Skip to main content
NCBI home page
Heart logoLink to Heart
. 1996 Jan;75(1):55–61. doi: 10.1136/hrt.75.1.55

Haemodynamic and energetic properties of stunned myocardium in rabbit hearts.

J D Schipke 1, B Korbmacher 1, A Dorszewski 1, G Selcan 1, U Sunderdiek 1, G Arnold 1
PMCID: PMC484223  PMID: 8624873

Abstract

OBJECTIVE--To amplify the description of myocardial stunning. DESIGN--Control versus 30 min after a 20 min no flow ischaemia. EXPERIMENTAL ANIMALS--15 isolated rabbit hearts perfused with erythrocyte suspension. MAIN OUTCOME MEASURES--Left ventricular systolic function in terms of aortic flow, peak systolic pressure (LVPmax), dP/dtmax, and the end systolic pressure-volume relation (ESPVR); early relaxation from dP/dtmin and rate of left ventricular pressure decay (tau). Passive properties: ventricular and myocardial stiffness. Coronary resistance from coronary blood flow and perfusion pressure. Total myocardial oxygen consumption (MVo2tot). Total mechanical energy via pressure-volume area (PVA). Contractile efficiency (Econ) and MVo2 of the unloaded contracting heart (MVo2unl). External mechanical efficiency (Eext) from stroke work and MVo2tot. RESULTS--Systolic variables in stunned myocardium were significantly decreased (mean (SD)): aortic flow: 38 (13) v 9 (11) ml/min; LVPmax: 112 (19) v 74 (18) mm Hg; dP/dtmax: 1475 (400) v 1075 (275) mm Hg/s. ESPVR was not significantly decreased, at 138 (73) v 125 (58) mm Hg/ml, but the volume axis intercept was shifted rightward: 0.30 (0.37) v 0.65 (0.25) ml. Likewise, early relaxation was impaired: dP/dtmin (-1275 (250) v -975 (250) mm Hg/s) and tau (37 (7) v 46 (10) ms). LVPed was significantly decreased at 19 (12) v 12 (7) mm Hg, and both the ventricular (end diastolic pressure-volume relation) and the myocardial stiffness (constant k) were increased by 75% and 31%, respectively. Coronary resistance increased non-significantly from 0.83 (0.31) to 1.04 (0.41) mm Hg/(ml/min/100 g). Decreases in PVA (570 (280) v 270 (200) mm Hg.ml/100 g), MVo2tot (40 (9) v 34 (8) microliters/beat/100 g), and MVo2unl (26 (9) v 22 (6) microliters/beat/100 g) did not reach significance, in contrast to significant decreases in Econ (31 (18) v 14 (7)%) and Eext (0.75 (0.29) v 0.18 (0.25) arbitrary units). CONCLUSIONS--Ventricular systolic function is decreased after brief episodes of ischaemia. The decrease in diastolic function probably amplifies the systolic deterioration during myocardial stunning. Passive diastolic properties are also changed, shown by increases in both ventricular and myocardial stiffness. The increase in coronary resistance indicates stunning at the vascular level which could limit oxygen supply. With maintained MVo2tot during stunning, external efficiency is decreased. Possible candidates for this metabolic stunning are inadequate excitation-contraction coupling and disturbed O2 utilisation by the contractile apparatus.

