Abstract
Myocardial stunning refers to the contractile dysfunction that occurs following an episode of acute ischaemia, despite the return of normal blood flow. The phenomenon was initially identified in animal models, where it has been very well characterised, and there was initial doubt about whether a similar syndrome occurred in humans, and if it did, whether it was of any clinical relevance. This article outlines the conditions that must be met to diagnose myocardial stunning and why it has been difficult to confirm its presence in humans. The clinical scenarios where it has now been clearly identified and those others where it may also occur and be of clinical importance are also reviewed.
Similar content being viewed by others
References
Tennant R, Wiggers CJ. The effects of coronary occlusion on myocardial contraction. Am J Physiol 1935;112:351–361.
Bolli R. Mechanism of myocardial "stunning". Circulation 1990;82:723–738.
Bolli R. Myocardial "stunning" in man. Circulation 1992;86:1671–1691.
Roberts AJ, Spies SM, Meyers SN, Moran JM, Sanders JH Jr, Lichtenthal PR et al. Early and long-term improvement in left ventricular performance following coronary bypass surgery. Surgery 1980;88:467–475.
Gray R, Maddahi J, Berman D, Raymond M, Waxman A, Ganz W et al. Scintigraphic and hemodynamic demonstration of transient left ventricular dysfunction immediately after uncomplicated coronary artery bypass grafting. J Thorac Cardiovasc Surg 1979;77:504–510.
Ballantyne CM, Verani MS, Short HD, Hyatt C, Noon GP. Delayed recovery of severely "stunned" myocardium with the support of a left ventricular assist device after coronary artery bypass graft surgery. J Am Coll Cardiol 1987;10:710–712.
Hauser AM, Gangadharan V, Ramos RG, Gordon S, Timmis GC. Sequence of mechanical, electrocardiographic and clinical effects of repeated coronary artery occlusion in human beings: Echocardiographic observations during coronary angioplasty. J Am Coll Cardiol 1985;5:193–197.
Labovitz AJ, Lewen MK, Kern M, Vandormael M, Deligonal U, Kennedy HL. Evaluation of left ventricular systolic and diastolic dysfunction during transient myocardial ischemia produced by angioplasty. J Am Coll Cardiol 1987;10:748–755.
Serruys PW, Wijns W, van den BM, Meij S, Slager C, Schuurbiers JC et al. Left ventricular performance, regional blood flow, wall motion, and lactate metabolism during transluminal angioplasty. Circulation 1984;70:25–36.
Visser CA, David GK, Kan G, Romijn KH, Meltzer RS, Koolen JJ et al. Two-dimensional echocardiography during percutaneous transluminal coronary angioplasty. Am Heart J 1986;111:1035–1041.
Wijns W, Serruys PW, Slager CJ, Grimm J, Krayenbuehl HP, Hugenholtz PG et al. Effect of coronary occlusion during percutaneous transluminal angioplasty in humans on left ventricular chamber stiffness and regional diastolic pressure-radius relations. J Am Coll Cardiol 1986;7:455–463.
Wohlgelernter D, Cleman M, Highman HA, Fetterman RC, Duncan JS, Zaret BL et al. Regional myocardial dysfunction during coronary angioplasty: Evaluation by twodimensional echocardiography and 12 lead electrocardiography. J Am Coll Cardiol 1986;7:1245–1254.
Sheiban I, Tonni S, Benussi P, Marini A, Trevi GP. Left ventricular dysfunction following transient ischaemia induced by transluminal coronary angioplasty. Beneficial effects of calcium antagonists against post-ischaemic myocardial stunning. Eur Heart J 1993;14(suppl A):14–21.
de Zwaan C, Cheriex EC, Braat SH, Stappers JL, Wellens HJ. Improvement of systolic and diastolic left ventricular wall motion by serial echocardiograms in selected patients treated for unstable angina. Am Heart J 1991;121:789–797.
Gerber BL, Wijns W, Vanoverschelde JL, Heyndrickx G, De-Bruyne B, Bartunek J et al. Myocardial perfusion and oxygen consumption in reperfused noninfarcted dysfunctional myocardium after unstable angina. J Am Coll Cardiol 1999;34:1939–1946.
Jeroudi MO, Cheirif J, Habib G, Bolli R. Prolongedwall motion abnormalities after chest pain at rest in patients with unstable angina: A possible manifestation of myocardial stunning. Am Heart J 1994;127:1241–1250.
Nixon JV, Brown CN, Smitherman TC. Identification of transient and persistent segmental wall motion abnormalities in patients with unstable angina by twodimensional echocardiography. Circulation 1982;65:1497–1503.
Renkin J, Wijns W, Ladha Z, Col J. Reversal of segmental hypokinesis by coronary angioplasty in patients with unstable angina, persistent T wave inversion, and left anterior descending coronary artery stenosis. Additional evidence for myocardial stunning in humans. Circulation 1990;82:913–921.
Bourdillon PD, Broderick TM, Williams ES, Davis C, Dillon JC, Armstrong WF et al. Early recovery of regional left ventricular function after reperfusion in acute myocardial infarction assessed by serial two-dimensional echocardiography. Am J Cardiol 1989;63:641–646.
Schmidt WG, Sheehan FH, von Essen R, Uebis R, Effert S. Evolution of left ventricular function after intracoronary thrombolysis for acute myocardial infarction.AmJ Cardiol 1989;63:497–502.
