An approach to determine myocardial ischemia by hidden Markov models

A hidden Markov model (HMM) of electrocardiogram (ECG) signal is presented for detection of myocardial ischemia. The time domain signals that are recorded by the ECG before and during the episode of local ischemia were pre-processed to produce input sequences, which is needed for the model training. The model is also verified by test data, and the results show that the models have certain function for the detection of myocardial ischemia. The algorithm based on HMM provides a possible approach for the timely, rapid and automatic diagnosis of myocardial ischemia, and also can be used in portable medical diagnostic equipment in the future.     

对肾上腺素性心肌缺血模型大鼠相关指标的探讨

目的进一步探讨客观评价大鼠心肌缺血模型的指标。方法观察皮下注射10mg kg异丙肾上腺素(ISO)造成SD大鼠心肌缺血性损伤模型后心电图的变化、检测血清中肌酸激酶(CK)、乳酸脱氢酶(LDH)、游离脂肪酸(FFA)以及心肌组织的坏死面积、超氧化物歧化酶(SOD)、丙二醛(MDA)含量的变化。结果腹腔注射ISO后30s,大鼠心电图的J点开始降低,2min后缓慢回升,但20min后仍未回复到原来的水平,而且20min内各时间点与给药前比较,模型对照组大鼠的J点与生理盐水对照组比较,差异有显著性(P<0.05);T波则在注射异丙肾上腺素30s后开始下降,10min内两组的T波一直保持显著差异(P<0.05),而且注射异丙肾上腺素后30s(P<0.01)以及5min(P<0.05)与给药前比较,T波均有显著差异;模型对照组大鼠血清中CK、LDH、FFA以及心肌组织中MDA浓度均显著高于生理盐水对照组,心肌坏死面积与这些指标呈正相关关系,心肌组织中SOD浓度显著低于生理盐水对照组。结论J点可以作为评价此种动物模型的主要指标,T波可以作为辅助指标,应重点观察20min内心电图的变化;可以选择CK、LDH、FFA、SOD、MDA等生化指标以及心肌坏死面积等来探讨抗心肌缺血药物的作用机理。     

三七总皂甙和灯盏花素复方注射剂对结扎大鼠冠脉致心肌缺血的保护作用

采用结扎大鼠冠脉造成急性心肌缺血模型 ,观察了三七总皂甙和灯盏花素复方注射剂 (简称复方注射剂 )抗实验性心肌缺血作用。结果表明 :大鼠静脉注射复方注射剂 5 0mg/kg和 10 0mg/kg对急性心肌缺血均有一定程度的保护作用 ,在改善心电图S T段的上移、降低血清CPK、LDH方面两个剂量组均有显著作用 (P <0 .0 5 ,P <0 .0 1)以 10 0mg/kg组缩小心肌梗塞范围为显著 (P <0 .0 5 )。复方注射剂与丹参注射剂均能保护超氧化物歧化酶活性 (P <0 .0 5 ,P <0 .0 1) ,显著降低丙二醛含量 (P <0 .0 1)。复方注射剂两个剂量组均能显著增加前列环素合成 (P <0 .0 5 ,P <0 .0 1)。提示三七总皂甙和灯盏花素复方注射剂对心肌缺血的保护作用与抗脂质过氧化作用有关 ,其促进前列环素合成作用可能与其抗心肌缺血有关。     

Shape identification of electrocardiographic ST segment based on radial basis function neural network

The types of myocardial ischemia can be revealed by electrocardiographic (ECG) ST segment.Effective measurement and electrocardiographic analysis of ST as well as calculation of displacement and shape change of ST segment can help doctors diagnose coronary heart disease and myocardial ischemia,especially for asymptomatic myocardial ischemia.Therefore,it is a very important subject in clinical practice to measure and classify the ECG ST segment.In this paper,we introduce a computerized automatic identification method of the electrocardiographic ST segment shape with radial basis function neural network based on adaptive fuzzy system,which has a better effect than other methods.It helps to analyze the reason of the ST segment change and confirm the position of myocardial ischemia,and is useful for doctor diagnosis.     

