[Cardiac decompensation: mechanism of reversibility].
Chronic regional left ventricular dysfunction in patients with coronary artery disease is a frequent cause of congestive heart failure. Chronic dysfunction might be reversed by restoration of myocardial blood flow. This condition has been referred to as myocardial hibernation. Until now, elucidation of the exact mechanisms leading to hibernation has remained difficult, owing mainly to the lack of relevant animal models. Therefore, we performed the present studies in patients with chronic left ventricular ischemic dysfunction undergoing coronary revascularization. The hibernating myocardium was characterized by : 1) a normal resting perfusion and oxidative metabolism; 2) a blunted coronary reserve; 3) a preserved contractile reserve with inotropic stimulation; 4) morphologic ultrastructural alteration, with aspects of cellular dedifferentiation; 5) a slow recovery of function overtime, inversely related to the severity of ultrastructural abnormalities. Further work should focus on designing appropriate animal models and on elucidating cellular and molecular bases of this phenomenon.
Melin
J
J
Vanoverschelde
J L
JL
D003326:Coronary Circulation; D003327:Coronary Disease / Q000503:physiopathology* / Q000601:surgery; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D009200:Myocardial Contraction; D009204:Myocardial Revascularization; D017682:Myocardial Stunning / Q000503:physiopathology; D009206:Myocardium / Q000648:ultrastructure; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology
Décompensation cardiaque: mécanismes de sa réversibilité.