Ito H, Tomooka T, Sakai N, Higashino Y, Fujii K, Katoh Oet al. Time course of functional improvement in stunned myocardium in risk area in patients with reperfused anterior infarction. Circulation 1993;87:355–362.
Agostini D, Iida H, Takahashi A. Positron emission tomography with oxygen-15 of stunned myocardium caused by coronary artery vasospasm after recovery. Br Heart J 1995;73:69–72.
Homans DC, Sublett E, Dai XZ, Bache RJ. Persistence of regional left ventricular dysfunction after exercise-induced myocardial ischemia. J Clin Invest 1986;77:66–73.
Robertson WS, Feigenbaum H, Armstrong WF, Dillon JC, O'Donnell J, McHenry PW. Exercise echocardiography: A clinically practical addition in the evaluation of coronary artery disease. J Am Coll Cardiol 1983;2:1085–1091.
Scognamiglio R, Ponchia A, Fasoli G, Miraglia G, Dalla Volta S. Exercise-induced left ventricular dysfunction in coronary heart disease. A model for studying the stunned myocardium in man. Eur Heart J 1991;12(suppl G):16–19.
Kloner RA, Allen J, Cox TA, Zheng Y, Ruiz CE. Stunned left ventricular myocardium after exercise treadmill testing in coronary artery disease. Am J Cardiol 1991;68:329–334.
Homans DC, Laxson DD, Sublett E, Pavek T, Crampton M. Effect of exercise intensity and duration on regional function during and after exercise-induced ischemia. Circulation 1991;83:2029–2037.
Stoddard MF, Pearson AC, Kern MJ, Ratcliff J, Mrosek DG, Labovitz AJ. Left ventricular diastolic function: Comparison of pulsed Doppler echocardiographic and hemodynamic indexes in subjects with and without coronary artery disease. J Am Coll Cardiol 1989;13:327–336.
Masani ND, Jones E, Hall RJC. Exercise induced myocardial stunning: Differential rates of systolic and diastolic recovery. Br Heart J 1994;71:78.
Fragasso G, Benti R, Sciammarella M, Rossetti E, Savi A, Gerundini P et al. Symptom-limited exercise testing causes sustained diastolic dysfunction in patients with coronary disease and low effort tolerance. J Am Coll Cardiol 1991;17:1251–1255.
Barnes E, Baker CS, Dutka DP, Rimoldi O, Rinaldi CA, Nihoyannopoulos P et al. Prolonged left ventricular dysfunction occurs in patients with coronary artery disease after both dobutamine and exercise induced myocardial ischaemia. Heart 2000;83:283–289.
Ambrosio G, Betocchi S, Pace L, Losi MA, Perrone FP, Soricelli A et al. Prolonged impairment of regional contractile function after resolution of exercise-induced angina. Evidence of myocardial stunning in patients with coronary artery disease. Circulation 1996;94:2455–2464.
Masani ND, Avery PG, Jones E, Hall RJC. Perfusioncontraction mismatch after exercise-induced ischaemia: Evidence of myocardial stunning in patients with angina. Circulation 1995;92:550–551.
Barnes E, Hall RJ, Dutka DP, Camici PG. Absolute blood flow and oxygen consumption in stunned myocardium in patients with coronary artery disease. J Am Coll Cardiol 2002;39:420–427.
Preuss KC, Gross GJ, Brooks HL, Warltier DC. Time course of recovery of "stunned" myocardium following variable periods of ischemia in conscious and anesthetized dogs. Am Heart J 1987;114:696–703.
Camici P, Araujo LI, Spinks T, Lammertsma AA, Kaski JC, Shea MJ et al. Increased uptake of 18F-fluorodeoxyglucose in postischemic myocardium of patients with exerciseinduced angina. Circulation 1986;74:81–88.
Dean EN, Shlafer M, Nicklas JM. The oxygen consumption paradox of "stunned myocardium" in dogs. Basic Res Cardiol 1990;85:120–131.
Laster SB, Becker LC, Ambrosio G, Jacobus WE. Reduced aerobic metabolic efficiency in globally "stunned" myocardium. J Mol Cell Cardiol 1989;21:419–426.
Schipke JD, Korbmacher B, Schwanke U, Frehen D, Schmidt T, Arnold G. Basal metabolism does not account for high O2 consumption in stunned myocardium. Am J Physiol 1998;274:H743–H746.
Laxson DD, Homans DC, Dai XZ, Sublett E, Bache RJ. Oxygen consumption and coronary reactivity in postischemic myocardium. Circ Res 1989;64:9–20.
Bergmann SR, Weinheimer CJ, Brown MA, Perez JE. Enhancement of regional myocardial efficiency and persistence of perfusion, oxidative, and functional reserve with paired pacing of stunned myocardium. Circulation 1994;89:2290–2296.
Rinaldi CA, Linka AZ, Masani ND, Avery PG, Jones E, Saunders H et al. Randomized, double-blind crossover study to investigate the effects of amlodipine and isosorbide mononitrate on the time course and severity of exercise-induced myocardial stunning. Circulation 1998;98:749–756.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Barnes, E., Khan, M.A. Myocardial Stunning in Man. Heart Fail Rev 8, 155–160 (2003). https://doi.org/10.1023/A:1023092702389
Issue Date:
DOI: https://doi.org/10.1023/A:1023092702389