Skip to main content
SpringerLink
Log in

Myocardial Stunning

  • Chapter
  • First Online:
Myocardial Preservation

  • 416 Accesses

Abstract

Myocardial stunning (STUN) is defined as the delayed recovery of systolic and diastolic cardiac function after reperfusion, despite restoration of normal flow. Its delayed reversibility implies that no irreversible cardiac damage has been caused. It is seen in many instances relevant to coronary artery disease, such as coronary angioplasty, angina pectoris, acute myocardial infarction, and exercise. It can be seen after cardiac surgery and tachycardia. More recently described situations are hemodialysis, sepsis, and the Takotsubo syndrome, i.e., cardiac dysfunction after severe mental stress. The cause of STUN is increased ROS production and calcium overload. Therapeutic aspects include the reversal of coronary artery stenosis and prevention or reversal of adrenergic activation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Braunwald E, Kloner RA. The stunned myocardium: prolonged, postischemic ventricular dysfunction. Circulation. 1982;66:1146–9.

    Article  CAS  PubMed  Google Scholar 

  2. Heyndrickx GR, Millard RW, McRitchie RJ, Maroko PR, Vatner SF. Regional myocardial functional and electrophysiological alterations after brief coronary artery occlusion in conscious dogs. J Clin Invest. 1975;56:978–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Weiner JM, Astein CS, Arthur JH, Pirzada FA, Hood WB Jr. Persistence of myocardial injury following brief periods of coronary occlusion. Cardiovasc Res. 1976;10:678–86.

    Article  CAS  PubMed  Google Scholar 

  4. Kloner RA, Ellis SG, Lange R, Braunwald E. Studies of experimental coronary artery reperfusion. Effects on infarct size, myocardial function, biochemistry, ultrastructure and microvascular damage. Circulation. 1983;68:I8–15.

    CAS  PubMed  Google Scholar 

  5. Bolli R, Zhu WX, Thornby JI, O'Neill PG, Roberts R. Time course and determinants of recovery of function after reversible ischemia in conscious dogs. Am J Phys. 1988;254:H102–14.

    CAS  Google Scholar 

  6. Bolli R, Marbán E. Molecular and cellular mechanisms of myocardial stunning. Physiol Rev. 1999;79:609–34.

    Article  CAS  PubMed  Google Scholar 

  7. Bolli R. Myocardial ‘stunning’ in man. Circulation. 1992;86:1671–91.

    Article  CAS  PubMed  Google Scholar 

  8. Kloner RA, Bolli R, Marban E, Reinlib L, Braunwald E. Medical and cellular implications of stunning, hibernation, and preconditioning: an NHLBI workshop. Circulation. 1998;97:1848–67.

    Article  CAS  PubMed  Google Scholar 

  9. Cohen MV, Downey JM. Myocardial stunning in dogs: preconditioning effect and influence of coronary collateral flow. Am Heart J. 1990;120:282–91.

    Article  CAS  PubMed  Google Scholar 

  10. Lavallee M, Cox D, Patrick TA, Vatner SF. Salvage of myocardial function by coronary artery reperfusion 1, 2, and 3 hours after occlusion in conscious dogs. Circ Res. 1983;53:235–47.

    Article  CAS  PubMed  Google Scholar 

  11. Bush LR, Buja LM, Samowitz W, Rude RE, Wathen M, Tilton GD, et al. Recovery of left ventricular segmental function after long-term reperfusion following temporary coronary occlusion in conscious dogs. Comparison of 2- and 4-hour occlusions. Circ Res. 1983;53:248–63.

    Article  CAS  PubMed  Google Scholar 

  12. Verani MS, Bolli R, Tadros S, Myers ML, Borges Neto S, Jain A, et al. Dissociation between global and regional systolic and diastolic ventricular function during coronary occlusion and reperfusion. Heart J. 1987;114:687–95.

