu, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Postresuscitation+myocardial+diastolic+dysfunction+following+prolonged+ventricular+fibrillation+and+cardiopulmonary+resuscitation.">Postresuscitation myocardial diastolic dysfunction following prolonged ventricular fibrillation and cardiopulmonary resuscitation.</a> Critical Care Medicine. 36 (1), 188-192 (2008).</li><li>Fumagalli, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ventilation+with+argon+improves+survival+with+good+neurological+recovery+after+prolonged+untreated+cardiac+arrest+in+pigs.">Ventilation with argon improves survival with good neurological recovery after prolonged untreated cardiac arrest in pigs.</a> Journal of the American Heart Association. 9 (24), 016494 (2020).</li><li>Nagueh, S. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=et+al+Recommendations+for+the+evaluation+of+left+ventricular+diastolic+function+by+echocardiography:+An+update+from+the+American+Society+of+Echocardiography+and+the+European+Association+of+Cardiovascular+Imaging.">et al Recommendations for the evaluation of left ventricular diastolic function by echocardiography: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.</a> Journal of the American Society of Echocardiography. 29 (4), 277-314 (2016).</li><li>Lang, R. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=et+al+Recommendations+for+cardiac+chamber+quantification+by+echocardiography+in+adults:+an+update+from+the+American+Society+of+Echocardiography+and+the+European+Association+of+Cardiovascular+Imaging.">et al Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.</a> Journal of the American Society of Echocardiography. 28 (1), 1-39 (2015).</li><li>Yang, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Investigation+of+myocardial+stunning+after+cardiopulmonary+resuscitation+in+pigs.">Investigation of myocardial stunning after cardiopulmonary resuscitation in pigs.</a> Biomed Environ Sci. 24 (2), 155-162 (2011).</li><li>Vammen, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cardiac+arrest+in+pigs+with+48+hours+of+post-resuscitation+care+induced+by+2+methods+of+myocardial+infarction:+A+methodological+description.">Cardiac arrest in pigs with 48 hours of post-resuscitation care induced by 2 methods of myocardial infarction: A methodological description.</a> Journal of the American Heart Association. 10 (23), 022679 (2021).</li><li>Ristagno, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Postresuscitation+treatment+with+argon+improves+early+neurological+recovery+in+a+porcine+model+of+cardiac+arrest.">Postresuscitation treatment with argon improves early neurological recovery in a porcine model of cardiac arrest.</a> Shock. 41 (1), 72-78 (2014).</li><li>Rysz, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=et+al+The+effect+of+levosimendan+on+survival+and+cardiac+performance+in+an+ischemic+cardiac+arrest+model+-+A+blinded+randomized+placebo-controlled+study+in+swine.">et al The effect of levosimendan on survival and cardiac performance in an ischemic cardiac arrest model - A blinded randomized placebo-controlled study in swine.</a> Resuscitation. 150, 113-120 (2020).</li></ol>

在猪 AMI 实验模型中进行完整的超声心动图检查、心脏骤停和复苏可能会提供有关左心室功能演变和左心室结构变化的不同信息，尽管文献中有一定数量的数据5，8。在实验性心脏骤停的“纯”模型中（仅限于诱导心室颤动），心肌功能损害在ROSC后的头几天逆转，但对AMI是心脏骤停的原因时会发生什么知之甚少。
这项针对猪的研究?...