Full text

PDF
55

Images in this article

57Image
on p.57

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allen B. S., Rosenkranz E. R., Buckberg G. D., Vinten-Johansen J., Okamoto F., Leaf J. High oxygen requirements of dyskinetic cardiac muscle. J Thorac Cardiovasc Surg. 1986 Sep;92(3 Pt 2):543–552. [PubMed] [Google Scholar]
  2. Ambrosio G., Jacobus W. E., Bergman C. A., Weisman H. F., Becker L. C. Preserved high energy phosphate metabolic reserve in globally "stunned" hearts despite reduction of basal ATP content and contractility. J Mol Cell Cardiol. 1987 Oct;19(10):953–964. doi: 10.1016/s0022-2828(87)80568-0. [DOI] [PubMed] [Google Scholar]
  3. Babbitt D. G., Virmani R., Forman M. B. Intracoronary adenosine administered after reperfusion limits vascular injury after prolonged ischemia in the canine model. Circulation. 1989 Nov;80(5):1388–1399. doi: 10.1161/01.cir.80.5.1388. [DOI] [PubMed] [Google Scholar]
  4. Bolli R. Myocardial 'stunning' in man. Circulation. 1992 Dec;86(6):1671–1691. doi: 10.1161/01.cir.86.6.1671. [DOI] [PubMed] [Google Scholar]
  5. Bolli R., Triana J. F., Jeroudi M. O. Prolonged impairment of coronary vasodilation after reversible ischemia. Evidence for microvascular "stunning". Circ Res. 1990 Aug;67(2):332–343. doi: 10.1161/01.res.67.2.332. [DOI] [PubMed] [Google Scholar]
  6. Borg T. K., Ranson W. F., Moslehy F. A., Caulfield J. B. Structural basis of ventricular stiffness. Lab Invest. 1981 Jan;44(1):49–54. [PubMed] [Google Scholar]
  7. Braunwald E., Kloner R. A. The stunned myocardium: prolonged, postischemic ventricular dysfunction. Circulation. 1982 Dec;66(6):1146–1149. doi: 10.1161/01.cir.66.6.1146. [DOI] [PubMed] [Google Scholar]
  8. Burkhoff D. Myocardial energetics and the postischemic heart. Ann Thorac Surg. 1990 Apr;49(4):525–527. doi: 10.1016/0003-4975(90)90296-i. [DOI] [PubMed] [Google Scholar]
  9. Burkhoff D., de Tombe P. P., Hunter W. C., Kass D. A. Contractile strength and mechanical efficiency of left ventricle are enhanced by physiological afterload. Am J Physiol. 1991 Feb;260(2 Pt 2):H569–H578. doi: 10.1152/ajpheart.1991.260.2.H569. [DOI] [PubMed] [Google Scholar]
  10. Charlat M. L., O'Neill P. G., Hartley C. J., Roberts R., Bolli R. Prolonged abnormalities of left ventricular diastolic wall thinning in the "stunned" myocardium in conscious dogs: time course and relation to systolic function. J Am Coll Cardiol. 1989 Jan;13(1):185–194. doi: 10.1016/0735-1097(89)90569-x. [DOI] [PubMed] [Google Scholar]
  11. Cohn P. F., Liedtke A. J., Serur J., Sonnenblick E. H., Urschel C. W. Maximal rate of pressure fall (peak negative dP-dt) during ventricular relaxation. Cardiovasc Res. 1972 May;6(3):263–267. doi: 10.1093/cvr/6.3.263. [DOI] [PubMed] [Google Scholar]
  12. Ehring T., Schulz R., Schipke J. D., Heusch G. Diastolic dysfunction of stunned myocardium. Am J Cardiovasc Pathol. 1993;4(4):358–366. [PubMed] [Google Scholar]
  13. Fishbein M. C., Y-Rit J., Lando U., Kanmatsuse K., Mercier J. C., Ganz W. The relationship of vascular injury and myocardial hemorrhage to necrosis after reperfusion. Circulation. 1980 Dec;62(6):1274–1279. doi: 10.1161/01.cir.62.6.1274. [DOI] [PubMed] [Google Scholar]
  14. Furchgott R. F., Zawadzki J. V. The obligatory role of endothelial cells in the relaxation of arterial smooth muscle by acetylcholine. Nature. 1980 Nov 27;288(5789):373–376. doi: 10.1038/288373a0. [DOI] [PubMed] [Google Scholar]
