Abstract
Myocardial stunning is defined as a transient postischemic myocardial dysfunction, occurring during full reperfusion after a short episode of non-lethal ischemia. This phenomenon was first recognized by Heyndrickx et al.1 and termed “myocardial stunning” by Braunwald and Kloner.2 The initial description of stunning i.e. a total coronary occlusion of only 5 to 15 minutes that was not associated with detectable myocardial necrosis, resulted in impairment of ventricular systolic function that lasted for several hours following reperfusion. Since then, myocardial stunning has been demonstrated experimentally under a variety of conditions and in many different animal species. Several of these conditions become extremely important for a better understanding of the clinical relevance of myocardial stunning. At first there is the problem of “peri-infarction stunning”. It has been well established that during prolonged coronary artery occlusion only a variable fraction of the area at risk will become necrotic.3 A “border zone” of myocardial tissue, adjacent to necrotic myocardium will survive mainly due to collateral flow, and myocardial stunning can be demonstrated in this border zone after delayed reperfusion of the blocked vessel.4Therefore, the akinetic area related to infarction can easy be overestimated in the early reperfusion phase: at this stage differentiation between viable and necrotic tissue cannot be made on the basis of regional function studies alone. Second, not only regional ischemia will result in stunning upon reperfusion but also global ischemia or anoxia. This finding has important implications because it explains why hearts of patients undergoing cardiac surgery are very often dysfunctional in the early period of reperfusion after cross clamping of the aorta despite cardioplegic protection. A third important circumstance under which stunning can be demonstrated is that stunning also occurs in the presence of partial coronary stenosis instead of complete occlusion followed by reperfusion.5 Obviously relative ischemia due to imbalance between oxygen supply and demand can induce stunning as well as a complete occlusion of the coronary vessel. This observation is important because it explains why transient coronary spasm may result in regional myocardial dysfunction.
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Flameng, W., Shivalkar, B., Borgers, M. (1995). Myocardial Viability: Stunning and Hibernation. In: van der Wall, E.E., Blanksma, P.K., Niemeyer, M.G., Paans, A.M.J. (eds) Cardiac Positron Emission Tomography. Developments in Cardiovascular Medicine, vol 166. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-0023-6_2
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DOI: https://doi.org/10.1007/978-94-011-0023-6_2
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