title: Variability of contractile reserve in hibernating myocardium: dependence on the method of inotropic stimulation.
abstract: OBJECTIVE
  Contractile reserve during graded beta-adrenergic stimulation identifies viability in patients with left ventricular dysfunction. Nevertheless, contractile reserve is frequently absent in viable, chronically dysfunctional myocardium with reduced resting flow (hibernating myocardium). The goal of this study was to evaluate the mechanisms responsible for limited contractile reserve in hibernating myocardium.
  
  
  METHODS
  Pigs were chronically instrumented with a left anterior descending coronary artery (LAD) stenosis to produce hibernating myocardium; and regional flow, function and hemodynamics were assessed during graded beta-adrenergic stimulation (epinephrine).
  
  
  RESULTS
  The chronic LAD stenosis produced a critical reduction in coronary flow reserve with regional reductions in resting subendocardial flow (0.69+/-0.05 vs. 1.03+/-0.11 ml/min/g in shams, P<0.05) and wall thickening (2.0+/-0.4 vs. 4.3+/-0.4 mm in shams, P<0.05), consistent with hibernating myocardium. In sham controls, LAD flow and function increased during graded, steady-state increases in epinephrine. Nevertheless, despite similar external determinants of demand in animals with hibernating myocardium, neither subendocardial flow (peak response: 0.66+/-0.14 and peak dose: 0.58+/-0.13 ml/min/g, respectively) nor wall thickening (3.0+/-0.5 and 2.5+/-0.6 mm, respectively) increased during graded epinephrine infusion. However, during a transient epinephrine infusion to the maximum dose used in the graded protocol, flow remained unchanged (0.80+/-0.06 to 0.85+/-0.08 ml/min/g) but wall thickening improved (2.3+/-0.4 to 4.1+/-0.6 mm, P<0.05).
  
  
  CONCLUSIONS
  These data indicate that variability in contractile reserve in hibernating myocardium is at least partly related to the protocol used for beta-adrenergic stimulation. The blunted steady-state responses to beta-adrenergic stimulation raise the possibility that, like moderate supply-induced ischemia, an exquisite matching between flow and function develops during moderate demand-induced ischemia. This prevents metabolic deterioration in hibernating myocardium but limits contractile function during increases in the external determinants of myocardial metabolism.
authors.affiliation: Department of Medicine, Biomedical Research Building, Room 347, University at Buffalo, 3435 Main Street, Buffalo, NY 14214, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Malm
authors.forename: Gen
authors.initials: G
authors.lastname: Suzuki
authors.forename: John M
authors.initials: JM
authors.lastname: Canty
authors.forename: James A
authors.initials: JA
authors.lastname: Fallavollita
mesh_terms: D000318:Adrenergic beta-Agonists / Q000494:pharmacology; D000818:Animals; D002316:Cardiotonic Agents / Q000494:pharmacology*; D004334:Drug Administration Schedule; D004837:Epinephrine / Q000494:pharmacology*; D006439:Hemodynamics / Q000187:drug effects; D009200:Myocardial Contraction / Q000187:drug effects*; D017682:Myocardial Stunning / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012039:Regional Blood Flow / Q000187:drug effects; D013268:Stimulation, Chemical; D013552:Swine; D014463:Ultrasonography
chemical_list: D000318:Adrenergic beta-Agonists; D002316:Cardiotonic Agents; D004837:Epinephrine