Cardiac stunning in the clinic: the full picture.
Cardiac stunning refers to different dysfunctional levels occurring after an episode of acute ischemia, despite blood flow is near normal or normal. The phenomenon was initially identified in animal models, where it has been very well characterized. After being established in the experimental setting, it remained unclear, whether a similar syndrome occurs in humans. In addition, it remained controversial, whether stunning was of any clinical relevance as it is spontaneously reversible. Hence, many studies continue to focus on the properties and mechanisms of stunning, although therapies seem more relevant for attenuating and treating myocardial ischemia/reperfusion (I/R) injury, i.e. to bridge until recovery. This article reviews the different facets of cardiac stunning, i.e. myocardial, vascular/microvascular/endothelial, metabolic, neural/neuronal, and electrical stunning. This review also displays where these facets exist and which clinical relevance they might have. Particular attention is directed to the different therapeutic interventions that the various facets of this I/R-induced cardiac injury might require. A final outlook considers possible alternatives to further reduce the detrimental consequences of brief episodes of ischemia and reperfusion.
Department of Internal Medicine, Federal University of Santa Maria, Santa Maria (RS), Brazil.
Valdeci J
VJ
Pomblum
Bernhard
B
Korbmacher
Sinclair
S
Cleveland
Ullrich
U
Sunderdiek
Rainhard C
RC
Klocke
Jochen D
JD
Schipke
D000818:Animals; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004730:Endothelium, Vascular / Q000187:drug effects / Q000503:physiopathology; D006329:Heart Conduction System / Q000187:drug effects / Q000503:physiopathology; D006353:Heart-Assist Devices; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial; D015428:Myocardial Reperfusion Injury / Q000503:physiopathology / Q000628:therapy*; D017682:Myocardial Stunning / Q000503:physiopathology / Q000628:therapy*; D013564:Sympathetic Nervous System / Q000187:drug effects / Q000503:physiopathology; D016896:Treatment Outcome
D002317:Cardiovascular Agents