Basic Research in Cardiology

, Volume 92, Issue 6, pp 426–434 | Cite as

Attenuation of S-T Segment elevation during repetitive coronary occlusions truly reflects the protection of Ischemic preconditioning and is not an epiphenomenon

  • M. V. Cohen
  • Xi-Ming Yang
  • J. M. Downey
Original Contribution

Abstract

Attenuation of S-T segment elevation between the first and subsequent balloon inflations of a coronary angioplasty procedure has been assumed to indicate a transition to a preconditioned state, but there has been no validation of this assumption. Open-chest rabbits were instrumented with a coronary snare and epicardial electrode. The coronary artery was occluded twice for 5 min with each occlusion followed by 10 min of reflow before a final 30 min occlusion. The evolving S-T elevation was quantitated as the voltage-time integral. For the first coronary occlusion total S-T segment elevation averaged 40.8±5.4 mV·min, significantly antly greater than 26.2±4.6 mV·min for the second occlusion (p<0.001). There was no further change during the initial 5 min of the third occlusion (24.5±4.5 mV·min). When the protection of ischemic preconditioning was blocked by intravenous infusion of 8-(p-sulfophenyl)theophylline, an adenosine receptor antagonist, attenuation of S-T segment elevation was no longer apparent. When preconditioning was pharmacologically triggered by tyramine rather than ischemia, there also was no alteration in S-T segment elevation among the 3 occlusions. Therefore, S-T elevation was diminished during the second episode of ischemia only when a transition occurred from non-preconditioned to preconditioned state between occlusions. An attenuated S-T segment is a valid marker for the presence of the preconditioned state.