心脏骤停经常发生在典型胸痛发作后几分钟，在某些情况下，这是冠状动脉疾病的首发表现1。事实上，48% 的院外心脏骤停幸存者在血管造影2 中出现冠状动脉闭塞。此外，对于心脏骤停后恢复自主循环（ROSC）的患者，心功能不全是发病率和死亡率的最重要决定因素之一3。
经胸超声心动图 （TTE） 是一种非侵入性诊断和预后工具，用于评估复苏后心肌功能障碍、结构变化和/或 AMI 扩展 ROSC 后和随后几天。在猪的实验性缺血性和非缺血性心脏骤停模型中，TTE 常用于无创连续评估心脏收缩功能、血流动力学和对治疗的反应。2008年，舒张功能障碍的变化表现为二尖瓣E速度和组织多普勒（TDI）e'速度比（E / e'）的增加以及复苏后不久二尖瓣E速度和A速度比（E / A）的降低4。
本研究描述了在缺血性猪心脏骤停模型中，TTE在不同时间点评估左心室（LV）结构以及左心室收缩和舒张功能所遵循的不同方法学步骤。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Aquasonic</td>
			<td>Parker</td>
			<td>-</td>
			<td>ultrasound gel</td>
		</tr>
		<tr>
			<td>Adult foam ECG disposable monitoring and stress testing, wet gel, non-invasive patien</td>
			<td>Philips</td>
			<td>40493E</td>
			<td>ECG electrode</td>
		</tr>
		<tr>
			<td>Bellavista 1000</td>
			<td>Bellavista</td>
			<td>MB230000</td>
			<td>ventilator with infrared capnometer</td>
		</tr>
		<tr>
			<td>ComPACS</td>
			<td>Medimatic SRL</td>
			<td>-</td>
			<td>local database and software</td>
		</tr>
		<tr>
			<td>CX50</td>
			<td>Philips</td>
			<td>-</td>
			<td>Echocardiographic machine</td>
		</tr>
		<tr>
			<td>InTube Tracheal tube</td>
			<td>Intersurgical Ltd</td>
			<td>8040080</td>
			<td>cuffed tracheal tube</td>
		</tr>
		<tr>
			<td>LUCAS2</td>
			<td>Phisio-Control Inc</td>
			<td>-</td>
			<td>mechanical chest compressor</td>
		</tr>
		<tr>
			<td>MRx defibrillator</td>
			<td>Philips</td>
			<td>-</td>
			<td>defibrillator</td>
		</tr>
		<tr>
			<td>S5-1</td>
			<td>Philips</td>
			<td>-</td>
			<td>Phased array probe</td>
		</tr>
		<tr>
			<td>Swan-Ganz catheter 2 lumen 5fr</td>
			<td>Edwards</td>
			<td>110F5</td>
			<td>for the coronary artery occlusion</td>
		</tr>
		<tr>
			<td>Swan-Ganz catheter 2 lumen 7fr</td>
			<td>Edwards</td>
			<td>111F7</td>
			<td>for mean arterial pressure measurement</td>
		</tr>
		<tr>
			<td>Swan-Ganz catheter for thermodiluition 7fr</td>
			<td>Edwards</td>
			<td>131F7</td>
			<td>to measure right atrial pressure, core temperature and cardiac output</td>
		</tr>
	</tbody>
</table>

transthoracic echocardiography to assess post-resuscitation left ventricular dysfunction after acute myocardial infarction and cardiac arrest in pigs

院外心脏骤停的主要原因之一是急性心肌梗死（AMI）。心脏骤停复苏成功后，约70%的患者在出院前因复苏后心肌和脑功能障碍而死亡。在实验模型中，心脏骤停后的心肌功能障碍（以左心室（LV）收缩和舒张功能受损为特征）已被描述为可逆的，但在与猪AMI相关的心脏骤停模型中可用的数据很少。经胸超声心动图是评估心肌功能障碍、结构改变和/或 AMI 扩展的一线诊断性检查。在这种缺血性心脏骤停的猪模型中，超声心动图在基线和复苏后2-4和96小时进行。在急性期，检查在麻醉，机械通气的猪（体重39.8±0.6kg）中进行，并连续记录心电图。获取单维和二维、多普勒和组织多普勒记录。测量主动脉和左心房直径、收缩末期和舒张末期左心室壁厚度、舒张末期和收缩末期直径以及缩短分数 （SF）。采集心尖 2 腔、3 腔、4 腔和 5 腔室视图，计算左心室体积和射血分数。进行节段室壁运动分析以检测定位并估计心肌梗死的程度。脉冲波多普勒超声心动图用于记录 4 腔室视图的经二尖瓣流速和 5 腔室视图的经主动脉流速，以计算左心室心输出量 （CO） 和每击输出量 （SV）。记录左心室外侧和间隔二尖瓣的组织多普勒成像（TDI）（TDI间隔和外侧s'，e'，a'速度）。所有记录和测量均根据美国和欧洲超声心动图学会指南的建议进行。

12头猪行冠状动脉闭塞，随后进行12 min心室颤动和5 min心肺复苏术。8头猪成功复苏，7头猪在AMI心脏骤停-ROSC后96 h存活。 表1总结了研究期间不同时间点的所有超声心动图变量。
心率 （HR） 和收缩期超声心动图参数的变化 与基线（BL）相比，AMI心脏骤停-ROSC后2小时和4小时HR显着增加（平均±SEM：+64 ± 9和+56±12 bpm，p < 0.001和p < 0.01）与ESV一起（+15 ± 3和...