  15. Furukawa S., Bavaria J. E., Kreiner G., Edmunds L. H., Jr Relationship between total mechanical energy and oxygen consumption in the stunned myocardium. Ann Thorac Surg. 1990 Apr;49(4):543–549. doi: 10.1016/0003-4975(90)90299-l. [DOI] [PubMed] [Google Scholar]
  16. Gibbs C. L., Chapman J. B. Cardiac mechanics and energetics: chemomechanical transduction in cardiac muscle. Am J Physiol. 1985 Aug;249(2 Pt 2):H199–H206. doi: 10.1152/ajpheart.1985.249.2.H199. [DOI] [PubMed] [Google Scholar]
  17. Glower D. D., Schaper J., Kabas J. S., Hoffmeister H. M., Schaper W., Spratt J. A., Davis J. W., Rankin J. S. Relation between reversal of diastolic creep and recovery of systolic function after ischemic myocardial injury in conscious dogs. Circ Res. 1987 Jun;60(6):850–860. doi: 10.1161/01.res.60.6.850. [DOI] [PubMed] [Google Scholar]
  18. Guevara M. R., Shrier A., Glass L. Phase-locked rhythms in periodically stimulated heart cell aggregates. Am J Physiol. 1988 Jan;254(1 Pt 2):H1–10. doi: 10.1152/ajpheart.1988.254.1.H1. [DOI] [PubMed] [Google Scholar]
  19. Guth B. D., Martin J. F., Heusch G., Ross J., Jr Regional myocardial blood flow, function and metabolism using phosphorus-31 nuclear magnetic resonance spectroscopy during ischemia and reperfusion in dogs. J Am Coll Cardiol. 1987 Sep;10(3):673–681. doi: 10.1016/s0735-1097(87)80212-7. [DOI] [PubMed] [Google Scholar]
  20. Hanaki Y., Sugiyama S., Ajioka M., Kondo T., Fukushima A., Ozawa T. Acceleration of recovery of mitochondrial function after coronary reperfusion by various coronary dilating drugs in canine hearts. J Cardiovasc Pharmacol. 1989 Feb;13(2):336–341. doi: 10.1097/00005344-198902000-00025. [DOI] [PubMed] [Google Scholar]
  21. Hasebe N., Shen Y. T., Vatner S. F. Inhibition of endothelium-derived relaxing factor enhances myocardial stunning in conscious dogs. Circulation. 1993 Dec;88(6):2862–2871. doi: 10.1161/01.cir.88.6.2862. [DOI] [PubMed] [Google Scholar]
  22. Hearse D. J. Stunning: a radical re-view. Cardiovasc Drugs Ther. 1991 Oct;5(5):853–876. doi: 10.1007/BF00053547. [DOI] [PubMed] [Google Scholar]
  23. Hess O. M., Osakada G., Lavelle J. F., Gallagher K. P., Kemper W. S., Ross J., Jr Diastolic myocardial wall stiffness and ventricular relaxation during partial and complete coronary occlusions in the conscious dog. Circ Res. 1983 Apr;52(4):387–400. doi: 10.1161/01.res.52.4.387. [DOI] [PubMed] [Google Scholar]
  24. Heusch G. The relationship between regional blood flow and contractile function in normal, ischemic, and reperfused myocardium. Basic Res Cardiol. 1991 May-Jun;86(3):197–218. doi: 10.1007/BF02190600. [DOI] [PubMed] [Google Scholar]
  25. Heyndrickx G. R., Baig H., Nellens P., Leusen I., Fishbein M. C., Vatner S. F. Depression of regional blood flow and wall thickening after brief coronary occlusions. Am J Physiol. 1978 Jun;234(6):H653–H659. doi: 10.1152/ajpheart.1978.234.6.H653. [DOI] [PubMed] [Google Scholar]
  26. Heyndrickx G. R., Millard R. W., McRitchie R. J., Maroko P. R., Vatner S. F. Regional myocardial functional and electrophysiological alterations after brief coronary artery occlusion in conscious dogs. J Clin Invest. 1975 Oct;56(4):978–985. doi: 10.1172/JCI108178. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Itoh H., Hiraoka N., Higuchi H., Ito M., Konishi T., Nakano T. Contractile actions of endothelin-1 in isolated helical strips from rat pulmonary artery: potentiation of serotonin-induced contraction. J Cardiovasc Pharmacol. 1992 Jul;20(1):1–6. [PubMed] [Google Scholar]
