Revascularization of hibernating myocardium: rate of metabolic and functional recovery and occurrence of oxidative stress.
BACKGROUND
Left ventricular (LV) dysfunction due to coronary artery disease (CAD) may improve after revascularization in patients with hibernating myocardium (HM).


RESULTS
We compared the rate of metabolic (arterial-great cardiac vein differences of lactate, glucose and pyruvate) and functional (intra-operative transesophageal and epicardial echocardiography) recovery and occurrence of oxidative stress (myocardial release of oxidized glutathione (GSSG)) early after surgical revascularization, in patients with CAD, LV dysfunction and HM (n=16) vs those with preserved LV function (n=15). By comparing the two groups, we observed that, after de-clamping, in patients with HM (a) the kinetic of lactate production was converted to extraction (P<0.01 at 1, 5, 10 and 20 min after revascularization), (b) myocardial extraction of pyruvate increased (P<0.01 during the first 5 min after revascularization), (c) GSSG release was less and of shorter duration (P<0.01 at all times), (d) segmental wall motion score improved from 2.4+/-0.3 to 1.7+/-0.5 (P<0.01) as did the thickening of the akinetic territories corresponding to the antero-distal septum and to the distal anterior wall regions (to 36+/-23%, and to 36+/-13%, respectively). There was a correlation between the rate of recovery of metabolic and functional indices.


CONCLUSIONS
The contractile and metabolic recovery of HM is more rapid than that of non-HM, and it is not accompanied by oxidative stress.
Ceconi
C
C
Cardiovascular Pathophysiology Research Center, Salvatore Maugeri Foundation, University of Ferrara, Via Pinidolo 23, 25064 Gussago, Brescia, Italy.
La Canna
G
G
Alfieri
O
O
Cargnoni
A
A
Coletti
G
G
Curello
S
S
Zogno
M
M
Parrinello
G
G
Rahimtoola
S H
SH
Ferrari
R
R
D001786:Blood Glucose / Q000378:metabolism; D003402:Creatine Kinase / Q000097:blood; D004452:Echocardiography / Q000379:methods; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D007773:Lactates / Q000097:blood; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D009204:Myocardial Revascularization / Q000379:methods*; D017682:Myocardial Stunning / Q000378:metabolism / Q000601:surgery*; D018384:Oxidative Stress; D019289:Pyruvic Acid / Q000378:metabolism
D001786:Blood Glucose; D007773:Lactates; D019289:Pyruvic Acid; D003402:Creatine Kinase