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Titolo:
DELETERIOUS EFFECTS OF A SYSTEMIC LYTIC STATE ON REPERFUSED MYOCARDIUM - MINIMIZATION OF REPERFUSION INJURY AND ENHANCED RECOVERY OF MYOCARDIAL-FUNCTION BY DIRECT ANGIOPLASTY
Autore:
OHNISHI Y; BUTTERFIELD MC; SAFFITZ JE; SOBEL BE; CORR PB; GOLDSTEIN JA;
Indirizzi:
WILLIAM BEAUMONT HOSP,3601 W 13 MILE RD ROYAL OAK MI 48073 WASHINGTON UNIV,SCH MED,DEPT MED,DIV CARDIOVASC ST LOUIS MO 63110
Titolo Testata:
Circulation
fascicolo: 3, volume: 92, anno: 1995,
pagine: 500 - 510
SICI:
0009-7322(1995)92:3<500:DEOASL>2.0.ZU;2-D
Fonte:
ISI
Lingua:
ENG
Soggetto:
LEFT-VENTRICULAR FUNCTION; CORONARY-ARTERY REPERFUSION; NO-REFLOW PHENOMENON; INFARCT SIZE; PLASMINOGEN-ACTIVATOR; THROMBOLYTIC THERAPY; IMMEDIATE ANGIOPLASTY; TIME COURSE; INTRACORONARY STREPTOKINASE; INTRAVENOUS STREPTOKINASE;
Keywords:
REPERFUSION; THROMBOLYSIS; ANGIOPLASTY; MYOCARDIUM;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
63
Recensione:
Indirizzi per estratti:
Citazione:
Y. Ohnishi et al., "DELETERIOUS EFFECTS OF A SYSTEMIC LYTIC STATE ON REPERFUSED MYOCARDIUM - MINIMIZATION OF REPERFUSION INJURY AND ENHANCED RECOVERY OF MYOCARDIAL-FUNCTION BY DIRECT ANGIOPLASTY", Circulation, 92(3), 1995, pp. 500-510

Abstract

Background The beneficial effects of flow restoration and the deleterious impact of reperfusion injury on ischemic myocardium are well known. However, most experimental studies have induced reperfusion by mechanical release of nonthrombotic occlusions, only occasionally in the presence of a systemic lytic state. Conditions differ markedly in patients undergoing pharmacological or mechanical recanalization of thrombotically occluded coronary arteries. Accordingly, this study was designed to determine whether the method of coronary occlusion and mode of recanalization influence the response of the heart to reperfusion.Methods and Results The acute effects of reperfusion on right ventricular (RV) function and histology were studied in open-chest dogs subjected to right coronary artery (RCA) balloon occlusion and deflation alone (group 1), pharmacological lysis of thrombotic occlusions (group 2), balloon occlusion with reperfusion induced by balloon deflation in the presence of a systemic lytic state (group 3), and recanalization of thrombotically occluded vessels by direct angioplasty (group 4). In all groups, 1 hour of RCA occlusion led to RV free wall (FW) dyskinesis. In group 1, reperfusion promptly improved RVFW function, with normal RVFWthickness and only minimal edema by microscopy. In contrast, in group2, clot lysis led to acute RVFW swelling and impaired recovery of RVFW contraction associated with striking interstitial edema, contractionband necrosis, and hemorrhage by microscopy. In group 3, balloon deflation in the presence of a lytic state led to a similar but less severe pattern of abrupt RVFW swelling and impaired recovery of RVFW function but lesser histological alterations than in group 2. However, mechanical recanalization of thrombotically occluded vessels (group 4) led to prompt recovery of RVFW function without significant RVFW swelling or histological abnormalities. Conclusions Our observations indicate that the responses of ischemic myocardium to reperfusion are influencedby factors beyond those effects attributable to ischemia and reperfusion per se. Pharmacological lysis of coronary thrombi results in alterations characteristic of reperfusion injury and associated with impaired functional recovery. Such changes are also evident, although to a lesser extent, when reperfusion of nonthrombotic occlusions is induced by mechanical recanalization in the presence of a systemic lytic statebut not in its absence. However, such effects were not seen with direct mechanical recanalization of thrombotically occluded vessels. In aggregate, these findings indicate that induction of a systemic lytic state, together with products released by lysis of introcoronary thrombi, generates an injurious milieu that exerts adverse effects on reperfused myocardium.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 30/10/20 alle ore 08:57:12