  28. Jeremy R. W., Links J. M., Becker L. C. Progressive failure of coronary flow during reperfusion of myocardial infarction: documentation of the no reflow phenomenon with positron emission tomography. J Am Coll Cardiol. 1990 Sep;16(3):695–704. doi: 10.1016/0735-1097(90)90362-s. [DOI] [PubMed] [Google Scholar]
  29. Kloner R. A., Przyklenk K., Patel B. Altered myocardial states. The stunned and hibernating myocardium. Am J Med. 1989 Jan 16;86(1A):14–22. doi: 10.1016/0002-9343(89)90005-3. [DOI] [PubMed] [Google Scholar]
  30. Krause S. M., Jacobus W. E., Becker L. C. Alterations in cardiac sarcoplasmic reticulum calcium transport in the postischemic "stunned" myocardium. Circ Res. 1989 Aug;65(2):526–530. doi: 10.1161/01.res.65.2.526. [DOI] [PubMed] [Google Scholar]
  31. Kumada T., Karliner J. S., Pouleur H., Gallagher K. P., Shirato K., Ross J., Jr Effects of coronary occlusion on early ventricular diastolic events in conscious dogs. Am J Physiol. 1979 Nov;237(5):H542–H549. doi: 10.1152/ajpheart.1979.237.5.H542. [DOI] [PubMed] [Google Scholar]
  32. Laster S. B., Becker L. C., Ambrosio G., Jacobus W. E. Reduced aerobic metabolic efficiency in globally "stunned" myocardium. J Mol Cell Cardiol. 1989 Apr;21(4):419–426. doi: 10.1016/0022-2828(89)90652-4. [DOI] [PubMed] [Google Scholar]
  33. Laxson D. D., Homans D. C., Dai X. Z., Sublett E., Bache R. J. Oxygen consumption and coronary reactivity in postischemic myocardium. Circ Res. 1989 Jan;64(1):9–20. doi: 10.1161/01.res.64.1.9. [DOI] [PubMed] [Google Scholar]
  34. Left ventricular relaxation and diastolic stiffness in experimental myocardial infarction. Cardiovasc Res. 1974 Sep;8(5):583–592. doi: 10.1093/cvr/8.5.583. [DOI] [PubMed] [Google Scholar]
  35. Liedtke A. J., DeMaison L., Eggleston A. M., Cohen L. M., Nellis S. H. Changes in substrate metabolism and effects of excess fatty acids in reperfused myocardium. Circ Res. 1988 Mar;62(3):535–542. doi: 10.1161/01.res.62.3.535. [DOI] [PubMed] [Google Scholar]
  36. Marban E. Myocardial stunning and hibernation. The physiology behind the colloquialisms. Circulation. 1991 Feb;83(2):681–688. doi: 10.1161/01.cir.83.2.681. [DOI] [PubMed] [Google Scholar]
  37. Nizolek J. A., Jr, Jacob R. J., Gilmore J. P. Insignificance of activation pathway on myocardial oxygen consumption. Cardiovasc Res. 1971 Jul;5(3):343–346. doi: 10.1093/cvr/5.3.343. [DOI] [PubMed] [Google Scholar]
  38. Ohgoshi Y., Goto Y., Futaki S., Taku H., Kawaguchi O., Suga H. Increased oxygen cost of contractility in stunned myocardium of dog. Circ Res. 1991 Oct;69(4):975–988. doi: 10.1161/01.res.69.4.975. [DOI] [PubMed] [Google Scholar]
  39. Preuss K. C., Gross G. J., Brooks H. L., Warltier D. C. Time course of recovery of "stunned" myocardium following variable periods of ischemia in conscious and anesthetized dogs. Am Heart J. 1987 Oct;114(4 Pt 1):696–703. doi: 10.1016/0002-8703(87)90777-0. [DOI] [PubMed] [Google Scholar]
  40. Przyklenk K., Patel B., Kloner R. A. Diastolic abnormalities of postischemic "stunned" myocardium. Am J Cardiol. 1987 Nov 15;60(14):1211–1213. doi: 10.1016/0002-9149(87)90435-8. [DOI] [PubMed] [Google Scholar]
