Die Beziehung zwischen regionaler myokardialer Durchblutung und Funktion bei Ischämie

  • Kim P. Gallagher
Conference paper


Das wesentliche Ziel dieser Übersicht besteht darin, neuere Befunde über die funktionellen Konsequenzen einer akuten regionalen Ischämie zusammenfassend darzustellen. Zusätzlich zur Präsentation der Fakten, die über die regionale Funktion während Ischämie bekannt sind, besteht ein zweites Anliegen in der Betonung der noch ungelösten Fragen. Es sollen potentielle Ziele für weitere Untersuchungen vorgeschlagen werden, die es sich zu verfolgen lohnt.


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  1. 1.
    Bogen DK, Rabinowitz SA, Needleman A, McMahon TA, Abelmann WH (1980) An analysis of the mechanical disadvantage of myocardial infarction in the canine left ventricle. Circ Res 47: 728–741PubMedGoogle Scholar
  2. 2.
    Bogen DK, Needleman A, McMahon TA (1984) An analysis of myocardial infarction. The effect of regional changes in contractility. Circ Res 55: 805–815PubMedGoogle Scholar
  3. 3.
    Bolli R, Zhu W-X, 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 (Heart Circ Physiol 23): H102 - H114PubMedGoogle Scholar
  4. 4.
    Buda AJ, Zotz RJ, Gallagher KP (1986) Characterization of the functional border zone around regionally ischemic myocardium using circumferential flow-function maps. J Am Coll Cardiol 8: 150–158PubMedCrossRefGoogle Scholar
  5. 5.
    Buda AJ, Zotz RJ, Gallagher KP (1987) The effect of inotropic stimulation on normal and ischemic myocardium following coronary occlusion. Circulation 76: 163–172PubMedCrossRefGoogle Scholar
  6. 6.
    Buda AJ, Shlafer M, Gallagher KP (1988) Spatial and temporal characteristics of circumferential flow-function relations during acute ischemia in the conscious dog. Am Heart J 116: 1514–1523PubMedCrossRefGoogle Scholar
  7. 7.
    Bugge-Asperheim B, Leraand S, Kiil F (1969) Local dimensional changes of the myocardium measured by ultrasound technique. Scand J Clin Lab Invest 24: 361–371PubMedCrossRefGoogle Scholar
  8. 8.
    Canty JM Jr (1988) Coronary pressure-function and steady-state pressure-flow relations during autoregulation in the unanesthetized dog. Circ Res 63: 821–836PubMedGoogle Scholar
  9. 9.
    Drake DH, McClanahan TB, Ning X-H, Gerren RA, Dunham WR, Gallagher KP (1987) Changes in contractility fail to alter the size of the functional border zone in anesthetized dogs. Circ Res 61: 166–180PubMedGoogle Scholar
  10. 10.
    Force T, Kemper A, Perkins L, Gilfoil M, Cohen C, Parisi AF (1986) Overestimation of infarct size by quantitative two-dimensional echocardiography: the role of tethering and of analytic procedures. Circulation 73: 1360–1368PubMedCrossRefGoogle Scholar
  11. 11.
    Forman R, Kirk ES, Downey JM, Sonnenblick EH (1973) Nitroglycerin and heterogeneity of myocardial blood flow: reduced subendocardial blood flow and ventricular contractile force. J Clin Invest 52: 905–911PubMedCrossRefGoogle Scholar
  12. 12.
    Franklin DL, Kemper W, Patrick T, McKown D (1973) Technique for continuous measurement of regional myocardial segment dimensions in chronic animal preparations (abstract). Fed Proc 32: 343Google Scholar
  13. 13.
    Freeman GL, LeWinter MM, Engler RL, Covell JW (1985) Relationship between myocardial fiber direction and segment shortening in the midwall of the canine left ventricle. Circ Res 56: 31–39PubMedGoogle Scholar
  14. 14.
    Gallagher KP, Kumada T, Reese JB, McKown D, Ross J Jr (1978) Correlation of regional myocardial blood flow and function during limited coronary inflow in dogs (abstract). Circulation 58: II - 56Google Scholar
  15. 15.