    CAS  Google Scholar 

  13. Serruys PW, Wijns W, van den Brand M, 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.

    Article  CAS  PubMed  Google Scholar 

  14. Sheiban I, Tonni S, Marini A, Trevi G. Clinical and therapeutic implications of chronic left ventricular dysfunction in coronary artery disease. Am J Cardiol. 1995;75:23E–30E.

    Article  CAS  PubMed  Google Scholar 

  15. 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;7:455–63.

    Article  CAS  PubMed  Google Scholar 

  16. Nixon JV, Brown CN, Smitherman TC. Identification of transient and persistent segmental wall motion abnormalities in patients with unstable angina by two-dimensional echocardiography. Circulation. 1982;65:1497–503.

    Article  CAS  PubMed  Google Scholar 

  17. de Feyter PJ, Suryapranata H, Serruys PW, Beatt K, van den Brand M, Hugenholtz PG. Effects of successful percutaneous transluminal coronary angioplasty on global and regional left ventricular function in unstable angina pectoris. Am J Cardiol. 1987;60:993–7.

    Article  PubMed  Google Scholar 

  18. 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;82:913–21.

    Article  CAS  PubMed  Google Scholar 

  19. Bolli R, Hartley CJ, Rabinovitz RS. Clinical Relevance of Myocardial Stunning. In: Opie LH, editor. Stunning, hibernating and calcium in myocardial ischemia and reperfusion: Kluver Academic publishers; 1992. p. 56–82.

    Google Scholar 

  20. Tamaki N, Yasuda T, Moore RH, Gill JB, Boucher CA, Hutter AM Jr, et al. Continuous monitoring of left ventricular function by an ambulatory radionuclide detector in patients with coronary artery disease. J Am Coll Cardiol. 1988;12:669–79.

    Article  CAS  PubMed  Google Scholar 

  21. Mathias P, Kerin NZ, Blevins RD, Cascade P, Rubenfire M. Coronary vasospasm as a cause of stunned myocardium. Am Heart J. 1987;113:383–5.

    Article  CAS  PubMed  Google Scholar 

  22. Sakata K, Miura F, Sugino H, Saegusa T, Shirotani M, Yoshida H, et al. Assessment of regional sympathetic nerve activity in vasospastic angina: analysis of iodine 123-labeled metaiodobenzylguanidine scintigraphy. Am Heart J. 1997;133:484–9.

    Article  CAS  PubMed  Google Scholar 

  23. Stack RS, Phillips HR 3rd, Grierson DS, Behar VS, Kong Y, Peter RH, et al. Functional improvement of jeopardized myocardium following intracoronary streptokinase infusion in acute myocardial infarction. J Clin Invest. 1983;72:84–95.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Schmidt WG, Sheehan FH, von Essen R, Uebis R, Effert S. Evolution of left ventricular function after intracoronary thrombolysis for acute myocardial infarction. Am J Cardiol. 1989;63:497–502.

    Article  CAS  PubMed  Google Scholar 

  25. 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;63:641–6.

    Article  CAS  PubMed  Google Scholar 

  26. Kokkinos AD. Investigation of cardioprotection induced by ischemic preconditioning in ischemic heart which have been subjected to an initial ischemic episode PhD. Thesis Athens; 2002, p. 19–22.

    Google Scholar 

  27. Sheehan FH, Mathey DG, Schofer J, Dodge HT, Bolson EL. Factors that determine recovery of left ventricular function after thrombolysis in patients with acute myocardial infarction. Circulation. 1985;71:1121–8.

    Article  CAS  PubMed  Google Scholar 

  28. Williamson BD, Lim MJ, Buda AJ. Transient left ventricular filling abnormalities (diastolic stunning) after acute myocardial infarction. Am J Cardiol. 1990;66:897–903.

    Article  CAS  PubMed  Google Scholar 

  29. Reimer KA, Jennings RB. The “wavefront phenomenon” of myocardial ischemic cell death. II. Transmural progression of necrosis within the framework of ischemic bed size (myocardium at risk) and collateral flow. Lab Investig. 1979;40:633–44.

