Development of short-term myocardial hibernation. Its limitation by the severity of ischemia and inotropic stimulation.

Schulz, Rainer; Rose, James E.; Martin, Claus; Brodde, O.‐E.; Heusch, Gerd

doi:10.1161/01.cir.88.2.684

Cited by 254 publications

(132 citation statements)

References 38 publications

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“…Myocardial hibernation may represent a functional adaptation to chronic hypoperfusion that can be reversed with restoration of regional MBF (the "smart heart" hypothesis) (15). There is evidence to suggest that hibernating myocardium is still highly vulnerable to increases in demand or reductions in oxygen supply (16), such as further hemodynamic stress during HD. Therefore, ongoing recurrent episodes of ischemia precipitated by HD may have negative consequences on this adaptive balance, leading to further myocardial injury and eventual nonviable myocardium with irreversible reduction in LV function.…”

mentioning

confidence: 99%

Hemodialysis-Induced Repetitive Myocardial Injury Results in Global and Segmental Reduction in Systolic Cardiac Function

Burton¹,

Jefferies²,

Selby³

et al. 2009

Clinical Journal of the American Society of Nephrology

352

294

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Background and objectives: Hemodialysis (HD)-induced regional wall motion abnormalities (RWMAs) are common in HD patients and driven by ischemia. In nondialysis patients, repeated ischemia leads to chronic reduction in left ventricular (LV) function. HD-induced myocardial ischemia may initiate the same process. We examined the effect of HD-induced repetitive myocardial stunning on global and regional LV function.Design, setting, participants & measurements: We analyzed data from 30 patients, previously identified as developing HD-induced myocardial ischemia. Serial echocardiographic assessments of global and regional LV performance were performed at baseline and repeated after 12 mo.Results: Several patients developed segments with a fixed reduction in systolic function of >60% after 1 yr. In this patient group, there was a significant reduction in resting LV ejection fraction (EF) from 61.5 ؎ 10.1% to 52.9 ؎ 8.6% (P < 0.007). Peak LV EF in response to dialysis also decreased from 59.5 ؎ 10% versus 49.9 ؎ 6.5% (P < 0.003), with a consequent increase in HD-induced hypotension (P < 0.0001).Conclusions: HD-induced myocardial stunning may progress over 12 mo to the development of regional fixed systolic dysfunction, consistent with underlying myocardial hibernation and fibrosis. This may be an important and potentially modifiable process in the development of heart failure in HD patients.

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mentioning

confidence: 99%

Hemodialysis-Induced Repetitive Myocardial Injury Results in Global and Segmental Reduction in Systolic Cardiac Function

Burton¹,

Jefferies²,

Selby³

et al. 2009

Clinical Journal of the American Society of Nephrology

352

294

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“…Increased coronary perfusion pressure may only be beneficial in partially occluded coronary vessels (i.e. after resolution of ECG changes) [13]. In rare cases, myocardial ischaemia is caused by coronary artery spasms triggered by intra-operative stimulation (i.e.…”

Section: Discussionmentioning

confidence: 99%

Coronary artery angioplasty for treatment of peri‐operative myocardial ischaemia

et al. 2005

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SummaryIncreasing numbers of elderly patients with severe co-existing medical diseases undergo major surgery. With these patients there is also an accompanying risk of age-related cardiovascular complications such as life-threatening myocardial ischaemia. We present a patient who suffered a myocardial infarction after a hemicolectomy and suffered a cardiac arrest in the recovery room. The therapeutic options available (e.g. coronary artery bypass grafting, acute percutaneous coronary angioplasty and peri-operative thrombolysis) are discussed and the successful management of the case by coronary angioplasty and stent implantation is described. Peri-operative myocardial ischaemia is a serious clinical condition. In non-cardiac surgery, approximately 4% of all patients will experience peri-operative cardiac complications and 0.5% will suffer myocardial infarction [1]. Although most ischaemic episodes occur on the second and third postoperative day [2], in some patients myocardial ischaemia is apparent during surgery. If ST-segment elevations persist despite adequate treatment, mortality increases to 20-50% [3,4]. Consequently rapid and aggressive treatment is required to improve the survival rate of these patients.We present a case of near-fatal intra-and postoperative myocardial ischaemia after a hemicolectomy. The patient was treated by percutaneous transluminal coronary angioplasty and stent implantation within the first hour after surgery. Case reportA 76-year-old male patient (ASA physical status III, New York Heart Association class III, weighing 73 kg) was admitted for resection of a transverse colonic carcinoma. The patient had had a myocardial infarction less than 3 months previously. Additional cardiovascular risk factors were arterial hypertension and non-insulin dependent diabetes. Four years previously, the patient had had a cerebral vascular accident but made a full recovery. He was treated with a calcium-channel blocker, a thiazide diuretic, an angiotensin converting enzyme inhibitor and oral hypoglycaemic drugs (a biguanide and a sulphonylurea). Pre-operative blood chemistry was normal; the haemoglobin concentration was low at 9.7 g.dl ) and nitroglycerine (1.6 lg.kg )1 .min )1) were started. The mean blood pressure increased and was then maintained at 80 mm Hg until the end of the operation. Blood samples were collected for measurement of troponin T (positive threshold concentration 0

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“…Persistence of viable myocardium N12 hours from coronary occlusion has been demonstrated [3][4][5][6] and related somehow to the residual blood flow to the area at risk. Incomplete occlusion or intermittent reopening, 13 and other factors such as ischemic preconditioning, 14 residual blood flow in the infarct-related artery, 6 or recruitment of collaterals 15,16 may prevent complete necrosis and preserve viable myocardium.…”

Section: American Heart Journal December 2006mentioning

confidence: 99%

“…1,2 Experimental 3 and clinical [4][5][6] studies have demonstrated that ischemic but viable myocardium can persist for N12 hours after the coronary occlusion or onset of symptoms. Thus, all these studies indicate that in patients with ST-segment elevation acute myocardial infarction (STEMI) there is a potential for myocardium salvage even after the first 12 hours from the symptom onset given the appropriate reperfusion approach is used.…”

mentioning

confidence: 99%

Ability of mechanical reperfusion to salvage myocardium in patients with acute myocardial infarction presenting beyond 12 hours after onset of symptoms

Parodi

Ndrepepa

Kastrati

et al. 2006

American Heart Journal

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Development of short-term myocardial hibernation. Its limitation by the severity of ischemia and inotropic stimulation.

Abstract: Both the increased severity of ischemia and the enhanced energy expenditure induced by dobutamine impair the development of myocardial short-term hibernation and precipitate myocardial infarction.

Cited by 254 publications

References 38 publications

Hemodialysis-Induced Repetitive Myocardial Injury Results in Global and Segmental Reduction in Systolic Cardiac Function

Hemodialysis-Induced Repetitive Myocardial Injury Results in Global and Segmental Reduction in Systolic Cardiac Function

Coronary artery angioplasty for treatment of peri‐operative myocardial ischaemia

Ability of mechanical reperfusion to salvage myocardium in patients with acute myocardial infarction presenting beyond 12 hours after onset of symptoms

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