    Gallagher KP, Kumada T, Koziol JA, McKown M, Kemper WS, Ross J Jr (1980) Significance of regional wall thickening abnormalities relative to transmural perfusion. Circulation 62: 1266–1274PubMedGoogle Scholar
  16. 16.
    Gallagher KP, Folts JD, Shebuski RJ, Rankin JHG, Rowe GG (1980) Subepicardial vasodilator reserve in the presence of critical coronary stenosis in dogs. Am J Cardiol 46: 67–73PubMedCrossRefGoogle Scholar
  17. 17.
    Gallagher KP, Osakada G, Hess OM, Koziol JA, Kemper WS, Ross J Jr (1982) Subepicardial segment function during coronary stenosis and the role of myocardial fiber orientation. Circ Res 50: 352–359PubMedGoogle Scholar
  18. 18.
    Gallagher KP, Kumada T, Battler A, Kemper WS, Ross J Jr (1982) Isoproterenol induced myocardial dysfunction in dogs with coronary stenosis. Am J Physiol 242 (Heart Circ Physiol 11): H260 - H267PubMedGoogle Scholar
  19. 19.
    Gallagher KP, Osakada G, Matsuzaki M, Kemper WS, Ross J Jr (1982) Myocardial blood flow and function with critical coronary stenosis in exercising dogs. Am J Physiol 243 (Heart Circ Physiol 12)H698- H707PubMedGoogle Scholar
  20. 20.
    Gallagher KP, Matsuzaki M, Osakada G, Kemper WS, Ross J Jr (1983) Effect of exercise on the relationship between myocardial blood flow and systolic wall thickening in dogs with acute coronary stenosis. Circ Res 52: 716–729PubMedGoogle Scholar
  21. 21.
    Gallagher KP, Matsuzaki M, Koziol JA, Kemper WS, Ross J Jr (1984) Regional myocardial perfusion and wall thickening during ischemia in conscious dogs. Am J Physiol 247 (Heart Circ Physiol 16): H727 - H738PubMedGoogle Scholar
  22. 22.
    Gallagher KP, Stirling MC, Choy M, Szpunar CA, Gerren RA, Botham MJ, Lemmer JH (1985) Dissociation between epicardial and transmural function during acute myocardial ischemia. Circulation 71: 1279–1291PubMedCrossRefGoogle Scholar
  23. 23.
    Gallagher KP, Osakada G, Matsuzaki M, Miller M, Kemper WS, Ross J Jr (1985) Nonuniformity of inner and outer systolic wall thickening. Am J Physiol 249 (Heart Circ Physiol 18): H241 - H248PubMedGoogle Scholar
  24. 24.
    Gallagher KP, Gerren RA, Stirling MC, Choy M, Dysko RC, McManimon SP, Dunham WR (1986) The distribution of functional impairment across the lateral border of acutely ischemic myocardium. Circ Res 58: 570–583PubMedGoogle Scholar
  25. 25.
    Gallagher KP, Ning X-H, Gerren RA, Drake DH, Dunham WR (1987) Effect of aortic constriction on the functional border zone. Am J Physiol 252 (Heart Circ Physiol 22): H826 - H835PubMedGoogle Scholar
  26. 26.
    Gallagher KP, Gerren RA, Choy M, Stirling MC, Dysko RC (1987) Subendocardial segment length shortening at the lateral margins of ischemic myocardium in dogs. Am J Physiol 253 (Heart Circ Physiol 22): H826 - H837PubMedGoogle Scholar
  27. 27.
    Gallagher KP, Gerren RA, Ning X-H, McManimon SP, Stirling MC, Shlafer M, Buda AJ (1987) The functional border zone in conscious dogs. Circulation 76: 929–942PubMedCrossRefGoogle Scholar
  28. 28.
    Gallagher KP, McClanahan TB, Lynch MJ, Deeb GM (1987) Systolic wall thickening and subendocardial segment length shortening are equally sensitive to acute reductions in myocardial perfusion (abstract). Circulation 76: IV - 377CrossRefGoogle Scholar
  29. 29.
    Gallagher KP, Stirling MC, Choy M, Gerren RA (1985) The relationship between fiber direction and segment shortening in the epicardium varies by location in the left ventricle (abstract). Fed Proc 44: 1380Google Scholar
  30. 30.