    CAS  PubMed  Google Scholar 

  30. Ellis SG, Henschke CI, Sandor T, Wynne J, Braunwald E, Kloner RA. Time course of functional and biochemical recovery of myocardium salvaged by reperfusion. J Am Coll Cardiol. 1983;1:1047–55.

    Article  CAS  PubMed  Google Scholar 

  31. Theroux P, Ross J Jr, Franklin D, Kemper WS, Sasayama S. Coronary arterial reperfusion. III. Early and late effects on regional myocardial function and dimensions in conscious dogs. Am J Cardiol. 1976;38:599–606.

    Article  CAS  PubMed  Google Scholar 

  32. Hittinger L, Shannon RP, Kohin S, Manders WT, Kelly P, Vatner SF. Exercise-induced subendocardial dysfunction in dogs with left ventricular hypertrophy. Circ Res. 1990;66:329–43.

    Article  CAS  PubMed  Google Scholar 

  33. Emmett L, Magee M, Freedman SB, Van der Wall H, Bush V, Trieu J, et al. The role of left ventricular hypertrophy and diabetes in the presence of transient ischemic dilation of the left ventricle on myocardial perfusion SPECT images. J Nucl Med. 2005;46:1596–601.

    PubMed  Google Scholar 

  34. Tanabe Y, Takahashi M, Hosaka Y, Ito M, Ito E, Suzuki K. Prolonged recovery of cardiac output after maximal exercise in patients with chronic heart failure. J Am Coll Cardiol. 2000;35:1228–36.

    Article  CAS  PubMed  Google Scholar 

  35. 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;2:1085–91.

    Article  CAS  PubMed  Google Scholar 

  36. 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;68:329–34.

    Article  CAS  PubMed  Google Scholar 

  37. 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;98:749–56.

    Article  CAS  PubMed  Google Scholar 

  38. 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;17:1251–15.

    Article  CAS  PubMed  Google Scholar 

  39. Schneider RM, Weintraub WS, Klein LW, Seelaus PA, Agarwal JB, Helfant RH. Rate of left ventricular functional recovery by radionuclide angiography after exercise in coronary artery disease. Am J Cardiol. 1986;57:927–32.

    Article  CAS  PubMed  Google Scholar 

  40. Vatterott PJ, Hanley PC, Mankin HT, Gibbons RJ. The divergent recovery of ST-segment depression and radionuclide angiographic indicators of myocardial ischemia. Am J Cardiol. 1990;66:296–301.

    Article  CAS  PubMed  Google Scholar 

  41. Tsoukas A, Ikonomidis I, Cokkinos P, Nihoyannopoulos P. Significance of persistent left ventricular dysfunction during recovery after dobutamine stress echocardiography. J Am Coll Cardiol. 1997;30:621–6.

    Article  CAS  PubMed  Google Scholar 

  42. 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 exercise-induced angina. Circulation. 1986;74:81–8.

    Article  CAS  PubMed  Google Scholar 

  43. Kloner RA, Jennings RB. Consequences of brief ischemia: stunning, preconditioning, and their clinical implications: part 2. Circulation. 2001;104:3158–67.

    Article  CAS  PubMed  Google Scholar 

  44. Harjai K, Mobarek S, Abi-Samra F, Gilliland Y, Davison N, Drake K, et al. Mechanical dysfunction of the left atrium and the left atrial appendage following cardioversion of atrial fibrillation and its relation to total electrical energy used for cardioversion. Am J Cardiol. 1998;81:1125–9.

    Article  CAS  PubMed  Google Scholar 

  45. Fatkin D, Kuchar DL, Thorburn CW, Feneley MP. Transesophageal echocardiography before and during direct current cardioversion of atrial fibrillation: evidence for “atrial stunning” as a mechanism of thromboembolic complications. J Am Coll Cardiol. 1994;23:307–16.

    Article  CAS  PubMed  Google Scholar 

  46. Jordaens L, Missault L, Germonpré E, Callens B, Adang L, Vandenbogaerde J, et al. Delayed restoration of atrial function after conversion of atrial flutter by pacing or electrical cardioversion. Am J Cardiol. 1993;71:63–7.

