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Circulation, Vol 85, 2247-2254, Copyright © 1992 by American Heart Association
M Ovize, K Przyklenk, SL Hale and RA Kloner
BACKGROUND. Despite numerous reports that one or more episodes of brief
coronary artery occlusion preconditions the myocardium and dramatically
reduces myocardial infarct size produced by a subsequent prolonged
ischemia, we recently demonstrated that preconditioning does not attenuate
contractile dysfunction in the peri-infarct tissue. However, the specific
effects of preconditioning on myocardium in which wall motion has not been
compromised by the preconditioning regimen per se and is further submitted
to a short ischemic insult (that is, not confounded by necrosis) remain
unknown. METHODS AND RESULTS. We addressed these issues in the canine model
of myocardial stunning. Eighteen anesthetized dogs underwent 15 minutes of
coronary occlusion followed by 3 hours of reperfusion. Before the 15-minute
coronary occlusion, each dog received one of three treatments: no
intervention (control group, n = 6), one episode of 5-minute coronary
occlusion/5- minute reperfusion (PC5 group, n = 6), or one episode of
2.5-minute coronary occlusion/5-minute reperfusion (PC2.5 group, n = 6).
Segment shortening (SS) in the ischemic/reperfused midmyocardium was
monitored by sonomicrometry, and myocardial blood flow was assessed by
injection of radiolabeled microspheres. All three groups were equally
ischemic during the 15-minute coronary occlusion: Midmyocardial blood flow
averaged 0.05 +/- 0.02, 0.07 +/- 0.04, and 0.08 +/- 0.03 ml/min/g in
control, PC2.5, and PC5 groups, respectively. Before the 15-minute coronary
occlusion, PC5 dogs exhibited significant stunning (SS = 55% baseline; p
less than 0.01 versus control), whereas PC2.5 dogs did not (SS = 91%
baseline; p = NS versus control). However, segment shortening during the
subsequent 15-minute coronary occlusion was equally depressed at -25% to
-42% of baseline values among the three groups. Furthermore, all three
groups demonstrated a similar degree of stunning after reperfusion: SS at 3
hours after reflow averaged 24 +/- 12%, 34 +/- 16%, and 48 +/- 12% of
baseline in control, PC2.5, and PC5 groups, respectively (p = NS). The
degree of recovery of function after reperfusion correlated with the amount
of midmyocardial blood flow during coronary artery occlusion. However, this
relation was not different among the three groups: Specifically, for any
given collateral flow during ischemia, preconditioning did not reduce the
degree of stunning. CONCLUSIONS. Preconditioning neither preserves
contractile function during a reversible ischemic insult nor prevents
myocardial stunning during the initial hours of reflow.
ARTICLES
Preconditioning does not attenuate myocardial stunning
Heart Institute Research, Hospital of the Good Samaritan, Los Angeles, CA 90017.
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