Skip to main content
SpringerLink
Log in

Regional asynchrony of segmental contraction may explain the “oxygen consumption paradox” in stunned myocardium

  • Original Contributions
  • Published:
Basic Research in Cardiology Aims and scope Submit manuscript

Summary

Despite apparently depressed function, stunned myocardium maintains oxygen consumption and has the capacity to increase contractility with inotropic stimulation. We hypothesized that during stunning, O2 demand is maintained because regional segment work is performed, but is asynchronous with global left ventricular contraction, and that inotropic stimulation would restore regional work and synchrony. Thirteen open-chest anesthetized dogs were subjected to three left anterior descending (LAD) coronary artery occlusions (10 min) and reperfusions (15 min) to produce regional myocardial stunning. Segment shortening and force development were measured independently and simultaneously in the LAD (experimental) region and circumflex (control) regions. Regional myocardial work was calculated as the integrated product of instantaneous force and shortening, during two periods: 1) over the entire cardiac cycle (Positive Work), and 2) limited to the systolic portion of the cardiac cycle (Systolic Work). Regional myocardial O2 consumption (MVO2) was calculated from regional blood flow (radiolabeled microspheres) and O2 saturation data (microspectrophotometry). Occlusion of the LAD produced a delay in onset of segment shortening in the ischemic region, but not in regional force development. A time delay of 67–81 ms persisted through the three stages of occlusions and reperfusion. Systolic regional work was depressed to a greater extent (924±182 to 149±118 g*mm*min−1) than total positive regional work (1437±337 to 857±174 g*mm*min−1). Regional subepicardial MVO2 in the stunned region was not different than in the control region (7.3±1.5 vs. 6.9±1.4 ml O2*min−1*100 g−1). Local infusion of isoproterenol reversed the delay in regional shortening from 73±7 to 21±8 ms, thereby augmenting systolic work (298%) more than positive work (60%), without a significant increase in MVO2 (7.3±1.5 to 10.5±3.2 ml O2*min−1*100 g−1). It is concluded that myocardial stunning decreases regional systolic work due to regional mechanical asynchrony, while MVO2 is used supported total positive work which was not significantly reduced. Isoproterenol restores regional work by restoring synchrony, without greatly affecting regional MVO2.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Acad B, Weiss HR (1989) Regional O2 consumption and coronary flow during beta adrenoceptor stimulation in reperfused canine myocardium. J Pharmacol Exp Ther 250:611–6

    Google Scholar 

  2. Ambrosio G, Jacobus W, Bergman CA, Weisman HF, Becker LC (1987) Preserved high energy phosphate metabolic reserve in globally “stunned” hearts despite reduction of basal ATP content and contractility. J Mol Cell Cardiol 219:953–64

    Google Scholar 

  3. Becker LC, Levine JH, DiPaula AF, Guarnieri T, Aversano T (1986) Reversal of dysfunction in postischemic stunned myocardium by epinephrine and postextrasystolic potentiation. J Am Coll Cardiol 7:580–9

    Google Scholar 

  4. Berne RM, Levy MN (1993) Physiology, p. 408, 3rd Ed., Mosby Year Book, St. Louis

    Google Scholar 

  5. Bolli R, Zhu W, Thornby JI, O'Neill PG, Roberts R (1988) Time course and determinants of recovery of function after reversible ischemia in conscious dogs. Am J Physiol 254:H102–14

    Google Scholar 

  6. Bolli R, Zhu W, Myers ML, Hartley CJ, Roberts R (1985) Beta-adrenergic stimulation reverses postischemic myocardial dysfunction without producing subsequent functional deterioration. Am J Cardiol 56:964–8

    Google Scholar 

  7. Boniface KJ, Brodie OJ, Walton RP (1953) Resistance strain gauge arches for direct measurement of heart contractile force in animals. Proc Soc Exp Biol Med 84:263(6)

    Google Scholar 

  8. Braunwald E, Sarnoff SJ, Case RB, Stainsby WN, Welch GH (1958) Hemodynamic determinants of coronary flow: effect of changes in aortic pressure and cardiac output on the relationship between myocardial oxygen consumption and coronary flow. Am J Physiol 192:157–63

    Google Scholar 

  9. Braunwald E, Kloner RA (1982) The stunned myocardium: prolonged, postischemic ventricular dysfunction. Circ 66:1146–9

    Google Scholar 

  10. Charlat ML, O'Neill PG, Hartley CJ, Roberts R, Bolli R (1989) Prolonged abnormalities of left ventricular diastolic wall thinning in the “stunned” myocardium in conscious dogs: time course and relation to systolic function. J Am Coll Cardiol 13:185–94

    Google Scholar 

  11. Ciuffo AA, Ouyang P, Becker LC, Levin L, Weisfeldt ML (1985) Reduction of sympathetic inotropic response after ischemia in dogs: contributor to stunned myocardium. J Clin Invest 75:1504–9

    Google Scholar 

  12. Dean EN, Shlafer M, Nicklas JM (1990) The oxygen consumption paradox of “stunned myocardium” in dogs. Basic Res Cardiol 85:120–31

    Google Scholar 

  13. Ellis SG, Wynne J, Braunwald E, Henschke CI, Sandor T, Kloner RA (1984) Response of reperfusion-salvaged, stunned myocardium to inotropic stimulation. Am Heart J 107:13–9