New aspects of ICD therapy: from rhythm therapy to complex cardiac monitoring. Development of an implantable, ICD-assisted, intrathoracic 6-channel ECG for continuous monitoring of high infarct risk patients]

Implantable defibrillator systems (ICD) are therapy of choice for the treatment of life-threatening ventricular arrhythmias and in prevention of sudden cardiac death. In more than 80% of patients who receive an ICD, the underlying cardiac disease is a coronary heart disease. Since arrhythmogenic sudden cardiac death can be reliably prevented in these patients by the use of ICD technology, the cardiac prognosis for these patients is determined by the occurrence of myocardial ischemia and myocardial infarction, as well as from the heart failure which develops in consequence. An intrathoracic 6-channel ECG comparable to the standard surface ECG can be reconstructed by further technical development of the electrode configurations currently present in ICD systems. The importance of this development in early diagnosis of myocardial ischemias and myocardial infarction can hardly be adequately estimated at the moment. The chronic consequences of myocardial infarction can be completely prevented or at least greatly reduced by means of such diagnostics and inclusion of immediate initiation of effective, appropriate early therapeutic measures before more serious symptoms even occur. In the development and pilot studies thus far, it has been found that the intrathoracic 6-channel ECG which can be generated in the ICD is capable of reliably recognizing acute myocardial ischemia, irrespective of localization or extent earlier and better than the standard surface ECG. Continuous preventive ischemia monitoring using the implanted ICD thus appears possible in patients at risk of infarction.     

缩醛基毛冬青提取化合物R4对缺血缺氧心肌的保护作用

目的：研究缩醛基毛冬青提取化合物R4对缺血缺氧心肌的保护作用,以便为缩醛基毛冬青提取化合物R4的临床新用途提供实验依据。方法：采用小鼠常压耐缺氧实验、夹闭气管小鼠心电消失时间、垂体后叶素所致大鼠心肌缺血模型及大鼠冠脉结扎所致的心肌缺血模型,观察缩醛基毛冬青提取化合物R4对缺血缺氧心肌的保护作用。结果：缩醛基毛冬青提取化合物R4（1.0、2.0、4.0 mg/kg）均能显著延长小鼠常压耐缺氧条件下的存活时间,延长夹闭气管小鼠心电消失时间,缩醛基毛冬青提取化合物R4（0.75、1.5和3.0 mg/kg）能拮抗垂体后叶素引起的心电图变化,并能明显降低结扎冠脉所致大鼠的心肌梗塞范围。结论：缩醛基毛冬青提取化合物R4对缺血缺氧心肌具有明显保护作用,其效应与剂量呈相关性,其机制可能是通过扩张冠脉,增加心肌的供血供氧而发挥抗心肌缺血的作用。     

HMM-based Supervised Machine Learning Framework for the Detection of fECG R-R Peak Locations

ObjectiveFetal Electro Cardiogram (fECG) provides critical information on the wellbeing of a foetus heart in its developing stages in the mother's womb. The objective of this work is to extract fECG which is buried in a composite signal consisting of itself, maternal ECG (mECG) and noises contributed from various unavoidable sources. In the past, the challenge of extracting fECG from the composite signal was dealt with by Stochastic Weiner filter, model-based Kalman filter and other adaptive filtering techniques. Blind Source Separation (BSS) based Independent Component Analysis (ICA) has shown an edge over the adaptive filtering techniques as the former does not require a reference signal. Recently, data-driven machine learning techniques e.g., adaptive neural networks, adaptive neuro-fuzzy inference system, support vector machine (SVM) are also applied.MethodThis work pursues hidden Markov model (HMM)-based supervised machine learning frame-work for the determination of the location of fECG QRS complex from the composite abdominal signal. HMM is used to model the underlying hidden states of the observable time series of the extracted and separated fECG data with its QRS peak location as one of the hidden states. The state transition probabilities are estimated in the training phase using the annotated data sets. Afterwards, using the estimated HMM networks, fQRS locations are detected in the testing phase. To evaluate the proposed technique, the accuracy of the correct detection of QRS complex with respect to the correct annotation of QRS complex location is considered and quantified by the sensitivity, probability of false alarm, and accuracy.ResultsThe best results that have been achieved using the proposed method are: accuracy – 97.1%, correct detection rate (translated to sensitivity) – 100%, and false alarm rate – 2.89%.ConclusionTwo primary challenges in these methods are finding the right reference threshold for the normalization of the extracted fECG signal during the initial trials and limitation of discrete frame work of HMM signal (converted from continuous time) which only offers a countable number of levels in observations. By feeding the posterior probabilities, obtained from SVM, into HMM, as emission probabilities, can further improve the accuracy of fQRS location detection.     

