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Effect of Transmyocardial Laser Revascularization on Myocardial Perfusion and Left Ventricular Remodeling after Myocardial Infarction in Rats¹

¹ From the Physikalisches Institut (EP5) (M.N., K.H.H., A.H.) and Medizinische Universitätsklinik (K.H., C.W., R.K., G.E., W.R.B.), Universität Würzburg, Josef Schneider-Strasse 2, 97080 Würzburg, Germany; and Medizinisches Laserzentrum Lübeck, Germany (D.T., R.B.). Received August 6, 2001; revision requested September 24; final revision received March 18, 2002; accepted April 1. Supported by Sonderforschungsbereich 355 Herzinsuffizienz and Graduiertenkolleg HA 1232/8-1. Address correspondence to W.R.B. (e-mail: w.bauer@medizin.uni-wuerzburg.de).

View larger version (24K): [in a new window]   Figure 1. Diagram shows the experimental protocol. A total of 32 rats were studied. Six rats from each group died after MI induction. Two rats died during TMLR as a result of surgical complications. MRI = MR imaging.

View larger version (142K): [in a new window]   Figure 2. Two TMLR-treated spots are seen shortly after TMLR, and the infarct scar is seen by means of lateral thoracotomy.

View larger version (37K): [in a new window]   Figure 3. Systolic short-axis cine MR frame perfusion image of the isolated heart (left and center) and corresponding histologic findings (right) obtained in the same heart 4 weeks after TMLR. (Hematoxylin-eosin stain; original magnification, x5.) Arrows point to TMLR-treated regions, and the box represents the region of interest within the TMLR-treated area. All images were obtained in the same heart at the same level of the LV. MR images and histologic findings are shown to demonstrate how landmarks such as the infarct scar and the strong similarity in the pattern of TMLR-induced changes helped to determine the regions of interest for measurement of perfusion and wall thickening.

View larger version (14K): [in a new window]   Figure 4. Graphs show the results of perfusion measurements as differences from the control region within the septum of the same heart at rest (left, the change in perfusion is the difference from the control region in milliliters per minute multiplied by grams). TMLR-treated regions exhibited higher perfusion than did control regions. In the graph on the right, the perfusion increase within the same region from baseline toward nitroglycerin-induced stress is shown (right, change in perfusion is the difference between perfusion during stress vs perfusion in the same region at rest). The relative perfusion reserve was higher in the control region, but during nitroglycerin-induced stress, absolute perfusion of TMLR-treated areas was still higher by 2.29 mL/min x g ± 1.06. x = P < .05 versus the control region, = P < .05 versus the same region at rest.

View larger version (17K): [in a new window]   Figure 5. Graphs show LV morphologic changes from 8 to 12 weeks in the control group and the TMLR group. An increase in LV mass and end-diastolic volume (EDV) was enhanced with TMLR treatment.

View larger version (152K): [in a new window]   Figure 6a. (a) Photomicrograph shows histologic findings in the TMLR-treated region, with unaffected remote myocardium at the lower corners. Arrow shows original direction of TMLR. Four weeks after the procedure, necrosis was replaced by a richly vascularized granulation tissue. (Hematoxylin-eosin stain; original magnification, x20.) (b) Photomicrograph shows histologic findings in the TMLR-treated region only; there is no myocardium within this expanded view. Note the numerous small vessels within the granulation tissue that has replaced the TMLR-induced necrosis. (Hematoxylin-eosin stain; original magnification, x32.)

View larger version (146K): [in a new window]   Figure 6b. (a) Photomicrograph shows histologic findings in the TMLR-treated region, with unaffected remote myocardium at the lower corners. Arrow shows original direction of TMLR. Four weeks after the procedure, necrosis was replaced by a richly vascularized granulation tissue. (Hematoxylin-eosin stain; original magnification, x20.) (b) Photomicrograph shows histologic findings in the TMLR-treated region only; there is no myocardium within this expanded view. Note the numerous small vessels within the granulation tissue that has replaced the TMLR-induced necrosis. (Hematoxylin-eosin stain; original magnification, x32.)