    Gascho JA, Lesnefsky EJ, Mahanes MS, Kaiser DL, Beller GA (1984) Effects of acute left anterior descending occlusion on regional myocardial blood flow and wall thickening in the presence of a circumflex stenosis in dogs. Am J Cardiol 54: 399–406PubMedCrossRefGoogle Scholar
  31. 31.
    Genain C, Theroux P, Thuillez C, Bourassa MG, Waters DD (1979) The interrelationships between function and flow in the subendocardial and subepicardial regions of the left ventricle (abstract). Circulation 60: 11–28Google Scholar
  32. 32.
    Gibbons EF, Hogan RD, Franklin TD, Nolting M, Weyman AE (1985) The natural history of regional dysfunction in a canine preparation of chronic infarction. Circulation 71: 394–402PubMedCrossRefGoogle Scholar
  33. 33.
    Gross GJ, Lamping K, Warltier DC, Hardman HF (1984) Effects of three bradycardiac drugs on regional myocardial blood flow and function in areas distal to a total or partial occlusion in dogs. Circulation 69: 391–399PubMedCrossRefGoogle Scholar
  34. 34.
    Guth BD, White FC, Gallagher KP, Bloor CM (1984) Decreased systolic wall thickening in myocardium adjacent to ischemic zones in conscious swine during brief coronary artery occlusion. Am Heart J 107: 458–464PubMedCrossRefGoogle Scholar
  35. 35.
    Guth BD, Heusch G, Seitelberger R, Ross J Jr (1987) Elimination of exercise-induced regional myocardial dysfunction by a bradycardiac agent in dogs with chronic coronary artery stenosis. Circulation 75: 661–669PubMedCrossRefGoogle Scholar
  36. 36.
    Guyton RA, McClenahan JH, Newman GE, Michaelis LL (1977) Significance of subendocardial S-T segment elevation caused by coronary stenosis in the dog. Am J Cardiol 40: 373–380PubMedCrossRefGoogle Scholar
  37. 37.
    Hamby RI, Hoffman I, Hilsenrath J, Aintablian A, Shanies S, Padmanabhan VS (1974) Clinical, hemodynamic and angiographie aspects of inferior and anterior myocardial infarction in patients with angina pectoris. Am J Cardiol 34: 513–519PubMedCrossRefGoogle Scholar
  38. 38.
    Harken AH, Barlow CH, Harden WR III, Chance B (1978) Two and three dimensional display of myocardial ischemic “border zone” in dogs. Am J Cardiol 42: 954–959PubMedCrossRefGoogle Scholar
  39. 39.
    Hattori S, Weintraub WS, Agarwal JB, Bodenheimer MM, Banka VS, Helfant RH (1983) Contrasting ischemic contraction pattern by zone and layer in canine myocardium. Am J Physiol 243 (Heart Circ Physiol 12): H852 - H855Google Scholar
  40. 40.
    Hearse DJ, Opie LH, Katseff IE, Lubbe WF, VanderWerff TJ, Peisach M, Boulle G (1977) Characterization of the “border zone” in acute regional ischemia in the dog. Am J Cardiol 40: 716–726PubMedCrossRefGoogle Scholar
  41. 41.
    Hearse DJ, Muller CA, Fukanami M, Kudoh Y, Opie LH, Yellon DM (1986) Regional myocardial ischemia: characterization of temporal, transmural and lateral flow interfaces in the porcine heart. Can J Cardiol 2: 48–61PubMedGoogle Scholar
  42. 42.
    Heusch G, Guth BD, Gilpin E, Oudiz R, Matsuzaki M, Ross J Jr (1987) Determinants of recovery of regional contractile function after exercise-induced myocardial ischemia in conscious dogs. Fed Proc 46: 834 (abstr.)Google Scholar
  43. 43.
    Heusch G, Guth BD, Seitelberger R, Ross J Jr (1987) Attenuation of exercise-induced myocardial ischemia in dogs with recruitment of coronary vasodilator reserve by nifedipine. Circulation 75: 482–490PubMedCrossRefGoogle Scholar
  44. 44.