  41. Reimer K. A., Hill M. L., Jennings R. B. Prolonged depletion of ATP because of delayed repletion of the adenine nucleotide pool following reversible myocardial ischemic injury in dogs. Adv Myocardiol. 1983;4:395–407. doi: 10.1007/978-1-4757-4441-5_36. [DOI] [PubMed] [Google Scholar]
  42. Sako E. Y., Kingsley-Hickman P. B., From A. H., Foker J. E., Ugurbil K. ATP synthesis kinetics and mitochondrial function in the postischemic myocardium as studied by 31P NMR. J Biol Chem. 1988 Aug 5;263(22):10600–10607. [PubMed] [Google Scholar]
  43. Schipke J. D., Heusch G., Deussen A., Thämer V. Acetylcholine induces constriction of epicardial coronary arteries in anesthetized dogs after removal of endothelium. Arzneimittelforschung. 1985;35(6):926–929. [PubMed] [Google Scholar]
  44. Suga H., Hisano R., Goto Y., Yamada O., Igarashi Y. Effect of positive inotropic agents on the relation between oxygen consumption and systolic pressure volume area in canine left ventricle. Circ Res. 1983 Sep;53(3):306–318. doi: 10.1161/01.res.53.3.306. [DOI] [PubMed] [Google Scholar]
  45. Suga H. Ventricular energetics. Physiol Rev. 1990 Apr;70(2):247–277. doi: 10.1152/physrev.1990.70.2.247. [DOI] [PubMed] [Google Scholar]
  46. Svendsen J. H., Bjerrum P. J., Haunsø S. Myocardial capillary permeability after regional ischemia and reperfusion in the in vivo canine heart. Effect of superoxide dismutase. Circ Res. 1991 Jan;68(1):174–184. doi: 10.1161/01.res.68.1.174. [DOI] [PubMed] [Google Scholar]
  47. Triana J. F., Li X. Y., Jamaluddin U., Thornby J. I., Bolli R. Postischemic myocardial "stunning". Identification of major differences between the open-chest and the conscious dog and evaluation of the oxygen radical hypothesis in the conscious dog. Circ Res. 1991 Sep;69(3):731–747. doi: 10.1161/01.res.69.3.731. [DOI] [PubMed] [Google Scholar]
  48. Wallace A. Do deficiencies of endothelial derived relaxing factor contribute to myocardial stunning? J Card Surg. 1993 Mar;8(2 Suppl):325–328. doi: 10.1111/j.1540-8191.1993.tb01333.x. [DOI] [PubMed] [Google Scholar]
  49. Weber K. T. Cardiac interstitium in health and disease: the fibrillar collagen network. J Am Coll Cardiol. 1989 Jun;13(7):1637–1652. doi: 10.1016/0735-1097(89)90360-4. [DOI] [PubMed] [Google Scholar]
  50. Whittaker P., Boughner D. R., Kloner R. A., Przyklenk K. Stunned myocardium and myocardial collagen damage: differential effects of single and repeated occlusions. Am Heart J. 1991 Feb;121(2 Pt 1):434–441. doi: 10.1016/0002-8703(91)90709-q. [DOI] [PubMed] [Google Scholar]
  51. Wijns W., Serruys P. W., Slager C. J., Grimm J., Krayenbuehl H. P., Hugenholtz P. G., Hess O. M. Effect of coronary occlusion during percutaneous transluminal angioplasty in humans on left ventricular chamber stiffness and regional diastolic pressure-radius relations. J Am Coll Cardiol. 1986 Mar;7(3):455–463. doi: 10.1016/s0735-1097(86)80453-3. [DOI] [PubMed] [Google Scholar]
  52. Zhao M. J., Zhang H., Robinson T. F., Factor S. M., Sonnenblick E. H., Eng C. Profound structural alterations of the extracellular collagen matrix in postischemic dysfunctional ("stunned") but viable myocardium. J Am Coll Cardiol. 1987 Dec;10(6):1322–1334. doi: 10.1016/s0735-1097(87)80137-7. [DOI] [PubMed] [Google Scholar]

Articles from Heart are provided here courtesy of BMJ Publishing Group

RESOURCES