    Article  CAS  PubMed  Google Scholar 

  47. Dabek J, Gasior Z, Monastyrska-Cup B, Jakubowski D. Cardioversion and atrial stunning. Pol Merkur Lekarski. 2007;22:224–8.

    PubMed  Google Scholar 

  48. Antonielli E, Pizzuti A, Dogliani S, Stasi M, Bassignana A, Doronzo B. Absence of left atrial stunning after cardioversion of recent-onset atrial fibrillation in patients at low-stroke risk. Eur J Emerg Med. 2017;24:217–23.

    Article  PubMed  Google Scholar 

  49. Dagres N, Karatasakis G, Panou F, Athanassopoulos G, Maounis T, Tsougos E, et al. Pre-treatment with Irbesartan attenuates left atrial stunning after electrical cardioversion of atrial fibrillation. Eur Heart J. 2006;27:2062–8.

    Article  CAS  PubMed  Google Scholar 

  50. Fung KC, Tan HC, Kritharides L. Acute reductions in ventricular myocardial tissue velocities after direct current cardioversion of atrial fibrillation. J Am Soc Echocardiogr. 2003;16:656–63.

    Article  PubMed  Google Scholar 

  51. Selby NM, McIntyre CW. The acute cardiac effects of dialysis. Semin Dial. 2007;20:220–8.

    Article  PubMed  Google Scholar 

  52. Zuidema MY, Dellsperger KC. Myocardial stunning with hemodialysis: clinical challenges of the cardiorenal patient. Cardiorenal Med. 2012;2:125–33.

    Article  PubMed  PubMed Central  Google Scholar 

  53. McIntyre CW, Burton JO, Selby NM, Leccisotti L, Korsheed S, Baker CS, et al. Hemodialysis-induced cardiac dysfunction is associated with an acute reduction in global and segmental myocardial blood flow. Clin J Am Soc Nephrol. 2008;3:19–26.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Suzuki T, Suzuki Y, Okuda J, Kurazumi T, Suhara T, Ueda T, et al. Sepsis-induced cardiac dysfunction and β-adrenergic blockade therapy for sepsis. J Intensive Care. 2017;5:22.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Suffredini AF, Fromm RE, Parker MM, Brenner M, Kovacs JA, Wesley RA, et al. The cardiovascular response of normal humans to the administration of endotoxin. N Engl J Med. 1989;321:280–7.

    Article  CAS  PubMed  Google Scholar 

  56. Guaricci AI, Bulzis G, Pontone G, Scicchitano P, Carbonara R, Rabbat M, et al. Current interpretation of myocardial stunning. Trends Cardiovasc Med. 2018;28:263–71.

    Article  PubMed  Google Scholar 

  57. Lyon AR, Bossone E, Schneider B, Sechtem U, Citro R, Underwood SR, et al. Current state of knowledge on Takotsubo syndrome: a Position Statement from the Taskforce on Takotsubo Syndrome of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2016;18:8–27.

    Article  PubMed  Google Scholar 

  58. Williams R, Arri S, Prasad A. Current Concepts in the Pathogenesis of Takotsubo Syndrome. Heart Fail Clin. 2016;12:473–84.

    Article  PubMed  Google Scholar 

  59. Boland TA, Lee VH, Bleck TP. Stress-induced cardiomyopathy. Crit Care Med. 2015;43:686–93.

    Article  CAS  PubMed  Google Scholar 

  60. Paur H, Wright PT, Sikkel MB, Tranter MH, Mansfield C, O'Gara P, et al. High levels of circulating epinephrine trigger apical cardiodepression in a β2-adrenergic receptor/Gi-dependent manner: a new model of Takotsubo cardiomyopathy. Circulation. 2012;126:697–706.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Lyon AR, Rees PS, Prasad S, Poole-Wilson PA, Harding SE. Stress (Takotsubo) cardiomyopathy – a novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning. Nat Clin Pract Cardiovasc Med. 2008;5:22–9.

