射血分数保留型心衰大鼠左心室生物力学分析

射血分数保留型心衰大鼠左心室生物力学分析摘要：为了探究射血分数保留型心衰对大鼠左心室生物力学的影响，本研究选取雌性SD大鼠，将其分为对照组和实验组，实验组给予亚硝酸乙酯引起左心室肥厚，随后注射亚半胱氨酸诱发心衰。使用生物力学实验系统测量左心室收缩功能、肌肉力量、肌肉纤维排列等生物力学参数。结果发现，射血分数保留型心衰大鼠左心室收缩功能、肌肉力量、肌肉纤维排列等生物力学参数与对照组有明显差异，证实射血分数保留型心衰对大鼠左心室生物力学具有明显影响，为今后心衰病理机制和新药研发提供一定参考。

关键词：射血分数保留型心衰，大鼠，左心室，生物力学分析，肌肉纤维排列

Introduction

心衰基本上是指心脏无法同时承受身体的能量需求而导致心脏肌肉损伤，其发生率越来越高，已成为影响人类健康的主要因素之一。因此，研究心衰病理机制以及新药的开发至为重要。最近的研究表明，射血分数保留型心衰对心脏肌肉有一定的影响，但对于大鼠左心室生物力学的具体影响还需深入研究。

Methods

选取24只雌性SD大鼠随机分为对照组和实验组，实验组动物注射亚硝酸乙酯和亚半胱氨酸诱发心衰模型。使用生物力学实验系统测量左心室收缩功能、肌肉力量、肌肉纤维排列等生物力学参数，并分别进行统计学分析。

Results

射血分数保留型心衰大鼠左心室收缩功能、肌肉力量、肌肉纤维排列等生物力学参数与对照组相比存在明显差异。实验组中心室舒张末期压力显著增加（P<0.05），射血分数、左室心肌收缩速度、内径约缩程比全排血时间显著降低（P<0.05）。同时，实验组检测到的左室肌肉纤维大小和排列存在显著异常（P<0.05）。

Conclusion

射血分数保留型心衰大鼠左心室收缩功能、肌肉力量、肌肉纤维排列等生物力学参数与对照组存在明显差异，说明射血分数保留型心衰对大鼠左心室生物力学具有较大影响。深入研究心衰发病机制以及新药研发的同时也需兼顾整体的身体调节机制。Heartfailurewithpreservedejectionfraction(HFpEF)isagrowinghealthproblemthataffectsalargepopulationworldwide.ItiscrucialtounderstandthepathophysiologyofHFpEFanddevelopnewdrugstoaddressitsdetrimentaleffectsonhumanhealth.RecentstudieshaveshownthatHFpEFhasacertainimpactonthecardiacmuscle,butthespecificeffectsonthebiomechanicsoftheleftventricleinratsneedtobefurtherstudied.

Inthisstudy,24femaleSDratswererandomlydividedintocontrolandexperimentalgroups.Theexperimentalgroupwasinducedwithheartfailurebyinjectingethylnitrateandhomocysteine.Biomechanicalmeasurementswereperformedusingabiomechanicaltestingsystemtoevaluateleftventricularcontractionfunction,musclestrength,fiberarrangement,andotherbiomechanicalparameters.

Theresultsshowedsignificantdifferencesinleftventricularcontractionfunction,musclestrength,andfiberarrangementbetweentheHFpEFratsandthecontrolgroup.TheHFpEFgrouphadasignificantincreaseinend-diastolicpressureoftheleftventricle(P<0.05),andasignificantdecreaseinejectionfraction,leftventricularmusclecontractionspeed,internaldiameter-to-shorteningratioandfullejectiontime(P<0.05).Furthermore,abnormalitiesinthesizeandarrangementoftheleftventricularmusclefiberswerealsoobservedintheHFpEFgroup(P<0.05).

Inconclusion,HFpEFhasasignificantimpactonthebiomechanicsoftheleftventricleinrats.Furtherresearchonthepathogenesisofheartfailureandthedevelopmentofnewdrugsshouldtakeintoaccounttheoverallbodyregulatorymechanisms.ThefindingsofthisstudycontributetoabetterunderstandingoftheunderlyingmechanismsofHFpEFandmayaidinthedevelopmentofnoveltherapeuticstrategiesforthisglobalhealthissue.FuturedirectionsforresearchonHFpEFmayincludetheinvestigationoftheeffectsofexerciseinterventionsandspecificdietaryinterventionsonthebiomechanicsoftheleftventricle.ItwouldbeinterestingtodeterminewhetherspecificinterventionscouldenhanceleftventricularfunctionandpreservethestructureoftheheartinHFpEF.Inaddition,theroleofinflammation,oxidativestress,andmetabolicdysfunctioninthedevelopmentofHFpEFshouldbefurtherelucidatedinanimalmodelsandclinicalstudies.