    Google Scholar 

  14. Ito BR, Tate H, Kobayashi M, Schaper W (1987) Reversibly injured, postischemic canine myocardium retains normal contractile reserve. Circ Res 61:834–6

    Google Scholar 

  15. Joselevitz-Goldman J, Upsher ME, Weiss HR (1987) Effects of propranolol on regional O2 supply and O2 consumption in reperfused dog myocardium. J Pharmacol Exp Ther 242:102–7

    Google Scholar 

  16. Kedem J, Sonn J, Scheinowitz M., Weiss HR (1989) Relationship between local O2 consumption and local and external cardiac work: Effect of tachycardia. Cardiovasc. Res. 23:1043–1052

    Google Scholar 

  17. Kedem J, Scholz PM, Weiss HR (1991) Augmented Efficiency of Regional Myocardial Work by Ouabain. Cardiovasc. Res. 25:916–922

    Google Scholar 

  18. Kedem J, Sonn J, Scheinowitz M, Weiss HR (1992) Effect of isoproterenol on regional myocardial segment work, O2 consumption and oxygen balance. Res Exp Med 192:323–334

    Google Scholar 

  19. Kedem J, Lee W, Weiss HR (1993) An experimental technique for quantitative determination of regional myocardial segment workin vivo. In press Ann Biomed Eng 1993

  20. Krukenkamp IB, Silverman NA, Sorlie D, Pridjian A, Feinberg H, Levitsky S (1986) Characterization of postischemic myocardial oxygen utilization. Circulation 74 (suppl III):111–125

    Google Scholar 

  21. Kusuoka H, Porterfield JK, Weisman HF, Weisfeldt ML, Marban E (1987) Pathophysiology and pathogenesis of stunned myocardium: depressed Ca2+ activation of contraction as a consequence of reperfusion-induced cellular calcium overload in ferret hearts. J Clin Invest 79:950–61

    Google Scholar 

  22. Laster SB, Becker LC, Ambrosio G, Jacobus WE (1989) Reduced aerobic metabolic efficiency in globally “stunned” myocardium. J Mol Cell Cardiol 21:419–426

    Google Scholar 

  23. Laxon DD, Homans DC, Dai X, Sublett E, Bache RJ (1989) Oxygen consumption and coronary reactivity in postischemic myocardium. Circ Res 64:9(20)

    Google Scholar 

  24. Lewinter MM, Kent RS, Kroener JM, Carew TE, Covell JW (1975) Regional differences in myocardial performance in the left ventricle of the dog. Cir Res 37:191–9

    Google Scholar 

  25. Liedtke AJ, DeMaison L, Eggleston AM, Cohen LM, Nellis SH (1988) Changes in substrate metabolism and effects of excess fatty acids in reperfused myocardium. Circ Res 62:535–62

    Google Scholar 

  26. Mercier JC, Lando U, Kanmatsuse K, Ninomiya K, Meerbaum S, Fishbein MC, Swan HJC, Ganz W (1982) Divergent effects of inotropic stimulation on the ischemic and severely depressed reperfused myocardium. Circ 66:397–400

    Google Scholar 

  27. Przyklenk K, Patel B, Kloner RA (1987) Diastolic abnormalities of postischemic “stunned” myocardium. Am J Cardiol 60:12–3

    Google Scholar 

  28. Sinha A, Neubauer JA, Lipp JA, Weiss HR (1975) Oxygen saturation determination in frozen blood. Microvasc Res 10:312–21

    Google Scholar 

  29. Sinha A, Neubauer JA, Lipp JA, Weiss HR (1977) Blood O2 saturation determination in frozen tissue. Microvasc Res 14:133–44

    Google Scholar 

  30. Stahl LD, Weiss HR, Becker LC (1988) Myocardial oxygen consumption, oxygen supply/demand heterogeneity, and microvascular patency in regionally stunned myocardium. Circ 77:865–72

    Google Scholar 

  31. Upsher ME, Joselevitz-Goldman J, Weiss HR (1988) Effect of reperfusion on O2 supply/consumption balance in ischemic canine left ventricle. Res Exp Med 188:377–90

    Google Scholar 

  32. Weiss HR, Sinha AK (1978) Regional oxygen saturation of small arteries and veins in the canine myocardium. Circ Res 42:119–26

    Google Scholar 

Download references

Author information

Author notes

  1. J. Kedem

    Present address: Heart and Brain Circulation Laboratory, Department of Physiology and Biophysics, The University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, 675-Hoes Lane, 08854-5636, Piscataway, New Jersey, USA

Authors and Affiliations

  1. Department of Surgery, The University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA

    W. C. Chiu & P. M. Scholz

  2. Heart and Brain Circulation Laboratory, Department of Physiology and Biophysics, The University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, 675-Hoes Lane, 08854-5636, Piscataway, New Jersey, USA

    H. R. Weiss

Authors
  1. W. C. Chiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Kedem
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. M. Scholz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. R. Weiss
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

This study was supported in part by a research grant from the Schulz Foundation and USPHS grant HL40320.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chiu, W.C., Kedem, J., Scholz, P.M. et al. Regional asynchrony of segmental contraction may explain the “oxygen consumption paradox” in stunned myocardium. Basic Res Cardiol 89, 149–162 (1994). https://doi.org/10.1007/BF00788734

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00788734

Key words

Search

Navigation