From the Division of Cardiology (R.W.J., L.C.B.) and the Division of
Nuclear Medicine (K.M.), Departments of Medicine and Radiology, The Johns
Hopkins Medical Institutions, Baltimore, Md, and the Department of
Experimental Cardiology, Max Planck Institut, Bad Nauheim, Germany (J.S.).
Correspondence to Dr Lewis C. Becker, Halsted 500, Johns Hopkins Medical Institutions, 600 N Wolfe St, Baltimore, MD 21205.
Background—The occurrence of myocyte
necrosis during reperfusion of ischemic myocardium
is controversial. This study measured myocardial 2-deoxyglucose uptake,
correlated with histology, to determine whether loss of viability
occurred during reperfusion of ischemic myocardium.
Methods and Results—In 12 anesthetized dogs, the left
anterior descending coronary artery was occluded for 90 minutes
before 4 hours reperfusion. Myocardial blood flow was measured by
microspheres and the tracers 14C-2-deoxyglucose and
18F-2-deoxyglucose were injected intravenously
after 5 and 180 minutes of reperfusion, respectively. After 240
minutes, the heart was stained with thioflavin-S (size of no-reflow
zone) and triphenyl-tetrazolium chloride (TTC, extent of necrosis).
Samples from normal, salvaged, and necrotic myocardium were
counted for 14C- and 18F-deoxyglucose and
microspheres. With the use of a three-compartment model of
2-deoxyglucose uptake, the rate constant k3
for phosphorylation of 14C- and
18F-2-deoxyglucose was calculated for each sample.
Viability was defined as k3
Conclusions—A large proportion of samples from infarcted
myocardium are viable at the end of the ischemic
period but lose viability during the first hours of reperfusion.
© 1998 American Heart Association, Inc.
Basic Science Reports
Progression of Myocardial Necrosis During Reperfusion of Ischemic Myocardium
0.125
min-1 (predictive accuracy 88% versus electron microscopy
and 97% versus TTC). Among 58 samples from no-reflow regions, 97%
were nonviable after 5 minutes of reperfusion
(k3=0.096±0.027 min-1). Among
164 samples from salvaged myocardium, 95% were viable
after both 5 and 180 minutes of reperfusion
(k3=0.170±0.056 min-1
P<.01 versus no-reflow). Among 179 samples from
infarcted myocardium, mean k3
after 5 minutes of reperfusion was 0.184±0.070 min-1 and
65% of samples were viable, but after 180 minutes of reperfusion mean
k3 had decreased to 0.077±0.032
min-1 (P<.0001) and 98% of samples were
nonviable.
Key Words: metabolism • myocardial infarction • ischemia • reperfusion • radioisotopes
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