Myocardial hibernation: a delicate balance |
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Authors: | Heusch Gerd Schulz Rainer Rahimtoola Shahbudin H |
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Institution: | Institut für Pathophysiologie, Zentrum für Innere Medizin, Universit?tsklinikum Essen, Hufelandstr. 55, 45122 Essen, Germany. gerd.heusch@uni-essen.de |
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Abstract: | The pathophysiology of myocardial hibernation is characterized as a situation of reduced regional contractile function distal to a coronary artery stenosis that recovers after removal of the coronary stenosis. A subacute "downregulation" of contractile function in response to reduced regional myocardial blood flow exists, which normalizes regional energy and substrate metabolism but does not persist for more than 12-24 h. Chronic hibernation develops in response to one or more episodes of myocardial ischemia-reperfusion, possibly progressing from repetitive stunning with normal blood flow to hibernation with reduced blood flow. An upregulation of a protective gene program is seen in hibernating myocardium, putting it into the context of preconditioning. The morphology of hibernating myocardium is characterized by both adaptive and degenerative features. |
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