Circulation, Vol 83, 1076-1083, Copyright © 1991 by American Heart Association
J Ross Jr
Experimental studies demonstrate that short-term regional perfusion-
contraction matching, in which the energy demands of regional myocardial
contraction are reduced to match the diminished myocardial substrate
supply, occurs during states of low coronary blood flow under resting
conditions and during exercise-induced ischemia. This phenomenon is rapidly
reversible and appears to occur in several clinical settings. Sustained
perfusion-contraction matching is observed in states of partial
experimental ischemia of intermediate duration lasting several hours. This
condition might be called short-term hibernation and resembles clinical
conditions such as unstable angina pectoris or myocardial infarction with
some residual perfusion in which the contractile defect can be improved by
reperfusion provided the ischemia is not severe enough to cause transmural
necrosis. Such experimental and clinical observations may or may not relate
to the setting of regional dysfunction at rest in patients with chronic
coronary heart disease, in whom manifestations of acute ischemia may be
absent but improvement of wall motion abnormalities occurs after CABG or
balloon angioplasty. This condition may constitute the hypothetical state
of chronic myocardial hibernation, for which tentative evidence exists from
metabolic and perfusion studies using PET. Whether such a condition of
prolonged perfusion-contraction matching might be associated with adaptive
processes that could allow its persistence for long periods without
manifest ischemia remains to be investigated.
ARTICLES
Myocardial perfusion-contraction matching. Implications for coronary heart disease and hibernation
Department of Medicine, University of California, San Diego, School of Medicine, La Jolla 92093.
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D. Neglia, O. Parodi, M. Gallopin, G. Sambuceti, A. Giorgetti, L. Pratali, P. Salvadori, C. Michelassi, M. Lunardi, G. Pelosi, et al. Myocardial Blood Flow Response to Pacing Tachycardia and to Dipyridamole Infusion in Patients With Dilated Cardiomyopathy Without Overt Heart Failure : A Quantitative Assessment by Positron Emission Tomography Circulation, August 15, 1995; 92(4): 796 - 804. [Abstract] [Full Text]
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A. E. Arai, S. E. Grauer, C. G. Anselone, G. A. Pantely, and J. D. Bristow Metabolic Adaptation to a Gradual Reduction in Myocardial Blood Flow Circulation, July 15, 1995; 92(2): 244 - 252. [Abstract] [Full Text]
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B. R. Ito Gradual Onset of Myocardial Ischemia Results in Reduced Myocardial Infarction : Association With Reduced Contractile Function and Metabolic Downregulation Circulation, April 1, 1995; 91(7): 2058 - 2070. [Abstract] [Full Text]
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