Stability of hibernating myocardium in pigs with a chronic left anterior descending coronary artery stenosis: Absence of progressive fibrosis in the setting of stable reductions in flow, function and coronary flow reserve

被引:62
作者
Fallavollita, JA
Logue, M
Canty, JM
机构
[1] SUNY Buffalo, Dept Med, Buffalo, NY 14260 USA
[2] SUNY Buffalo, Dept Physiol Biophys, Buffalo, NY 14260 USA
[3] Vet Affairs Western New York Hlth Care Syst, Buffalo, NY USA
关键词
D O I
10.1016/S0735-1097(01)01250-5
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES This study was performed to determine whether hibernating myocardium is adaptive or is destined to undergo progressive irreversible injury. BACKGROUND Previous studies have suggested that hibernating myocardium eventually results in progressive dysfunction. Since serial studies cannot be performed in humans, the temporal progression of physiologic and structural adaptations was evaluated in pigs with hibernating myocardium. METHODS Pigs were instrumented with a left anterior descending coronary artery (LAD) stenosis (1.5 mm) and underwent physiologic studies three to five months later to quantify regional function, perfusion and F-18-2-deoxyglucose (FDG) uptake. Viability was confirmed by histology and contractile reserve. Hibernating myocardium was characterized by severe regional dysfunction (centerline score, -1.9 +/- 0.1), reduced resting subendocardial flow (LAD: 0.85 +/- 0.03 vs. normal: 1.02 +/- 0.03 ml/min/g, p < 0.01), critically reduced subendocardial flow reserve (adenosine flow: 1.04 +/- 0.09 ml/min/g, p = NS vs. rest; epinephrine flow: 0.88 +/- 0.07 ml/min/g, p = NS vs. rest) and increased FDG uptake (0.022 +/- 0.002 vs. 0.014 +/- 0.001 ml/g/min, p < 0.01). Physiologic parameters were not different among animals studied at three (93 +/- 1 days, n = 27), four (118 +/- 2 days, n = 26) or five months (150 +/- 6 days, n = 9). Pathology revealed a small increase in LAD connective tissue (6.4 +/- 0.4% vs. 4.0 +/- 0.2%, p < 0.001), with no change over this time frame. CONCLUSIONS Thus, physiologic and structural features of hibernating myocardium remain constant for at least two months. The absence of functional deterioration or progressive fibrosis suggests that hibernation is adaptive rather than an unstable physiology destined to progress to irreversible injury. The stability of this model appears ideally suited for interventions targeted to improve flow and function in chronically dysfunctional myocardium. (J Am Coll Cardiol 2001;37: 1989-95) (C) 2001 by the American College of Cardiology.
引用
收藏
页码:1989 / 1995
页数:7
相关论文
共 26 条
  • [1] MECHANISM OF MYOCARDIAL STUNNING
    BOLLI, R
    [J]. CIRCULATION, 1990, 82 (03) : 723 - 738
  • [2] STRUCTURAL CORRELATES OF REGIONAL MYOCARDIAL DYSFUNCTION IN PATIENTS WITH CRITICAL CORONARY-ARTERY STENOSIS - CHRONIC HIBERNATION
    BORGERS, M
    THONE, F
    WOUTERS, L
    AUSMA, J
    SHIVALKAR, B
    FLAMENG, W
    [J]. CARDIOVASCULAR PATHOLOGY, 1993, 2 (04) : 237 - 245
  • [3] CANTY JM, 1995, BASIC RES CARDIOL, V90, P5
  • [4] Resting myocardial flow in hibernating myocardium: validating animal models of human pathophysiology
    Canty, JM
    Fallavollita, JA
    [J]. AMERICAN JOURNAL OF PHYSIOLOGY-HEART AND CIRCULATORY PHYSIOLOGY, 1999, 277 (01): : H417 - H422
  • [5] Chronic hibernation and chronic stunning: A continuum
    Canty, JM
    Fallavollita, JA
    [J]. JOURNAL OF NUCLEAR CARDIOLOGY, 2000, 7 (05) : 509 - 527
  • [6] CANTY JM, 1987, CIRC RES, V61, P107
  • [7] Prognostic implications of myocardial contractile reserve in patients with coronary artery disease and left ventricular dysfunction
    Chaudhry, FA
    Tauke, JT
    Alessandrini, RS
    Vardi, G
    Parker, MA
    Bonow, RO
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1999, 34 (03) : 730 - 738
  • [8] Impact of delayed reperfusion of myocardial hibernation on myocardial ultrastructure and function and their recoveries after reperfusion in a pig model of myocardial hibernation
    Chen, CG
    Liu, J
    Hua, DP
    Ma, LJ
    Lai, TJ
    Fallon, JT
    Knibbs, D
    Gillam, L
    Mangion, J
    Knight, DR
    Waters, D
    [J]. CARDIOVASCULAR PATHOLOGY, 2000, 9 (02) : 67 - 84
  • [9] STRUCTURAL AND METABOLIC CORRELATES OF THE REVERSIBILITY OF CHRONIC LEFT-VENTRICULAR ISCHEMIC DYSFUNCTION IN HUMANS
    DEPRE, C
    VANOVERSCHELDE, JLJ
    MELIN, JA
    BORGERS, M
    BOL, A
    AUSMA, J
    DION, R
    WIJNS, W
    [J]. AMERICAN JOURNAL OF PHYSIOLOGY-HEART AND CIRCULATORY PHYSIOLOGY, 1995, 268 (03): : H1265 - H1275
  • [10] Long-term survival of patients with coronary artery disease and left ventricular dysfunction: Implications for the role of myocardial viability assessment in management decisions
    Di Carli, MF
    Maddahi, J
    Rokhsar, S
    Schelbert, HR
    Bianco-Batlles, D
    Brunken, RC
    Fromm, B
    [J]. JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 1998, 116 (06) : 997 - 1004