    Heymann MA, Payne BD, Hoffman JIE, Rudolph AM (1977) Blood flow measurements with radionuclide-labeled particles. Prog Cardiovasc Dis 20: 55–79PubMedCrossRefGoogle Scholar
  45. 45.
    Heyndrickx GR, Millard RW, McRitchie RJ, Maroko PR, Vatner SF (1975) Regional myocardial functional and electrophysiological alterations after brief coronary artery occlusion in the conscious dog. J Clin Invest 56: 978–985PubMedCrossRefGoogle Scholar
  46. 46.
    Hill RC, Pellom GL, Chitwood WR Jr, Sink JD, Wechsler AS (1980) The relationship of trans-mural myocardial blood flow to midwall function. J Surg Res 28: 306–313PubMedCrossRefGoogle Scholar
  47. 47.
    Hill RC, Kleinman LH, Tiller WH Jr, Chitwood WR, Rembert JC, Greenfield JC Jr, Wechsler AS (1983) Myocardial blood flow and function during gradual coronary occlusion in awake dogs. Am J Physiol 244 (Heart Circ Physiol 13): H60 - H67PubMedGoogle Scholar
  48. 48.
    Hoffman JIE (1987) A critical view of coronary reserve. Circulation 75 (Suppl I): I6 - I11PubMedGoogle Scholar
  49. 49.
    Homans DC, Asinger R, Elsperger KJ, Erlien D, Sublett E, Mikell F, Bache RJ (1985) Regional function and perfusion at the lateral border of ischemic myocardium. Circulation 71: 1038–1047PubMedCrossRefGoogle Scholar
  50. 50.
    Homans DC, Sublett E, Lindstrom P, Nesbitt T, Bache RJ (1988) Subendocardial and subepicardial wall thickening during ischemia in exercising dogs. Circulation 78: 1267–1276PubMedCrossRefGoogle Scholar
  51. 51.
    Hori M, Inoue M, Fukui S, Shimazu T, Mishima M, Ohgitani N, Minamino T, Abe H (1979) Correlation of ejection fraction and infarct size estimated from the total CK released in patients with acute myocardial infarction. Br Heart J 41: 433–440PubMedCrossRefGoogle Scholar
  52. 52.
    Kavanaugh KM, Brenner KM, Gallagher KP, Buda AJ (1988) Effect of afterload alterations on the functional border zone measured with two-dimensional echocardiography during acute coronary occlusion. Am Heart J 116: 942–953PubMedCrossRefGoogle Scholar
  53. 53.
    Kerber RE, Marcus ML, Ehrhardt J, Wilson R, Abboud FM (1975) Correlation between echocardiographically demonstrated segmental dyskinesis and regional myocardial perfusion. Circulation 52: 1097–1104PubMedGoogle Scholar
  54. 54.
    Kerber RE, Marcus ML, Wilson R, Ehrhardt J, Abboud FM (1976) Effects of acute coronary occlusion on the motion and perfusion of the normal and ischemic interventricular septum. Circulation 54: 928–935PubMedGoogle Scholar
  55. 55.
    Lee J-D, Tajimi T, Guth B, Seitelberger R, Miller M, Ross J Jr (1986) Exercise-induced regional dysfunction with subcritical coronary stenosis. Circulation 73: 596–605PubMedCrossRefGoogle Scholar
  56. 56.
    Lima JAC, Becker LC, Melin JA, Lima S, Kallman CH, Weisfeldt ML, Weiss JL (1985) Impaired thickening of non-ischemic myocardium during acute regional ischemia in the dog. Circulation 71: 1048–1059PubMedCrossRefGoogle Scholar
  57. 57.
    Matre K, Hexeberg K, Lekven J (1985) Interpretation of contraction recorded from local segments. Cardiovasc Res 19: 193–200PubMedCrossRefGoogle Scholar
  58. 58.
    Matsuzaki M, Gallagher KP, Kemper WS, White F, Ross J Jr (1983) Sustained regional dysfunction during prolonged coronary stenosis: Gradual recovery of function after reperfusion. Circulation 68: 170–182PubMedCrossRefGoogle Scholar
  59. 59.
