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Circulation, Vol 88, 223-234, Copyright © 1993 by American Heart Association
M Miyamae, H Fujiwara, M Kida, R Yokota, M Tanaka, M Katsuragawa, K Hasegawa, M Ohura, K Koga and Y Yabuuchi
BACKGROUND. It has been reported that a brief period of coronary occlusion
and reperfusion slows the rate of ATP depletion during subsequent sustained
ischemia as well as limiting infarct size. However, it has not yet been
determined whether ischemic preconditioning also has an effect on the
functional and metabolic recovery of stunned myocardium. Our study was
designed to address this problem. METHODS AND RESULTS. Farm pigs were
anesthetized with fluothane and randomly assigned to either a control group
or a preconditioned group. The control group (n = 15) underwent 15 minutes
of coronary occlusion followed by 120 minutes of reperfusion. The
preconditioned group (n = 14) underwent two episodes of 5-minute occlusion
and 5-minute reperfusion followed by 15 minutes of occlusion and 120
minutes of reperfusion. This protocol was designed to exclude the stunning
effect of the preconditioning procedure itself as much as possible besides
preconditioning the heart. A pair of ultrasonic crystals was implanted in
the area at risk perfused by the left anterior descending coronary artery.
31P-nuclear magnetic resonance spectroscopy and sonomicrometry were
performed alternately. Regional myocardial blood flow (RMBF) was determined
with colored microspheres. At 15 minutes of sustained ischemia,
phosphocreatine (Pcr), ATP, and intracellular pH were significantly better
preserved in the preconditioned group (Pcr: control/preconditioned, 1 +/-
1%/14 +/- 1%; ATP:control/preconditioned, 66 +/- 2%/74 +/- 2%;
pH:control/preconditioned, 6.32 +/- 0.07/6.52 +/- 0.05; P < .05). After
reperfusion, ATP increased progressively and was almost normalized at 120
minutes of reperfusion in the preconditioned group (control/preconditioned,
73 +/- 4%/95 +/- 3%; P < .05). Overshoot of Pcr (which indicates that
the energy generating system is operating better than energy utilizing
system) persisted in preconditioned hearts but disappeared rapidly in
controls (control/preconditioned, 104 +/- 3%/130 +/- 3% after 120 minutes
of reperfusion). There was no significant difference in percent segment
shortening (%SS), RMBF, and hemodynamics between the two groups throughout
the experiment (%SS: control/preconditioned, 29.8 +/- 5.9%/28.8 +/- 6.3% of
baseline after 120 minutes of reperfusion). CONCLUSIONS. Preconditioning
improves energy metabolism during reperfusion, although it does not
attenuate myocardial stunning for at least 2 hours after reperfusion.
ARTICLES
Preconditioning improves energy metabolism during reperfusion but does not attenuate myocardial stunning in porcine hearts
Third Division, Faculty of Medicine, Kyoto University, Japan.
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