白鲜皮水提物对大鼠心肌缺血再灌注损伤的保护作用

目的研究白鲜皮水提物对大鼠心肌缺血再灌注损伤的保护作用。方法 Wistar大鼠随机分为假手术组,模型组,阳性药组(地奥心血康)及白鲜皮低、中、高剂量组(白鲜皮水提物0.128、0.64、1.28 g/kg),每组6只。结扎冠状动脉左前降支制备大鼠心肌缺血再灌注损伤模型,观察给药后大鼠心电图ST段的改变,测量心肌梗死面积,观察大鼠心肌组织病理形态,检测大鼠血清CK,SOD活性、MDA含量。结果白鲜皮中、高剂量组给药后能明显减少心肌梗死面积,明显降低缺血30 min和再灌注120 min时ST段的抬高,并能降低大鼠血清中MDA含量,升高SOD活性,减少因缺血导致的心肌组织病理损害。结论白鲜皮水提物对大鼠心肌缺血再灌注损伤具有保护作用,其作用机制可能与保护心肌细胞功能、提高心肌抗氧化能力、清除氧自由基有关。     

Qualitative and quantitative description of myocardial ischemia by means of magnetocardiography.

In the framework of this study quantitative parameters are presented which, derived from magnetocardiographic maps, aid in making a conclusion about ischemia in the myocardium. The analysis is based on the examination of 86 patients with unstable angina, of which 53 exhibited myocardial ischemia with high probability (Group I: angiographically proven stenosis of at least 50% in a coronary artery of first or second order and positive troponin), while in the 33 other patients myocardial ischemia could be ruled out with high probability (Group II: angiographically clean coronary bed and normal troponin values). The negative predictive value (the probability that there is no myocardial ischemia when the magnetocardiogram (MCG) is negative) is 96.2%; the positive predictive value (the probability that there is actually coronary heart disease when the magnetocardiogram is positive) is 91.2%. A 12-lead ECG taken at the same time as the MCG achieved a positive predictive value of 92.8%, but a negative predictive value of 53.4%. Consequently, the boundary values of the parameters selected lead to a markedly distinct separation between patients with myocardial ischemia from those without. For ruling out coronary heart disease in patients with unstable angina the MCG is superior to 12-lead ECG.     

Shape identification of electrocardiographic ST segment based on radial basis function neural network

The types of myocardial ischemia can be revealed by electrocardiographic (ECG) ST segment. Effective measurement and electrocardiographic analysis of ST as well as calculation of displacement and shape change of ST segment can help doctors diagnose coronary heart disease and myocardial ischemia, especially for asymptomatic myocardial ischemia. Therefore, it is a very important subject in clinical practice to measure and classify the ECG ST segment. In this paper, we introduce a computerized automatic identification method of the electrocardiographic ST segment shape with radial basis function neural network based on adaptive fuzzy system, which has a better effect than other methods. It helps to analyze the reason of the ST segment change and confirm the position of myocardial ischemia, and is useful for doctor diagnosis. Translated from Acta Biophysica Sinica, 2005, 21(6): 443–448 [译自: 生物物理学报]     

Decreases in Electrocardiographic R-Wave Amplitude and QT Interval Predict Myocardial Ischemic Infarction in Rhesus Monkeys with Left Anterior Descending Artery Ligation

Clinical studies have demonstrated the predictive values of changes in electrocardiographic (ECG) parameters for the preexisting myocardial ischemic infarction. However, a simple and early predictor for the subsequent development of myocardial infarction during the ischemic phase is of significant value for the identification of ischemic patients at high risk. The present study was undertaken by using non-human primate model of myocardial ischemic infarction to fulfill this gap. Twenty male Rhesus monkeys at age of 2–3 years old were subjected to left anterior descending artery ligation. This ligation was performed at varying position along the artery so that it produced varying sizes of myocardial infarction at the late stage. The ECG recording was undertaken before the surgical procedure, at 2 h after the ligation, and 8 weeks after the surgery for each animal. The correlation of the changes in the ECG waves in the early or the late stage with the myocardial infarction size was analyzed. The R wave depression and the QT shortening in the early ischemic stage were found to have an inverse correlation with the myocardial infarction size. At the late stage, the R wave depression, the QT prolongation, the QRS score, and the ST segment elevation were all closely correlated with the developed infarction size. The poor R wave progression was identified at both the early ischemic and the late infarction stages. Therefore, the present study using non-human primate model of myocardial ischemic infarction identified the decreases in the R wave and the QT interval as early predictors of myocardial infarction. Validation of these parameters in clinical studies would greatly help identifying patients with myocardial ischemia at high risk for the subsequent development of myocardial infarction.     

