(Circulation. 1996;94:2210-2215.)
© 1996 American Heart Association, Inc.
Articles |
Spatial Heterogeneity of Myocardial Blood Flow Presages Salvage Versus Necrosis With Coronary Artery Reperfusion in Conscious Baboons
the Departments of Medicine, Harvard Medical School, Brigham & Women's Hospital, Boston, Mass; and the New England Regional Primate Research Center, Southborough, Mass.
Correspondence to Stephen F. Vatner, MD, New England Regional Primate Research Center, One Pine Hill Dr, PO Box 9102, Southborough, MA 01772-9102 or to You-Tang Shen, MD, Merck Research Laboratories, Pharmacology Department, West Point, PA 19486.
Background Myocardial blood flow distribution is known to be heterogeneous. It is also known that not all of the area at risk (AAR) infarcts with coronary artery occlusion (CAO) and coronary artery reperfusion (CAR). The goal of the present study was to determine whether the proportion of AAR that is salvaged or infarcted can be predicted by the pre-CAO level of myocardial blood flow, which varies considerably in individual samples as a result of natural heterogeneity.
Methods and Results The effects of 90-minute CAO followed by 5- to 7-day CAR were examined in six conscious baboons instrumented with aortic and left atrial catheters and coronary artery occluders. AAR was determined by dual perfusion. Myocardial blood flow was measured by radioactive microspheres before and after CAO and CAR. The AAR was cut into small pieces (0.21±0.01 g) and separated into two categories: salvaged (n=252) or infarcted (n=133). Analysis of myocardial blood flow distribution revealed two distinct populations (P<.01); infarcted tissues demonstrated higher pre-CAO myocardial blood flow than salvaged tissues. Importantly, 50% of the salvaged tissue samples were characterized by pre-CAO myocardial blood flows of <0.90 mL·min-1·g-1 compared with 29% for infarcted samples, whereas 51% of infarcted samples were characterized by pre-CAO myocardial blood flows of >1.12 mL·min-1·g-1 compared with 22% of salvaged samples. Endocardial analyses were qualitatively similar to transmural analyses.
Conclusions This study suggests that heterogeneity of pre-CAO myocardial blood flows can predict the proportion of myocardium salvaged by CAR and can further explain the spatial heterogeneity of infarction that occurs after CAR, potentially independent of CAR injury.
Key Words: myocardial infarction • microspheres • coronary blood flow
This article has been cited by other articles:
 |
|
 |
|
  A. R. Pries and T. W. Secomb Origins of heterogeneity in tissue perfusion and metabolism Cardiovasc Res, February 1, 2009; 81(2): 328 - 335. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Stoll, M. Quentin, A. Molojavyi, V. Thamer, and U. K.M. Decking Spatial heterogeneity of myocardial perfusion predicts local potassium channel expression and action potential duration Cardiovasc Res, February 1, 2008; 77(3): 489 - 496. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. F. De Marchi, P. Meier, P. Oswald, and C. Seiler Variable ECG signs of ischemia during controlled occlusion of the left and right coronary artery in humans Am J Physiol Heart Circ Physiol, July 1, 2006; 291(1): H351 - H356. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. A. Kaufmann and P. G. Camici Myocardial Blood Flow Measurement by PET: Technical Aspects and Clinical Applications J. Nucl. Med., January 1, 2005; 46(1): 75 - 88. [Full Text] [PDF]
|
|
|
|
|
|
T. Lauer, R. Loncar, and A. Deussen Tracer Adenosine: A Novel Myocardial Flow Marker J. Nucl. Med., April 1, 2003; 44(4): 641 - 648. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. C. Marshall, P. Powers-Risius, B. W. Reutter, A. M. Schustz, C. Kuo, M. K. Huesman, and R. H. Huesman Flow heterogeneity following global no-flow ischemia in isolated rabbit heart Am J Physiol Heart Circ Physiol, February 1, 2003; 284(2): H654 - H667. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 U. K. M. Decking Spatial Heterogeneity in the Heart: Recent Insights and Open Questions Physiology, December 1, 2002; 17(6): 246 - 250. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. R. Graham, R. K. Warrian, L. G. Girling, L. Doiron, G. R. Lefevre, M. Cheang, and W. A. C. Mutch Fractal or biologically variable delivery of cardioplegic solution prevents diastolic dysfunction after cardiopulmonary bypass J. Thorac. Cardiovasc. Surg., January 1, 2002; 123(1): 63 - 71. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Chareonthaitawee, P. A Kaufmann, O. Rimoldi, and P. G Camici Heterogeneity of resting and hyperemic myocardial blood flow in healthy humans Cardiovasc Res, April 1, 2001; 50(1): 151 - 161. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. K. Kudej, S.-J. Kim, Y.-T. Shen, J. B. Jackson, A. B. Kudej, G.-P. Yang, S. P. Bishop, and S. F. Vatner Nitric oxide, an important regulator of perfusion-contraction matching in conscious pigs Am J Physiol Heart Circ Physiol, July 1, 2000; 279(1): H451 - H456. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C.-H. Huang, S.-J. Kim, B. Ghaleh, R. K. Kudej, Y.-T. Shen, S. P. Bishop, and S. F. Vatner An adenosine agonist and preconditioning shift the distribution of myocardial blood flow in conscious pigs Am J Physiol Heart Circ Physiol, February 1, 1999; 276(2): H368 - H375. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. HEUSCH Hibernating Myocardium Physiol Rev, October 1, 1998; 78(4): 1055 - 1085. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. K. Kudej, B. Ghaleh, N. Sato, Y.-T. Shen, S. P. Bishop, and S. F. Vatner Ineffective Perfusion-Contraction Matching in Conscious, Chronically Instrumented Pigs With an Extended Period of Coronary Stenosis Circ. Res., June 15, 1998; 82(11): 1199 - 1205. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. G. Camici, W. Wijns, M. Borgers, R. De Silva, R. Ferrari, J. Knuuti, A. A. Lammertsma, A. J. Liedtke, G. Paternostro, and S. F. Vatner Pathophysiological Mechanisms of Chronic Reversible Left Ventricular Dysfunction due to Coronary Artery Disease (Hibernating Myocardium) Circulation, November 4, 1997; 96(9): 3205 - 3214. [Full Text]
|
|