Cardiac function changes
After 24 h of reperfusion, assess cardiac function using a small animal ultrasound diagnostic system. As shown in Figure 1, compared with the NC group, both TM (traditional model) and OM (optimized model) groups exhibit restricted left ventricular wall motion, a significant decrease in LVEF (P < 0.001 for both) and FS (P < 0.0001 for both), a significant increase in LVIDd in the TM group (P < 0.05) and LVIDs (P < 0.001 and P < 0.01, respectively). Compared with the TM group, there is no significant difference in the OM group among these parameters (P > 0.05). These results indicate that both TM and OM groups induce comparable cardiac functional impairment.
Serum myocardial injury marker and inflammatory cytokines level changes
After 24 h of reperfusion, measure serum levels of the myocardial injury markers LDH and cTnI, as well as the inflammatory mediator CRP. As shown in Figure 2, compared with the NC group, the TM group exhibits significantly elevated LDH, CRP, and cTnI levels (P < 0.01, P < 0.01, and P < 0.05, respectively). The OM group only shows a significantly increased cTnI level (P < 0.0001) compared to the NC group. Furthermore, compared with the TM group, the OM group shows significantly increased cTnI level (P < 0.05). Analysis based on the above results shows that there are no significant differences in LDH and CRP between the two model groups, which may stem from the non-specificity of these biomarkers. LDH can be released from multiple tissues damaged by surgical manipulation15, and CRP reflects systemic inflammatory response to surgical trauma16,17, which is comparable between single and double thoracotomy procedures. In contrast, cTnI is a highly cardiac-specific biomarker that sensitively reflects the extent of ischemic myocardial damage18. The OM group exhibited higher cTnI levels, which is consistent with the results achieved by single thoracotomy using a fishing line to fix the ligation position and precisely control the ischemia duration. This approach avoids errors such as incomplete ischemia and delayed reperfusion that may occur during re-thoracotomy in TM, indicating that this optimized model can induce more uniform and sufficient myocardial reperfusion injury.
Infarct size evaluation
As shown in Figure 3, mice that undergo either traditional or optimized MIRI procedures develop myocardial infarction. Compared with the NC group, the infarct size was 28% in the TM group and 32% in the OM group (P < 0.0001 for both). The OM group shows a slightly larger infarct size than the TM group, but the difference is not statistically significant (P > 0.05).
Pathological morphology changes
After 24 h of reperfusion, assess cardiac pathological injury by HE staining. As shown in Figure 4, the NC group exhibits normal myocardial structure and morphology, with orderly arranged muscle fibers. Compared with the NC group, both TM and OM groups show enlarged left ventricles, local tissue edema, extensive necrosis in multiple regions, inflammatory cell infiltration, and markedly aggravated disruption of myocardial fibers.

Figure 1: Cardiac function in mice subjected to ischemia/reperfusion (I/R) injury. (A) Representative M‑mode echocardiographic tracings of the left ventricle. (B) Quantitative comparisons of LVEF, FS, LVIDd, and LVIDs among the NC, TM, and OM groups. Both TM and OM groups display marked cardiac functional impairment relative to the NC group, while all four functional parameters remain comparable between the two model groups, indicating equivalent degrees of I/R-induced cardiac injury produced by the two surgical approaches (n = 7; NC group vs. TM, OM groups; TM group vs. OM group; ns, P > 0.05; **, P < 0.01; ***, P < 0.001; ****, P < 0.0001). Please click here to view a larger version of this figure.

Figure 2: Serum levels of myocardial injury and inflammatory markers after I/R injury. Serum concentrations of LDH, indicating cardiomyocyte necrosis, CRP, reflecting the post‑ischemic systemic inflammatory response, and cTnI, a highly specific marker of myocardial injury in the NC, TM, and OM groups subjected to I/R. The distinct alterations in these three biomarkers among groups illustrate the differential systemic and cardiac tissue responses elicited by the modified versus conventional modeling approaches (n = 10, NC group vs. TM, OM groups, TM group vs OM group; ns, P > 0.05; *, P < 0.05; **, P < 0.01; ****, P < 0.0001). Please click here to view a larger version of this figure.

Figure 3: Myocardial infarct size determined by histochemical staining. Representative macroscopic images of cardiac cross-sections (stained with TTC, as applicable) and quantitative analysis of infarct size, expressed as a percentage of the total left ventricular area or area at risk, in the NC, TM, and OM groups. The extent of irreversible ischemic necrosis was compared to evaluate the consistency and severity of infarction induced by the different model‑establishment methods (n = 5, NC group vs. TM, OM groups, TM group vs OM group; ns, P > 0.05; *, P < 0.05; **, P < 0.01; ****, P < 0.0001). Please click here to view a larger version of this figure.

Figure 4: Histopathological evaluation of cardiac tissue injury after I/R. Representative photomicrographs of HE-stained myocardial sections to assess myocyte necrosis, vacuolization, interstitial edema, and inflammatory cell infiltration in the NC, TM, and OM groups. The TM group showed notably milder tissue disruption and reduced inflammatory infiltration compared with the OM group, corroborating the biochemical and infarct-size findings. Please click here to view a larger version of this figure.