Copyright © 2002 by the European Society of Cardiology.
Revascularization of hibernating myocardium. Rate of metabolic and functional recovery and occurrence of oxidative stress
a Cattedra di Cardiologia Spedali Civili, Brescia, Italy
b Divisione di Cardiochirurgia, Ospedale S. Raffaele, Milano, Italy
c Centro di Fisiopatologia Cardiovascolare, Fondazione "S. Maugeri" IRCCS, Gussago, Brescia, Italy
d II Divisione di Cardiochirurgia Spedali Civili, Brescia, Italy
e Dipartimento di Statistica, Università di Brescia, Italy
f Griffith Center, Division of Cardiology, University of Southern California, Los Angeles, USA
g Cattedra di Cardiologia, Università di Ferrara, Italy
revised July 16, 2002; accepted July 17, 2002
Abstract
Background Left ventricular (LV) dysfunction due to coronary artery disease (CAD) may improve after revascularization in patients with hibernating myocardium (HM).
Methods and Results We compared the rate of metabolic (arterial–great cardiac vein differences of lactate, glucose and pyruvate) and functional (intra-operative transesophageal and epicardial echocardiography) recovery and occurrence of oxidative stress (myocardial release of oxidized glutathione (GSSG)) early after surgical revascularization, in patients with CAD, LV dysfunction and HM (n=16) vs those with preserved LV function (n=15). By comparing the two groups, we observed that, after de-clamping, in patients with HM (a) the kinetic of lactate production was converted to extraction (P<0·01 at 1, 5, 10 and 20min after revascularization), (b) myocardial extraction of pyruvate increased (P<0·01 during the first 5min after revascularization), (c) GSSG release was less and of shorter duration (P<0·01 at all times), (d) segmental wall motion score improved from 2·4±0·3 to 1·7±0·5 (P<0·01) as did the thickening of the akinetic territories corresponding to the antero-distal septum and to the distal anterior wall regions (to 36±23%, and to 36±13%, respectively). There was a correlation between the rate of recovery of metabolic and functional indices.
Conclusions The contractile and metabolic recovery of HM is more rapid than that of non-HM, and it is not accompanied by oxidative stress. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.
Key Words: Left ventricular dysfunction, coronary artery disease, hibernating myocardium, metabolic and contractile recovery, oxidative stress.
f1 Correspondence: Prof. Roberto Ferrari, Chair of Cardiology, University of Ferrara, Cardiovascular Pathophysiology Research Center, Salvatore Maugeri Foundation, Via Pinidolo, 23, 25064 Gussago, Brescia, Italy.
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