Electrocardiograms Corresponding to the Development of Myocardial Infarction in Anesthetized WHHLMI Rabbits (Oryctolagus cuniculus), an Animal Model for Familial Hypercholesterolemia

The aim of this study was to determine whether features indicative of myocardial ischemia occur in the electrocardiograms (ECG) in myocardial infarction-prone Watanabe heritable hyperlipidemic (WHHLMI) rabbits, an animal model for human familial hypercholesterolemia. ECG were recorded in 110 anesthetized WHHLMI rabbits (age, 10 to 39 mo) by using unipolar and bipolar limb leads with or without chest leads. We noted the following electrocardiographic changes: T wave inversion (37.4%), ST segment depression (31.8%), deep Q wave (16.3%), reduced R wave amplitude (7.3%), ST segment elevation (2.7%), and high T wave (1.8%). These ECG changes resembled those in human patients with coronary heart disease. Histopathologic examination revealed that the left ventricular wall showed acute myocardial lesions, including loss of cross-striations, vacuolar degeneration, coagulation necrosis of cardiac myocytes, and edema between myofibrils, in addition to chronic myocardial lesions such as myocardial fibrosis. The coronary arteries that caused these ECG changes were severely stenosed due to atherosclerotic lesions. Ischemic ECG changes corresponded to the locations of the myocardial lesions. Normal ECG waveforms were similar between WHHLMI rabbits and humans, in contrast to the large differences between rabbits and mice or rats. In conclusion, ischemic ECG changes in WHHLMI rabbits reflect the location of myocardial lesions, making this model useful for studying coronary heart disease.Abbreviations: CHD, coronary heart disease; ECG, electrocardiogram; WHHL, Watanabe heritable hyperlipidemic; WHHLMI, myocardial infarction-prone Watanabe heritable hyperlipidemicCoronary heart disease (CHD) is prevalent in developed countries, including the United States.^16,24 Although potent compounds (for example, statins to inhibit cholesterol synthesis) have been developed to reduce the public health burden of this disease, CHD remains a leading cause of death, and further efforts are needed to reduce associated morbidity and mortality.²⁵ In evaluating the therapeutic effects of CHD interventions, the electrocardiogram (ECG) is an essential tool for examining myocardial function.³⁹In humans, various ischemic ECG changes occur in association with myocardial ischemia and infarction, such as high T wave, ST segment elevation, emergence of the deep Q wave, reduction of R wave amplitude, resolution of ST segment elevation, and T wave inversion.^21,39 In addition, ST segment depression is a typical change observed with subendocardial ischemia.^2,7In the study of myocardial ischemia, animal models that show ECG waveforms comparable to those of human patients with CHD play an important role. This similarity is important not only for assessing the effects of agents for the treatment of CHD but also for assessing adverse effects of newly developed agents on cardiac function. Although ECG have been used to study myocardial ischemia in several species including pigs, dogs, rabbits, rats, and mice,^{3,9,10,14,18,23} most of these studies used coronary ligation models. These models do not fully reflect the events that occur during myocardial ischemia caused by atherosclerotic coronary stenosis, which is seen typically in patients with CHD.The Watanabe heritable hyperlipidemic (WHHL) rabbit⁴⁰ and the myocardial infarction-prone WHHL (WHHLMI) rabbit³³ are animal models for the study of human myocardial ischemia. WHHLMI rabbits spontaneously develop hypercholesterolemia due to a deficiency of receptors for low-density lipoproteins and manifest severe coronary atherosclerosis and myocardial infarction. Importantly, lipoprotein metabolism in WHHL and WHHLMI rabbits resembles that in humans.^28,30 Using these advantages of the WHHL and WHHLMI models, we and others have been studying the effects of hypocholesterolemic and antiatherosclerotic agents on coronary atherosclerosis.^29,32,34 However, ECG were not examined in these studies. Because the rabbit heart is electrophysiologically similar to the human heart,^27,38 using ECG to monitor myocardial function in the WHHLMI rabbit may be valuable.In the present study, we examined whether ECG changes observed in WHHLMI rabbits reflect myocardial ischemia and whether those changes correspond to ECG features in human patients with CHD.     