Key words

Ischemia preconditioning 8-(p-sulfophenyl)theophylline ST segments tyramine 

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References

  1. 1.
    Anzai T, Yoshikawa T, Asakura Y, Abe S, Meguro T, Akaishi M, Mitamura H, Handa S, Ogawa S (1994) Effect on short-term prognosis and left ventricular function of angina pectoris prior to first Q-wave anterior wall acute myocardial infarction. Am J Cardiol 74: 755–759Google Scholar
  2. 2.
    Birnbaum Y, Hale SL, Kloner RA (1996) Progressive decrease in the ST segment elevation during ischemic preconditioning: is it related to recruitment of collateral vessels? J Mol Cell Cardiol 28: 1493–1499Google Scholar
  3. 3.
    Cribier A, Korsatz L, Koning R, Rath P, Gamra H, Stix G, Merchant S, Chan C, Letac B (1992) Improved myocardial ischemic response and enhanced collateral circulation with long repetitive coronary occlusion during angioplasty: a prospective study. J Am Coll Cardiol 20: 578–586Google Scholar
  4. 4.
    Deutsch E, Berger M, Kussmaul WG, Hirshfeld JW Jr, Herrmann HC, Laskey WK (1990) Adaptation to ischemia during percutaneous transluminal coronary angioplasty: clinical, hemodynamic, and metabolic features. Circulation 82: 2044–2051Google Scholar
  5. 5.
    Downing SE, Chen V (1985) Myocardial injury following endogenous catecholamine release in rabbits. J Mol Cell Cardiol 17: 377–387Google Scholar
  6. 6.
    Eltchaninoff H, Cribier A, Tron C, Derumeaux G, Koning R, Hecketsweiller B, Letac B (1997) Adaptation to myocardial ischemia during coronary angioplasty demonstrated by clinical, electrocardiographic, echocardiographic, and metabolic parameters. Am Heart J 133: 490–496Google Scholar
  7. 7.
    Goto M, Cohen MV, Van Wylen DGL, Downey JM (1996) Attenuated purine production during subsequent ischemia in preconditioned rabbit myocardium is unrelated to the mechanism of protection. J Mol Cell Cardiol 28: 447–454Google Scholar
  8. 8.
    Goto M, Liu Y, Yang X-M, Ardell JL, Cohen MV, Downey JM (1995) Role of bradykinin in protection of ischemic preconditioning in rabbit hearts. Circ Res 77: 611–621Google Scholar
  9. 9.
    Heibig J, Bolli R, Harris S (1989) Initial coronary occlusion improves tolerance to subsequent prolonged balloon inflations. Cathet Cardiovasc Diagn 16: 99–102Google Scholar
  10. 10.
    Ikonomidis JS, Shirai T, Weisel RD, Derylo B, Rao V, Whiteside CI, Mickle DAG, Li R-K (1997) Preconditioning cultured human pediatric myocytes requires adenosine and protein kinase C. Am J Physiol 272: H1220-H1230Google Scholar
  11. 11.
    Kerensky RA, Kutcher MA, Braden GA, Applegate RJ, Solis GA, Little WC (1995) The effects of intracoronary adenosine on preconditioning during coronary angioplasty. Clin Cardiol 18: 91–96Google Scholar
  12. 12.
    Kloner RA, Shook T, Przyklenk K, Davis VG, Junio L, Matthews RV, Burstein S, Gibson CM, Poole WK, Cannon CP, McCabe CH, Braunwald E (1995) Previous angina alters in-hospital outcome in TIMI 4: a clinical correlate to preconditioning? Circulation 91: 37–45Google Scholar
  13. 13.
    Leesar MA, Stoddard M, Ahmed M, Broadbent J, Bolli R (1997) Preconditioning of human myocardium with adenosine during coronary angioplasty. Circulation 95: 2500–2507Google Scholar
  14. 14.
    Li GC, Vasquez JA, Gallagher KP, Lucchesi BR (1990) Myocardial protection with preconditioning. Circulation 82: 609–619Google Scholar
  15. 15.
    Libby P, Maroko PR, Covell JW, Malloch CI, Ross J Jr, Braunwald E (1973) Effect of practolol on the extent of myocardial ischaemic injury after experimental coronary occlusion and its effects on ventricular function in the normal and ischaemic heart. Cardiovasc Res 7: 167–173Google Scholar
  16. 16.
    Liu GS, Thornton J, Van Winkle DM, Stanley AWH, Olsson RA, Downey JM (1991) Protection against infarction afforded by preconditioning is mediated by A1 adenosine receptors in rabbit heart. Circulation 84: 350–356Google Scholar
  17. 17.
    Liu Y, Downey JM (1992) Ischemic preconditioning protects against infarction in rat heart. Am J Physiol 263: H1107-H1112Google Scholar
  18. 18.
    Ludbrook J (1994) Repeated measurements and multiple comparisons in cardiovascular research. Cardiovasc Res 28: 303–311Google Scholar
  19. 19.
    Maroko PR, Kjekshus JK, Sobel BE, Watanabe T, Covell JW, Ross J Jr, Braunwald E (1971) Factors influencing infarct size following experimental coronary artery occlusions. Circulation 43: 67–82Google Scholar
  20. 20.
    Maroko PR, Radvany P, Braunwald E, Hale SL (1975) Reduction of infarct size by oxygen inhalation following acute coronary occlusion. Circulation 52: 360–368Google Scholar
  21. 21.
    Miura T, Adachi T, Ogawa T, Iwamoto T, Tsuchida A, Iimura O (1992) Myocardial infarct size-limiting effect of ischemic preconditioning: its natural decay and the effect of repetitive preconditioning. Cardiovasc Pathol 1: 147–154Google Scholar
  22. 22.
    Murry CE, Jennings RB, Reimer KA (1986) Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation 74: 1124–1136Google Scholar
  23. 23.
    Nakagawa Y, Ito H, Kitakaze M, Kusuoka H, Hori M, Kuzuya T, Higashino Y, Fujii K, Minamino T (1995) Effect of angina pectoris on myocardial protection in patients with reperfused anterior wall myocardial infarction: retrospective clinical evidence of “preconditioning”. J Am Coll Cardiol 25: 1076–1083Google Scholar
  24. 24.
    Ottani F, Galvani M, Ferrini D, Sorbello F, Limonetti P, Pantoli D, Rusticali F (1995) Prodromal angina limits infarct size: a role for ischemic preconditioning. Circulation 91: 291–297Google Scholar
  25. 25.
    Shattock MJ, Lawson CS, Hearse DJ, Downey JM (1996) Electrophysiological characteristics of repetitive ischemic preconditioning in the pig heart. J Mol Cell Cardiol 28: 1339–1347Google Scholar
  26. 26.
    Tamura Y, Miura M, Saito T, Chiba Y, Yuasa N, Nakagomi A, Abe T, Kanazawa T (1990) Phenomenon of decreased heart surface electrocardiographic S-T segment shift in a repeated coronary occlusion model and its mechanism of existence—proposal of the concept of electrical stunning. Jpn J Electrocardiology 10: 351–362Google Scholar
  27. 27.
    Thornton JD, Daly JF, Cohen MV, Yang X-M, Downey JM (1993) Catecholamines can induce adenosine receptormediated protection of the myocardium but do not participate in ischemic preconditioning in the rabbit. Circ Res 73: 649–655Google Scholar
  28. 28.
    Tomai F, Crea F, Gaspardone A, Versaci F, De Paulis R, Penta de Peppo A, Chiariello L, Gioffrè PA (1994) Ischemic preconditioning during coronary angioplasty is prevented by glibenclamide, a selective ATP-sensitive K+ channel blocker. Circulation 90: 700–705Google Scholar
  29. 29.
    Van Winkle DM, Thornton JD, Downey DM, Downey JM (1991) The natural history of preconditioning: cardioprotection depends on duration of transient ischemia and time to subsequent ischemia. Coron Artery Dis 2: 613–619Google Scholar
  30. 30.
    Van Wylen DGL (1994) Effect of ischemic preconditioning on interstital purine metabolite and lactate accumulation during myocardial ischemia. Circulation 89: 2283–2289Google Scholar
  31. 31.
    Weinbrenner C, Wang P, Downey JM (1996) Loss of glycogen during preconditioning is not a prerequisite for protection of the rabbit heart. Basic Res Cardiol 91: 374–381Google Scholar
  32. 32.
    Yellon DM, Alkhulaifi AM, Pugsley WB (1993) Preconditioning the human myocardium. Lancet 342: 276–277Google Scholar

Copyright information

© Steinkopff Verlag 1997

Authors and Affiliations

  • M. V. Cohen
    • 1
  • Xi-Ming Yang
    • 1
  • J. M. Downey
    • 1
  1. 1.Department of Physiology MSB 3050University of South Alabama Colleg of MedicineMobileUSA

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