    Article  CAS  PubMed  Google Scholar 

  62. Murthy SB, Shah S, Venkatasubba Rao CP, Suarez JI, Bershad EM. Clinical characteristics of myocardial stunning in acute stroke. J Clin Neurosci. 2014;21:1279–82.

    Article  PubMed  Google Scholar 

  63. Sugimoto K, Inamasu J, Hirose Y, Kato Y, Ito K, Iwase M, et al. The role of norepinephrine and estradiol in the pathogenesis of cardiac wall motion abnormality associated with subarachnoid hemorrhage. Stroke. 2012;43:1897–903.

    Article  CAS  PubMed  Google Scholar 

  64. Dawson DK. Acute stress-induced (takotsubo) cardiomyopathy. Heart. 2018;104:96–102.

    Article  PubMed  Google Scholar 

  65. Wittstein IS, Thiemann DR, Lima JA, Baughman KL, Schulman SP, Gerstenblith G, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med. 2005;352:539–48.

    Article  CAS  PubMed  Google Scholar 

  66. Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, Jaguszewski M, et al. Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy. N Engl J Med. 2015;373:929–38.

    Article  CAS  PubMed  Google Scholar 

  67. Tornvall P, Collste O, Ehrenborg E, Järnbert-Petterson H. A case-control study of risk markers and mortality in takotsubo stress cardiomyopathy. J Am Coll Cardiol. 2016;67:1931–6.

    Article  PubMed  Google Scholar 

  68. Varghese RT, John AM, Paul TV. Catecholamine induced cardiomyopathy in pheochromocytoma. Indian J Endocrinol Metab. 2013;17:733–5.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Tofield A. Connecting the pieces of Takotsubo ‘broken heart’. Eur Heart J. 2018;39:2021–2.

    Article  PubMed  Google Scholar 

  70. Pereira N, Parisi A, Dec GW, Choo J, Hajjar R, Gordon PC. Myocardial stunning in hyperthyroidism. Clin Cardiol. 2000;23:298–300.

    Article  CAS  PubMed  Google Scholar 

  71. Schwartz BG, Rezkalla S, Kloner RA. Cardiovascular effects of cocaine. Circulation. 2010;122:2558–69.

    Article  PubMed  Google Scholar 

  72. Cruz FE, Cheriex EC, Smeets JL, Atié J, Peres AK, Penn OC, et al. Reversibility of tachycardia-induced cardiomyopathy after cure of incessant supraventricular tachycardia. J Am Coll Cardiol. 1990;16:739–44.

    Article  CAS  PubMed  Google Scholar 

  73. Tanaka R, Spinale FG, Crawford FA, Zile MR. Effect of chronic supraventricular tachycardia on left ventricular function and structure in newborn pigs. J Am Coll Cardiol. 1992;20:1650–60.

    Article  CAS  PubMed  Google Scholar 

  74. Spinale FG, Holzgrefe HH, Mukherjee R, Arthur SR, Child MJ, Powell JR, et al. LV and myocyte structure and function after early recovery from tachycardia-induced cardiomyopathy. Am J Phys. 1995;268:H836–47.

    CAS  Google Scholar 

  75. Kim SJ, Depre C, Vatner SF. Novel mechanisms mediating stunned myocardium. Heart Fail Rev. 2003;8:143–53.

    Article  CAS  PubMed  Google Scholar 

  76. Pantos C, Mourouzis I, Cokkinos DV. Myocardial ischemia. Basic concepts. In: Myocardial Ischemia. p. 11–76.

    Google Scholar 

  77. Kloner RA, Jennings RB. Consequences of brief ischemia: stunning, preconditioning, and their clinical implications: part 1. Circulation. 2001;104:2981–9.