Watch this Scientific Journal Video about Transthoracic Echocardiography to Assess Post-Resuscitation Left Ventricular Dysfunction After Acute Myocardial Infarction and Cardiac Arrest in Pigs at JoVE.

Transthoracic Echocardiography to Assess Post-Resuscitation Left Ventricular Dysfunction After Acute Myocardial Infarction and Cardiac Arrest in Pigs

经胸超声心动图是复苏后左心室功能障碍和猪心脏骤停模型中结构变化的一线诊断性检查。

经胸超声心动图评估猪急性心肌梗死和心脏骤停后复苏后左心室功能障碍

One of the main causes of out-of-hospital cardiac arrest is acute myocardial infarction (AMI). After successful resuscitation from cardiac arrest, ...

经胸超声心动图是一种非侵入性诊断和预后工具，用于评估复苏后心肌功能障碍、结构改变和/或复苏后急性心肌梗死扩展。在猪的实验性缺血性和非缺血性心脏骤停模型中，经胸超声心动图经常用于认真评估无创心脏解剖结构和功能。超声心动图用于与心脏可能涉及的不同心脏和非心脏疾病相关的不同类型的动物的各种实验模型。首先在主动脉和左心室水平拍摄单维和二维超声心动图短轴和长轴图像。在主动脉水平拍摄二维短轴视图。此视图显示左心房主动脉瓣、右心房三尖瓣、右心室流出道和肺动脉瓣。将光标放在主动脉和左心房的中间以记录相应的M模式图像。采用二维胸骨旁长轴视图。此视图允许主动脉根部和主动脉瓣叶、室间隔、左心室和左心房的可视化。主动脉必须与室间隔处于同一水平面和连续体，主动脉瓣应清晰可见。将探头放置在左肋间隙的第三或第四处，其指示器朝向右侧，对探头角度进行微小的改变，以获得标准化的视图。在状水平拍摄左心室的二维短轴视图。对于左心室尺寸测量，在状或科迪斯水平使用短轴视图，这比在长轴视图中更容易获得通气动物的标准化图像。将光标放在左心室的中间，然后在状水平记录左心室的M模式图像。对左心室的下和顶端水平重复此过程。拍摄顶端四室视图。在心房间和室间隔的三尖瓣中，左右心房和心室与二尖瓣一起可见。将探头定位在心尖水平，然后将探头上的标记物定位在左侧，有助于标准化视图的结构是室间隔，应通过内侧或横向移动换能器来平行于超声束显示。采取顶端两室视图。从顶端四腔视图，将换能器逆时针方向旋转 45 到 60 度，只有左心房和左心室必须可见，因此请避开室间隔并验证光标是否通过左心房和左心室的中间。要获得心尖三腔视图，请将换能器从心尖四腔视图逆时针旋转 45 至 60 度，左心室顶点应与前间隔和后侧心室段一起可见。其他可见的结构将是主动脉瓣，左心房。欣赏五室的顶端景色。从顶端四腔开始，将探头向腹侧倾斜，然后横向倾斜，以观察斜鼻中隔、主动脉、左心室、右心室和两个心房。对于标准化的顶端四腔室视图，请记录一个符号环。将样品体积放在二尖瓣小叶的尖端，并使用彩色多普勒将光标正交于二尖瓣血流，并将其与左心室长轴对齐。然后，切换到脉冲多普勒并记录至少三个心动周期。同样，获得标准化的顶端五腔视图，并记录至少具有三个心动周期的符号环。使用彩色多普勒将光标与主动脉血流正交放置，将样本量移向主动脉瓣，直到流速加快，记录至少三个心动周期。从 2D 标准化顶点四腔室视图使用 TDI。PW-TDI测量单个节段的峰值纵向心肌速度。对于主动脉和左心房直径，使用前缘到前缘法测量主动脉窦水平处短轴视图的 M 模式。对于 LVOT 直径，从胸骨旁长轴视图测量主动脉尖下方 0.5 至 1 厘米处。对于状水平的舒张末期、前舒张期和舒张期后壁厚度，应从心肌壁和腔之间的边界以及心肌壁和心包之间的边界测量舒张末期。要计算左心室射血，将舒张末期定义为二尖瓣闭合后的第一个框架，或左心室尺寸最常见的框架，然后将收缩末期定义为主动脉瓣关闭后的框架，或心脏尺寸最小的框架。跟踪心肌和心室腔之间边界处左心室面积测量的轨迹，通过从心尖四腔视图修改辛普森单平面规则来测量面积并计算心室容积。按照文本手稿中的描述，在双翼辛普森方法的顶端双室视图中重复该过程。对于PW峰值二尖瓣流入速度，E和A速度以及E波减速时间是根据二尖瓣流谱测量的。对于 TDI 收缩压 S 素数速度以及舒张压 E 和 A 素数速度，根据隔膜环或侧环顶端四腔视图的 TDI 光谱图像进行测量，并计算冠状动脉闭塞后 96 小时内基线时的平均值。与基线和收缩末期容积相比，急性心肌功能障碍心脏骤停后2小时和4小时动物心率显著增加，而舒张末期容积在不同时间无明显变化。基线与2小时和4小时之间的LVEF平均差异分别约为负40和负39绝对分百分比。从急性心肌功能障碍心脏骤停后2至96小时ROSC，HR趋于正常化，LVEF改善，上升约25个百分点，但仍低于基线。左心室容量的变化很小且不显着，AMI心脏骤停ROSC后4至96小时的变化结果相似。减速时间是唯一在不同研究时间点发生显著变化的超声心动图舒张变量。在2小时时，减速时间较基线减少16%，并在急性心肌功能障碍心脏骤停ROSC后4小时保持减少。在96小时时，DT返回与基线坐标相似。补充方法可以是单光子发射计算机断层扫描或磁共振成像，不含钆或钆，以评估心肌灌注，最后一种方法也评估心肌水肿。

