(Circulation. 1996;94:3055-3061.)
© 1996 American Heart Association, Inc.
Articles |
Hibernating Myocardium Has Reduced Blood Flow at Rest That Increases With Low-Dose Dobutamine
the Griffith Center and the Division of Cardiology, Department of Medicine, LAC+USC Medical Center, University of Southern California Medical Center, Los Angeles, Calif.
Key Words: blood flow • ischemia • revascularization • myocardial contraction • echocardiography • Editorials
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Introduction |
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Hibernating myocardium1 2 3 was defined by Hearse4 as "exquisitely regulated tissue successfully adapting its activity to prevailing circumstances." Ross5 has described it as perfusion-contraction matching-which it is; however, in the normal heart and probably also in one with infarction and a high degree of interstitial fibrosis and of myocytes with myolysis or loss of sarcomeres, there is also a match between perfusion and contraction.6 7 Ross also suggested that "acute" experimental studies of hibernation be called short-term hibernation. In 1986, Braunwald and Rutherford8 endorsed the concept of HM, believed it was an appropriate use of the term, and confirmed its occurrence in patients. As a result, the subsequent decade has seen (1) a great deal of basic and clinical research in this area, (2) a reassessment of the definition of ischemia,4 (3) development and assessment of tests for diagnosis of HM, and (4) better treatment of patients.
However, much work still needs to be done. In the current issue of Circulation, the group from UCLA9 who have made major contributions to HM present data that contribute to an understanding of the response to dobutamine and document reduced resting MBF in HM. Their conclusion that functionally impaired though normally perfused myocardium frequently exists in patients with coronary artery disease is problematic.
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Dobutamine Echocardiography |
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In the early 1970s, with use of inotropic agents (epinephrine, isoproterenol, and postextrasystolic potentiation) and contrast ventriculography, it was documented that resting wall motion abnormalities may improve10 11 12 and that this improvement was predictive of subsequent improvement with coronary bypass surgery.13 14 15
The study
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