    Matsuzaki M, Gallagher KP, Patritti J, Tajimi T, Kemper WS, Ross J Jr (1984) Effects of a calcium entry blocker (diltiazem) on regional myocardial flow and function during exercise in conscious dogs. Circulation 69: 801–814PubMedCrossRefGoogle Scholar
  60. 60.
    Matsuzaki M, Guth B, Tajimi T, Kemper WS, Ross J Jr (1985) Effect of the combination of diltiazem and atenolol on exercise-induced regional myocardial ischemia in conscious dogs. Circulation 72: 233–243PubMedCrossRefGoogle Scholar
  61. 61.
    Miller MM, Thorvaldson J, Ilebekk A, Lekven J (1979) Myocardial ischemia. Relationship between local flow, function and ST-segment elevation. Eur J Cardiol 10: 7–18PubMedGoogle Scholar
  62. 62.
    Miller RR, Olson HG, Vismara LA, Bogren HG, Amsterdam EA, Mason DT (1976) Pump dysfunction after myocardial infarction: Importance of location, extent and pattern of abnormal left ventricular segmental contraction. Am J Cardiol 37: 340–344PubMedCrossRefGoogle Scholar
  63. 63.
    Murdock RH Jr, Harlan DM, Morris JJ III, Pryor WW Jr, Cobb FR (1983) Transitional blood flow zones between ischemic and nonischemic myocardium in the awake dogs. Analysis based on distribution of the intramural vasculature. Circ Res 52: 451–459PubMedGoogle Scholar
  64. 64.
    Myers JH, Stirling MC, Choy M, Buda AJ, Gallagher KP (1986) Direct measurement of inner and outer wall thickening dynamics with epicardial echocardiography. Circulation 74: 164–172PubMedCrossRefGoogle Scholar
  65. 65.
    Nagata M, Lavallee M (1989) Contractile function of heterogeneously perfused myocardium in conscious dogs. Am J Physiol 256 (Heart Circ Physiol 25): H352 - H360PubMedGoogle Scholar
  66. 66.
    Pandian NG, Skorton DJ, Collins SM, Falsetti HL, Burke ER, Kerber RE (1983) Heterogeneity of left ventricular segmental wall thickening and excursion in 2-dimensional echocardiograms of normal human subjects. Am J Cardiol 51: 1667–1673PubMedCrossRefGoogle Scholar
  67. 67.
    Roan PG, Buja LM, Izquierdo C, Hashimi H, Saffer S, Willerson JT (1981) Interrelationships between regional left ventricular function, coronary blood flow and myocellular necrosis during the initial 24 hours and 1 week after experimental coronary occlusion in awake, unsedated dogs. Circ Res 49: 31–40PubMedGoogle Scholar
  68. 68.
    Russell RO, Hunt D, Rackley CE (1973) Left ventricular hemodynamics in anterior and inferior myocardial infarction. Am J Cardiol 32: 8–16PubMedCrossRefGoogle Scholar
  69. 69.
    Sabbah HN, Marzilli M, Stein PD (1981) The relative role of subendocardium and subepicardium in left ventricular mechanics. Am J Physiol 240 (Heart Circ Physiol 9): H290 - H296Google Scholar
  70. 70.
    Sakai K, Watanabe K, Millard RW (1985) Defining the mechanical border zone: A study in the pig heart. Am J Physiol 249 (Heart Circ Physiol 18): H88 - H94PubMedGoogle Scholar
  71. 71.
    Sasayama S, Franklin D, Ross J Jr, Kemper WS, McKown D (1976) Dynamic changes in left ventricular wall thickness and their use in analyzing cardiac function in the conscious dog. Am J Cardiol 38: 870–879PubMedCrossRefGoogle Scholar
  72. 72.
    Savage RM, Guth B, White FC, Hagan AD, Bloor CM (1981) Correlation of regional myocardial blood flow and function with myocardial infarct size during acute myocardial ischemia in the conscious pig. Circulation 64: 699–707PubMedCrossRefGoogle Scholar
  73. 73.
    Schaper W (1979) Residual perfusion of acutely ischemic heart muscle. In: The pathophysiology of myocardial perfusion. In: Schaper W (ed) Elsevier/North Holland Biomedical Press, Amsterdam, pp 345–378Google Scholar
  74. 74.
