Document Detail


Myocardial perfusion and contraction in acute ischemia and chronic ischemic heart disease.
MedLine Citation:
PMID:  21889943     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
A large body of evidence has demonstrated that there is a close coupling between regional myocardial perfusion and contractile function. When ischemia is mild, this can result in the development of a new balance between supply and energy utilization that allows the heart to adapt for a period of hours over which myocardial viability can be maintained, a phenomenon known as "short-term hibernation". Upon reperfusion after reversible ischemia, regional myocardial function remains depressed. The "stunned myocardium" recovers spontaneously over a period of hours to days. The situation in myocardium subjected to chronic repetitive ischemia is more complex. Chronic dysfunction can initially reflect repetitive stunning with insufficient time for the heart to recover between episodes of spontaneous ischemia. As the frequency and/or severity of ischemia increases, the heart undergoes a series of adaptations which downregulate metabolism to maintain myocyte viability at the expense of contractile function. The resulting "hibernating myocardium" develops regional myocyte cellular hypertrophy as a compensatory response to ischemia-induced apoptosis along with a series of molecular adaptations that while regional, are similar to global changes found in advanced heart failure. As a result, flow-function relations become independently affected by tissue remodeling and interventions that stimulate myocyte regeneration. Similarly, chronic vascular remodeling may alter flow regulation in a fashion that increases myocardial vulnerability to ischemia. Here we review our current understanding of myocardial flow-function relations during acute ischemia in normal myocardium and highlight newly identified complexities in their interpretation in viable chronically dysfunctional myocardium with myocyte cellular and molecular remodeling. This article is part of a Special Issue entitled "Coronary Blood Flow".
Authors:
John M Canty; Gen Suzuki
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review     Date:  2011-08-26
Journal Detail:
Title:  Journal of molecular and cellular cardiology     Volume:  52     ISSN:  1095-8584     ISO Abbreviation:  J. Mol. Cell. Cardiol.     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-03-16     Completed Date:  2012-07-12     Revised Date:  2014-09-18    
Medline Journal Info:
Nlm Unique ID:  0262322     Medline TA:  J Mol Cell Cardiol     Country:  England    
Other Details:
Languages:  eng     Pagination:  822-31     Citation Subset:  IM    
Copyright Information:
Published by Elsevier Ltd.
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MeSH Terms
Descriptor/Qualifier:
Animals
Coronary Circulation / physiology*
Humans
Myocardial Contraction / physiology*
Myocardial Ischemia / physiopathology*
Myocardial Reperfusion
Grant Support
ID/Acronym/Agency:
HL-55324/HL/NHLBI NIH HHS; HL-61610/HL/NHLBI NIH HHS; R01 HL055324/HL/NHLBI NIH HHS; R01 HL055324-12/HL/NHLBI NIH HHS; R01 HL061610/HL/NHLBI NIH HHS; R01 HL061610-09/HL/NHLBI NIH HHS; R01 HL076252/HL/NHLBI NIH HHS; R01 HL076252-05/HL/NHLBI NIH HHS
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