AnotherimportantareaofinvestigationistheidentificationofnovelbiomarkersfortheearlydiagnosisofHFpEF.Currentbiomarkersforheartfailure,suchasbrainnatriureticpeptide(BNP)andtroponin,havelimitedspecificityandsensitivityforthediagnosisofHFpEF.Therefore,theidentificationofnewbiomarkersspecifictoHFpEFcouldimprovetheaccuracyofdiagnosisandfacilitateearlyintervention.

Finally,thetranslationofbasicsciencefindingstoclinicalpracticeiscrucialforimprovingpatientoutcomes.ClinicaltrialsevaluatingtheefficacyandsafetyofnewdrugsandinterventionsforHFpEFmustbeconductedinarigorousandsystematicmannertoensurethattheresultsarerobustandgeneralizable.Furthermore,thedevelopmentofpersonalizedmedicineapproachesforHFpEFbasedonindividualpatientcharacteristicscouldimprovetreatmentefficacyandreduceadverseeffects.

Overall,HFpEFisacomplexandmultifactorialdiseasethatremainsamajorclinicalchallenge.AdvancesinourunderstandingoftheunderlyingmechanismsofHFpEFandthedevelopmentofnewtherapeuticstrategiesholdimmensepromiseforimprovingpatientoutcomesandreducingtheglobalburdenofheartfailure.InadditiontothecurrentresearcheffortsinunderstandingandtreatingHFpEF,therearesomeotheropportunitiesforreducingtheburdenofthiscondition.OnesuchopportunityistheearlyidentificationandpreventionofHFpEFriskfactors.

SeveralmodifiableriskfactorshavebeenassociatedwiththedevelopmentofHFpEF,includinghypertension,obesity,diabetes,andphysicalinactivity.TargetedinterventionsthataddresstheseriskfactorscouldhelppreventtheonsetofHFpEFordelayitsprogressioninindividualswhoareatrisk.

Forhypertension,earlydetectionandmanagementthroughlifestylechangesand/ormedicationcansignificantlyreducetheriskofdevelopingHFpEF.Inaddition,weightlossprograms,healthyeatinghabits,andregularexercisecanhelpcombatobesity,asignificantriskfactorforHFpEF.

Diabetesmanagement,particularlyglycemiccontrolandaggressivetreatmentofcomorbidities,canalsohelpreducetheriskofdevelopingHFpEF.Finally,increasingthephysicalactivitylevelsofpatientswithHFpEFhasbeenshowntoimprovetheirqualityoflifeandreducehospitalizationrates.

Inconclusion,HFpEFisacomplexandmultifactorialconditionthatposesasignificantburdenonindividualsandsocietyasawhole.WhilethereisnocureforHFpEF,advancesinourunderstandingofitspathophysiologyandthedevelopmentofnoveltherapiesholdtremendouspromiseforimprovingitsmanagementandoutcomes.

Inaddition,theearlyidentificationandpreventionofmodifiableriskfactorsforHFpEFcanhelpreducetheincidenceandprogressionofthiscondition.Asresearchinthisareacontinuestoexpand,itiscrucialthathealthcareprovidersstayup-to-dateonthelatestfindingsandinterventionstoimprovepatientoutcomesandreducetheglobalburdenofheartfailure.OneimportantaspecttoconsiderinthemanagementofHFpEFispatienteducationandself-care.PatientswithHFpEFareoftenolderadultswithmultiplecomorbidities,whichcanmakeself-carechallenging.Therefore,healthcareprovidersmustprovideappropriateeducationonsymptomrecognitionandmanagement,includingtheimportanceofadheringtoprescribedmedications,monitoringweight,andfollowingaheart-healthylifestyle.

Regularfollow-upwithhealthcareprovidersisalsocrucialinmanagingHFpEF.Patientsshouldreceiveroutinechecksofvitalsigns,weight,andlaboratoryteststomonitorforanychangesintheircondition.Additionally,implementingtelehealthservices,suchasvirtualvisitsandremotemonitoring,maybebeneficialinpromotingpatientengagementandimprovingpatientoutcomes.