基于单个细胞动作电位计算心电:若干异常仿真心电图

根据构造的心脏电生理模型及提出的基于单细胞动作电位计算心电图的算法,介绍异常心电活动的描述方式及对若干异常心电图的仿真结果,包括心肌缺血、心肌梗死、房室传导阻滞、束支传导阻滞、以及房室旁路,并对这些心电图的 产生机制进行说明,算法及仿真结果表明,细胞间的跨缝隙连结电位差是产生场点电热进而产生各种心电图波形的原因。     

SMT对大鼠在体心脏缺血-再灌注损伤超微结构的保护作用

目的：研究ＳＭＴ对心脏缺血－再灌注损伤（ＩＲＩ）心肌超微结构的影响。方法：ＳＤ大鼠１８只,体重３２０￣３８０ｇ,随机分为三组：①缺血－再灌注组（ＩＲ）：夹闭冠状动脉左前降支６０ｍｉｎ,松夹２０ｍｉｎ。②缺血－再灌注＋ＳＭＴ组（ＳＭＴ）：再灌注前５ｍｉｎ,股静脉注射ｉＮＯＳ抑制剂Ｓ－ｍｅｔｈｙｌｉｓｏｔｈｉｏｕｒｅａ ｓｕｌｆａｔｅ（ＳＭＴ ５ｍｇ／ｋｇ ｗ）,余同ＩＲ组;③对照组（Ｃ）：暴露心脏后     

Value of positive myocardial infarction imaging in coronary care units.

Positive myocardial imaging was undertaken on 120 unselected patients admitted to a coronary care unit with clinical suspicion of acute myocardial infarction. Multipurpose mobile gamma-cameras were used for serial imaging after administration of 99mtechnetium-labelled imidodiphosphonate, a low-cost radiopharmaceutical that is 97% specific for myocardial necrosis, with myocardial uptake and blood clearance most suitable for myocardial imaging. The sensitivty of detection was 94% for patients whose infarction was unequivocal on the ECG; when the presence of raised enzyme concentrations was also used as a criterion for myocardial necrosis, the overall sensitivity for all 120 patients remained 94%. In 73 patients (61%), whose ECGs were unhelpful or difficult to interpret, scintigraphy allowed infarction to be diagnosed in 11 (15%) and to be excluded in five (7%). In 32 (44%) of this group whose ECGs were totally uninterpretable due to previous myocardial damage or disorders of electrical activation, scintigraphy provided confirmation of a diagnosis that otherwise rested only on whether enzyme concentrations were raised. Myocardial imaging is thus a useful technique that permits more definite diagnosis in patients for whom ECG and enzyme data are uncertain.     

Inhibition of nonexocytotic norepinephrine release by desipramine reduces myocardial infarction size

During myocardial ischemia, a substantial accumulation of norepinephrine occurs in the ischemic zone due to a local nonexocytotic release of norepinephrine. Norepinephrine release is driven by the neuronal monoamine transporter (NET), which reverses its usual transmembrane transport direction. We investigated whether this local accumulation of norepinephrine contributes to irreversible myocardial injury in an in vivo model of myocardial infarction. Male, anaesthetized Wistar rats were subjected to 30 min coronary occlusion and subsequent 120 min reperfusion. Five minutes prior to coronary occlusion, the NET inhibitor desipramine was administered intravenously. Infarct size (IS) was determined by TTC-staining and was related to the area at risk (AAR). The influence of desipramine on cardiac norepinephrine release was investigated in isolated perfused hearts with 30 min of regional ischemia. Norepinephrine was measured in the effluent from the hearts by HPLC and electrochemical detection. Desipramine (0.1-0.8 mg/kg) dose-dependently reduced infarct size (IS/AAR) from 0.54 to 0.21 and suppressed postischemic norepinephrine release from 245 to 108 pg/mL. In summary, the data indicate that nonexocytotic release of norepinephrine in myocardial ischemia exaggerates acute ischemic damage, because suppression of ischemia-induced release of norepinephrine by the tricyclic antidepressant desipramine effectively reduces infarct size in an in vivo model of myocardial ischemia.     

