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European Heart Journal 1993 14(Supplement A):14-21; doi:10.1093/eurheartj/14.suppl_A.14
Copyright © 1993 by the European Society of Cardiology.
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© 1993 The European Society of Cardiology

Left ventricular dysfunction following transient ischaemia induced by transluminal coronary angioplasty. Beneficial effects of calcium antagonists against post-ischaemic myocardial stunning

I. Sheiban, S. Tonni, P. Benussi, A. Marini and G. P. Trevi

Centro di Fisiopatologia Cardiocircolatoria, 1st. Clinica Medica, Universitá di Verona; Cattedra di Cardiologia, Universita' di Chieti

Correspondence: I. Sheiban, MD, Centro di Fisiopatologia Cardiocircolatoria, Instituto di Clinica Medica, Universita' di Verona, Ospedale Policlinico, Via delle Menegone, 1-37134 Verona, Italy.

Acute and severe ischaemia is followed by depression of myocardial contractility during reperfusion; return to full recovery might take a long time. This phenomenon, termed myocardial stunning, has been extensively demonstrated in experimental studies and in different clinical settings.

The beneficial effects of calcium antagonists in preventing post-ischaemic myocardial stunning have been tested in experimental studies, showing that when administered before or during ischaemia, they inhibit post-ischaemic myocardial dysfunction.

The present study was undertaken to verify the possible occurrence of myocardial stunning following transient ischaemia induced by coronary angioplasty. The aim was also to evaluate the possible protective effects of calcium antagonists (nisoldipine) and nitrates against myocardial stunning in patients with coronary artery disease undergoing routine coronary angioplasty (PCTA) with prolonged inflation.

The study included 25 patients, aged between 40 and 69 years, with exercise-induced angina and single vessel disease. The stenosis was severe (80% to subtotal occlusion), localized on the left anterior descending artery, but without collaterals at coronary angiogram. All patients had normal left ventricular (LV) overall function and normal systolic thickening of the anterior wall supplied by the diseased artery.

Our data suggest that post-ischaemic myocardial stunning is not only an experimental curiosity, but that it does occur in different clinical settings. Calcium antagonists (i.e. nisoldipine), when added before or during ischaemia, seem to prevent myocardial stunning. These findings confer a potential role to these agents in the treatment of post-ischaemic myocardial dysfunction.

Key Words: Myocardial stunning • calcium antagonist • nisoldipine • acute myocardial ischaemia


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