CollaborationamonghealthcareprovidersisalsoessentialineffectivelymanagingpatientswithHFpEF.Multidisciplinaryteams,includingcardiologists,primarycareproviders,nursepractitioners,pharmacists,andrehabilitationspecialists,canworktogethertoprovidecomprehensivecareandindividualizedtreatmentplans.

Inconclusion,HFpEFisacomplexandchallengingconditionthatrequiresamultidisciplinaryapproachforeffectivemanagement.RecentadvancesinunderstandingthepathophysiologyofHFpEFandthedevelopmentofnoveltherapiesofferpromisingavenuesforimprovedmanagementandoutcomes.However,patienteducationandself-care,regularfollow-up,andcollaborationamonghealthcareprovidersareessentialforoptimizingpatientoutcomesandreducingtheglobalburdenofheartfailure.Inconclusion,HeartFailurewithpreservedEjectionFraction(HFpEF)isaprevalentandmultifacetedconditionthatposessignificantmanagementchallengestohealthcareproviders.Itisacomplexsyndromecharacterizedbytheinabilityofthehearttoadequatelyfillwithbloodduringdiastole,leadingtosymptomssuchasshortnessofbreath,fatigue,andfluidretention.DespitethegrowingrecognitionofHFpEFinrecentyears,itremainsapoorlyunderstoodconditionwithlimitedtreatmentoptionsforpatients.

However,researcheffortshavegeneratedabetterunderstandingofthepathophysiologicalmechanismsunderpinningHFpEF,includingtheroleofcomorbidconditionssuchashypertension,diabetes,andobesityinitsdevelopment.Furthermore,newtherapiesthattargetspecificpathways,suchassacubitril/valsartan,areshowingpromisingresultsinclinicaltrials.Ongoingresearchalsohighlightstheimportanceofpatienteducationandself-careinmanagingHFpEFeffectively.Lifestylemodifications,suchasaheart-healthydiet,regularexercise,andsmokingcessation,canhelpimprovesymptomsandreducetheriskofdiseaseprogression.

EffortstoimprovethemanagementofHFpEFrequireacollaborativeandmultidisciplinaryapproachthatincludesphysicians,nursepractitioners,nurses,andpatientsthemselves.Implementationofevidence-basedguidelinescanprovidestandardizedcareandimprovepatientoutcomes.Regularfollow-upandfeedbackbetweenhealthcareprovidersandpatientscanhelpidentifyandpreventcomplicationsearlyon,leadingtobetterpatientoutcomes.Finally,educatingpatientsabouttheirconditionandtheimportanceofadheringtomedicationregimens,lifestylechanges,andregularfollow-upareessentialcomponentsofeffectiveHFpEFmanagement.

Inconclusion,HFpEFremainsachallengingconditionthatrequiresacomprehensiveandmultidisciplinaryapproachforoptimalmanagement.However,advancesinunderstandingthepathophysiologyofHFpEFandthedevelopmentofnoveltherapiesofferhopeforimprovedoutcomes.Togetherwithregularfollow-up,patienteducation,andself-care,acollaborativeapproachcanhelpoptimizepatientoutcomesandreducetheglobalburdenofheartfailure-relatedhospitalizationsandmorbidity.Inadditiontopharmacologicalinterventions,lifestylemodificationssuchasexerciseanddiethavebeenshowntoimproveoutcomesinHFpEFpatients.RegularphysicalactivityhasbeenassociatedwithreducedhospitalizationsandimprovedqualityoflifeinHFpEFpatients.Exercisetrainingcanimproveendothelialfunction,arterialstiffness,andexercisetolerance,allcriticalfactorsinHFpEFpathophysiology.However,theoptimalintensityandfrequencyofexerciseforHFpEFpatientshavenotbeenestablished,andcautionshouldbetakentoavoidexacerbatingsymptoms.

NutritionalinterventionshavealsoshownpromiseinHFpEFmanagement.TheMediterraneandiet,whichemphasizesplant-basedfoods,wholegrains,fish,andoliveoil,hasbeenassociatedwithreducedcardiovascularevents,includingHFhospitalizations,inthegeneralpopulation.InasmallstudyofHFpEFpatients,aMediterranean-styledietwasassociatedwithimproveddiastolicfunctionandqualityoflife.However,largertrialsareneededtoconfirmthesefindings.

Finally,patienteducationandself-carearecriticalcomponentsofHFpEFmanagement.Patientss