Thrombin inhibitor reduces myocardial infarction in apoE-/- x LDLR-/- mice

We have previously shown that atherosclerotic apolipoprotein E-deficient (apoE(-/-)) x LDL receptor-deficient (LDLR(-/-)) mice develop myocardial infarction when exposed to hypoxic stress. This study was performed to assess the role of thrombin and thrombosis in this process. ApoE(-/-) x LDLR(-/-) mice were fed a cholesterol-rich diet for 8 mo and were then subjected to hypoxic stress while receiving isoflurane anesthesia. One group received a bolus dose (5.6 micromol/kg) of the thrombin inhibitor melagatran, and control animals received PBS 10 min before the hypoxic stress. The mice were exposed to 10 min of hypoxia followed by normoxia. Ten minutes after the stress, Alzet pumps delivering melagatran (20 nmol x kg x (-1)min(-1)) or PBS were implanted, and the mice were allowed to recover for 48 h. The cardiac response was analyzed by histology, immunohistochemistry, and serum troponin T assay. All animals showed reversible ECG changes as a sign of ischemia during hypoxic stress, and 50% developed infarctions afterward as judged by troponin T levels. The group that received thrombin inhibitor had significantly lower troponin T and smaller myocardial infarctions than the PBS-treated group. These data show that thrombin generation is an important pathogenetic factor and suggest that coronary thrombosis is involved in myocardial infarction in atherosclerotic mice. Exposure of atherosclerotic mice to hypoxia leads to myocardial infarction through a two-phase pathway in which acute transient ischemia is followed by thrombin-dependent, irreversible, myocardial ischemia and myocardial cell death.     

Progressive epicardial coronary blood flow reduction fails to produce ST-segment depression at normal heart rates

ST-segment depression is commonly seen in patients with acute coronary syndromes. Most authors have attributed it to transient reductions in coronary blood flow due to nonocclusive thrombus formation on a disrupted atherosclerotic plaque and dynamic focal vasospasm at the site of coronary artery stenosis. However, ST-segment depression was never reproduced in classic animal models of coronary stenosis without the presence of tachycardia. We hypothesized that ST-segment depression occurring during acute coronary syndromes is not entirely explained by changes in epicardial coronary artery resistance and thus evaluated the effect of a slow, progressive epicardial coronary artery occlusion on the ECG and regional myocardial blood flow in anesthetized pigs. Slow, progressive occlusion over 72 min (SD 27) of the left anterior descending coronary artery in 20 anesthetized pigs led to a 90% decrease in coronary blood flow and the development of ST-segment elevation associated with homogeneous and transmural myocardial blood flow reductions, confirmed by microspheres and myocardial contrast echocardiography. ST-segment depression was not observed in any ECG lead before the development of ST-segment elevation. At normal heart rates, progressive epicardial stenosis of a coronary artery results in myocardial ischemia associated with homogeneous, transmural reduction in regional myocardial blood flow and ST-segment elevation, without preceding ST-segment depression. Thus, in coronary syndromes with ST-segment depression and predominant subendocardial ischemia, factors other than mere increases in epicardial coronary resistance must be invoked to explain the heterogeneous parietal distribution of flow and associated ECG changes.     

Acupuncture pretreatment protects heart from injury in rats with myocardial ischemia and reperfusion via inhibition of the beta(1)-adrenoceptor signaling pathway

Our previous study showed that a cardioprotective effect was produced by pretreatment with acupuncture at bilateral Neiguan acupoints (PC6) and the effect of EA was diminished by propranolol, a nonspecific antagonist of beta-adrenoceptors (beta-ARs) which are the most powerful cardiac receptors, indicating an involvement of beta-ARs. The present study explored further the signaling mechanism underlying the cardioprotective effect of acupuncture pretreatment in rats subjected to myocardial ischemia and reperfusion (MIR). Myocardial ischemia was achieved by ligating the left anterior descending coronary artery and reperfusion by releasing the ligation. Adult rats were divided into three groups, namely, a normal control (NC) group, a group subjected to ischemia and reperfusion (IR) only, and a group given electro-acupuncture (EA) before IR. For EA, bilateral Neiguan points (PC6) of the rats were stimulated for 30 min once a day for 3 consecutive days. The ST segment of ECG, the ratio of infarct size over risk zone, and the contents of beta(1)-adrenoceptor (beta(1)-AR), Gsalpha protein and cAMP in ischemic myocardium were compared among the three groups. IR increased the elevation of ECG ST segment, myocardial infarct size, contents of beta(1)-AR, Gsalpha protein and cAMP. These effects were attenuated by EA pretreatment at bilateral Neiguan acupoints. In conclusion, the present results indicate that EA produces cardioprotective effect against IR which may be mediated via the beta(1)-AR-Gs-protein-cAMP pathway.