Research

JoVE Journal

Medicine

Transthoracic Echocardiography in Mice

经胸超声心动图在小鼠

In recent years, murine models have become the primary avenue for studying the molecular mechanisms of cardiac dysfunction resulting from changes in gene ...

科研

医学

Acute Myocardial Infarction in Rats

大鼠急性心肌梗死

With heart failure leading the cause of death in the USA (Hunt), biomedical research is fundamental to advance medical treatments for cardiovascular ...

Assessment of Right Ventricular Structure and Function in Mouse Model of Pulmonary Artery Constriction by Transthoracic Echocardiography

右心室结构和功能的肺动脉缩窄经胸超声小鼠模型的评估

Emerging clinical data support the notion that RV dysfunction is critical to the pathogenesis of cardiovascular disease and heart failure1-3. Moreover, ...

Myocardial Infarction and Functional Outcome Assessment in Pigs

心肌梗死和功能预后评估的猪

Introduction of newly discovered cardiovascular therapeutics into first-in-man trials depends on a strictly regulated ethical and legal roadmap. One ...

Primary Outcome Assessment in a Pig Model of Acute Myocardial Infarction

急性心肌梗死的猪模型主要成果评估

Mortality after acute myocardial infarction remains substantial and is associated with significant morbidity, like heart failure. Novel therapeutics are ...

Myocardial Infarction in Neonatal Mice, A Model of Cardiac Regeneration

心肌梗死新生小鼠，心肌再生的模型

Myocardial infarction induced by coronary artery ligation has been used in many animal models as a tool to study the mechanisms of cardiac repair and ...

Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation

经胸斑点跟踪超声心动图左室心肌变形的定量评价

The value of conventional echocardiography is limited by differences in inter-individual image interpretation and therefore largely dependent on the ...

Real-time Pressure-volume Analysis of Acute Myocardial Infarction in Mice

小鼠急性心肌梗死的实时压力容积分析

Acute myocardial infarction can lead to acute heart failure and cardiogenic shock. The evaluation of hemodynamics is critical for the evaluation of any ...

Digital PCR for Quantifying Circulating MicroRNAs in Acute Myocardial Infarction and Cardiovascular Disease

数字 PCR 在急性心肌梗死和心血管疾病中量化循环 MicroRNAs 的临床观察

Circulating serum microRNAs (miRNAs) have shown promise as biomarkers for the cardiovascular disease and acute myocardial infarction (AMI), being released ...

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

使用左前部降冠动脉的永久结扎的月心肌梗死模型

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