    Scheel KW, Ingram LA, Gordey RL (1982) Relationship of coronary flow and perfusion territory in dogs. Am J Physiol 243 (Heart Circ Physiol 12): H738 - H747PubMedGoogle Scholar
  75. 75.
    Schneider RM, Chu A, Akaishi M, Weintraub WS, Morris KG, Cobb FR (1985) Left ventricular ejection fraction after acute coronary occlusion in conscious dogs: Relation to the extent and site of myocardial infarction. Circulation 72: 623–628CrossRefGoogle Scholar
  76. 76.
    Schneider RM, Morris KG, Chu A, Roberts KB, Coleman RE, Cobb FR (1987) Relation between myocardial perfusion and left ventricular function following acute coronary occlusion: Disproportionate effects of anterior vs. inferior ischemia. Circ Res 60: 60–71PubMedGoogle Scholar
  77. 77.
    Schneider RM, Roberts KB, Morris KG, Stanfield JA, Cobb FR (1984) Relation between radionuclide angiographic regional ejection fraction and left ventricular regional ischemia in awake dogs. Am J Cardiol 53: 294–301PubMedCrossRefGoogle Scholar
  78. 78.
    Stowe DF, Mathey DG, Moores WY, Glantz SA, Townsend RM, Kabra P, Chatterjee K, Parmley WW, Tyberg JV (1978) Segment stroke work and metabolism depend on coronary blood flow in the pig. Am J Physiol 234 (Heart Circ Physiol 3): H597 - H607PubMedGoogle Scholar
  79. 79.
    Tatakawa S, Traber KB, Hantler CB, Tait AR, Gallagher KP, Knight PR (1987) The effects of isoflurane on myocardial blood flow, function and oxygen consumption in the presence of critical coronary stenosis. Anesth Analg 66: 1073–1082Google Scholar
  80. 80.
    Tennant R, Wiggers CJ (1935) The effect of coronary occlusion on myocardial contraction. Am J Physiol 112: 351–361Google Scholar
  81. 81.
    Theroux P, Franklin D, Ross J Jr, Kemper WS (1974) Regional myocardial function during acute coronary occlusion and its modification by pharmacologic agents in the dog. Circ Res 35: 896–908PubMedGoogle Scholar
  82. 82.
    Tomoike H, Inou T, Watanabe K, Mizukami M, Kikuchi Y, Nakamura M (1983) Functional significance of collaterals during ameroid-induced coronary stenosis in conscious dogs. Circulation 67: 1001–1008PubMedCrossRefGoogle Scholar
  83. 83.
    Vatner SF (1980) Correlation between acute reductions in myocardial blood flow and function in conscious dogs. Circ Res 47: 201–207PubMedGoogle Scholar
  84. 84.
    Waldman LK, Fung YC, Covell JW (1985) Transmural myocardial deformation in the canine left ventricle. Normal in vivo three-dimensional finite strains. Circ Res 57: 152–163Google Scholar
  85. 85.
    Weintraub WS, Hattori S, Agarwal JB, Bodenheimer MM, Banka VS, Helfant RH (1981) The relationship between myocardial blood flow and contraction by myocardial layer in the canine left ventricle during ischemia. Circ Res 48: 430–438PubMedGoogle Scholar
  86. 86.
    Weiss RM, Marcus ML (1988) The extent of regional systolic dysfunction during acute ischemia is load-dependent (abstract). Circulation 78: II - 484Google Scholar
  87. 87.
    Yellon DM, Hearse DJ, Come R, Grannell J, Wyse RKG (1981) Characterization of the lateral interface between normal and ischemic tissue in the canine heart during evolving myocardial infarction. Am J Cardiol 47: 1233–1249PubMedCrossRefGoogle Scholar

Copyright information

© Dr. Dietrich Steinkopff Verlag, GmbH & Co. KG, Darmstadt 1990

Authors and Affiliations

  • Kim P. Gallagher
    • 1
  1. 1.Thoracic Surgery Research LaboratoryUniversity of Michigan Medical SchoolAnn ArborUSA

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