Circulation, Vol 87, 893-899, Copyright © 1993 by American Heart Association
K Przyklenk, B Bauer, M Ovize, RA Kloner and P Whittaker
BACKGROUND. One or more brief episodes of coronary artery occlusion protect
or "precondition" the myocardium perfused by that artery from a subsequent
episode of sustained ischemia. We sought to determine whether ischemic
preconditioning protects only those myocytes subjected to brief coronary
occlusion or whether brief occlusions in one vascular bed also limit
infarct size and/or attenuate contractile dysfunction in remote virgin
myocardium subjected to subsequent sustained coronary occlusion. METHODS
AND RESULTS. In the preliminary limb of the study, six anesthetized dogs
underwent four episodes of 5-minute circumflex branch occlusion plus
5-minute reperfusion, followed by 1 hour of sustained left anterior
descending coronary artery occlusion and 4.5 hours of reflow.
Subendocardial blood flow during left anterior descending coronary artery
occlusion (measured by injection of radiolabeled microspheres) was 0.07 +/-
0.03 mL.min-1 x g tissue-1, similar to the value of 0.07 +/- 0.02 mL.min-1
x g-1 observed in a group of eight concurrent control dogs. However,
infarct size (assessed by triphenyltetrazolium staining) in the circumflex
preconditioned group averaged 4 +/- 1% of the myocardium at risk,
significantly less (p < 0.05) than the value of 13 +/- 4% observed in
the concurrent controls. An additional 18 dogs were then randomized to
undergo either four episodes of circumflex branch occlusion (n = 8) or no
intervention (n = 10) before 1 hour of left anterior descending coronary
artery occlusion and 4.5 hours of reflow. Subendocardial blood flow
averaged 0.08 +/- 0.02 versus 0.08 +/- 0.03 mL.min-1 x g-1 in the control
versus circumflex preconditioned groups, yet infarct size was significantly
smaller in circumflex preconditioned dogs than in the controls (6 +/- 2%
versus 16 +/- 5% of the risk region; p < 0.05). At 4.5 hours following
reperfusion, segment shortening in the left anterior descending coronary
artery bed (assessed by sonomicrometry) averaged - 21 +/- 19% of baseline
in control animals versus 13 +/- 12% of baseline in the preconditioned
group (p = NS). Circumflex preconditioning did not, however, have an
independent beneficial effect on contractile function: Regression analysis
revealed that the trend toward improved function in circumflex
preconditioned dogs reflected the smaller infarct sizes in this group.
CONCLUSIONS. Brief episodes of ischemia in one vascular bed protect remote,
virgin myocardium from subsequent sustained coronary artery occlusion in
this canine model. These data imply that preconditioning may be mediated by
factor(s) activated, produced, or transported throughout the heart during
brief ischemia/reperfusion.
ARTICLES
Regional ischemic 'preconditioning' protects remote virgin myocardium from subsequent sustained coronary occlusion
Heart Institute, Hospital of the Good Samaritan, Los Angeles, CA 90017.
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