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Mitral regurgitation augments post-myocardial infarction remodeling failure of hypertrophic compensation.

Abstract：

OBJECTIVES:We examined whether mitral regurgitation (MR) augments post-myocardial infarction (MI) remodeling. BACKGROUND:MR doubles mortality after MI, but its additive contribution to left ventricular (LV) remodeling is debated and has not been addressed in a controlled fashion. METHODS:Apical MIs were created in 12 sheep, and 6 had an LV-to-left atrial shunt implanted, consistently producing regurgitant fractions of approximately 30%. The groups were compared at baseline, 1, and 3 months. RESULTS:Left ventricular end-systolic volume progressively increased by 190% with MR versus 90% without MR (p < 0.02). Pre-load-recruitable stroke work declined by 82 +/- 13% versus 25 +/- 16% (p < 0.01) with MR, with decreased remote-zone sarcoplasmic reticulum Ca(2+)-ATPase levels (0.56 +/- 0.03 vs. 0.76 +/- 0.02, p < 0.001), and decreased isolated myocyte contractility. In remote zones, pro-hypertrophic Akt and gp130 were upregulated in both groups at 1 month, but significantly lower and below baseline in the MR group at 3 months. Pro-apoptotic caspase 3 remained high in both groups. Matrix metalloproteinase (MMP)-13 and membrane-type MMP-1 were increased in remote zones of MR versus infarct-only animals at 1 month, then fell below baseline. The MMP tissue inhibitors rose from baseline to 3 months in all animals, rising higher in the MI + MR-group border zone. CONCLUSIONS:In this controlled model, moderate MR worsens post-MI remodeling, with reduced contractility. Pro-hypertrophic pathways are initially upregulated but subsequently fall below infarct-only levels and baseline; with sustained caspase 3 elevation, transformation to a failure phenotype occurs. Extracellular matrix turnover increases in MR animals. Therefore, MR can precipitate an earlier onset of dilated heart failure.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Beeri R,Yosefy C,Guerrero JL,Nesta F,Abedat S,Chaput M,del Monte F,Handschumacher MD,Stroud R,Sullivan S,Pugatsch T,Gilon D,Vlahakes GJ,Spinale FG,Hajjar RJ,Levine RA

doi

10.1016/j.jacc.2007.07.093

subject

Has Abstract

pub_date

2008-01-29 00:00:00

pages

476-86

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(07)03504-8

journal_volume

pub_type

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Mitral regurgitation augments post-myocardial infarction remodeling failure of hypertrophic compensation.