    Article  CAS  PubMed  Google Scholar 

  78. Bolli R, Patel BS, Jeroudi MO, Lai EK, McCay PB. Demonstration of free radical generation in “stunned” myocardium of intact dogs with the use of the spin trap alpha-phenyl N-tert-butyl nitrone. J Clin Invest. 1988;82:476–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  79. Li XY, McCay PB, Zughaib M, Jeroudi MO, Triana JF, Bolli R. Demonstration of free radical generation in the “stunned” myocardium in the conscious dog and identification of major differences between conscious and open-chest dogs. J Clin Invest. 1993;92:1025–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  80. Sekili S, McCay PB, Li XY, Zughaib M, Sun JZ, Tang L, et al. Direct evidence that the hydroxyl radical plays a pathogenetic role in myocardial “stunning” in the conscious dog and demonstration that stunning can be markedly attenuated without subsequent adverse effects. Circ Res. 1993;73:705–23.

    Article  CAS  PubMed  Google Scholar 

  81. Charlat MI, O'Neill PG, Egan JM, Abernethy DR, Michael LH, Myers ML, et al. Evidence for a pathogenetic role of xanthine oxidase in the “stunned” myocardium. Am J Phys. 1987;252:H566–77.

    CAS  Google Scholar 

  82. Xia Y, Zweier JL. Substrate control of free radical generation from xanthine oxidase in the postischemic heart. J Biol Chem. 1995;270:18797–803.

    Article  CAS  PubMed  Google Scholar 

  83. Tang X-L, Rizvi AN, Qiu Y, et al. Evidence that the hydroxyl radical triggers late preconditioning against myocardial stunning in conscious rabbits. Circulation. 1997;96(Suppl I):I–255.

    Google Scholar 

  84. Sun JZ, Tang XL, Park SW, Qiu Y, Turrens JF, Bolli R. Evidence for an essential role of reactive oxygen species in the genesis of late preconditioning against myocardial stunning in conscious pigs. J Clin Invest. 1996;97:562–76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  85. Shlafer M, Kane PF, Kirsh MM. Superoxide dismutase plus catalase enhances the efficacy of hypothermic cardioplegia to protect the globally ischemic, reperfused heart. J Thorac Cardiovasc Surg. 1982;83:830–9.

    CAS  PubMed  Google Scholar 

  86. Ishida H, Genka C, Hirota Y, Hamasaki Y, Nakazawa H. Distinct roles of peroxynitrite and hydroxyl radical in triggering stunned myocardium-like impairment of cardiac myocytes in vitro. Mol Cell Biochem. 1999;198:31–8.

    Article  CAS  PubMed  Google Scholar 

  87. Renlund DG, Gerstenblith G, Lakatta EG, Jacobus WE, Kallman CH, Weisfeldt ML. Perfusate sodium during ischemia modifies post-ischemic functional and metabolic recovery in the rabbit heart. J Mol Cell Cardiol. 1984;16:795–801.

    Article  CAS  PubMed  Google Scholar 

  88. Corretti MC, Koretsune Y, Kusuoka H, Chacko VP, Zweier JL, Marban E. Glycolytic inhibition and calcium overload as consequences of exogenously generated free radicals in rabbit hearts. J Clin Invest. 1991;88:1014–25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  89. Van Eyk JE, Murphy AM. The role of troponin abnormalities as a cause for stunned myocardium. Coron Artery Dis. 2001;12:343–7.

    Article  PubMed  Google Scholar 

  90. Gao WD, Liu Y, Mellgren R, Marban E. Intrinsic myofilament alterations underlying the decreased contractility of stunned myocardium. A consequence of Ca2+−dependent proteolysis? Circ Res. 1996;78:455–65.

    Article  CAS  PubMed  Google Scholar 

  91. Anselmi A, Abbate A, Girola F, Nasso G, Biondi-Zoccai GG, Possati G, et al. Myocardial ischemia, stunning, inflammation, and apoptosis during cardiac surgery: a review of evidence. Eur J Cardiothorac Surg. 2004;25:304–11.

    Article  PubMed  Google Scholar 

  92. Pipikos T, Kapelouzou A, Tsilimigras DI, Fostinis Y, Pipikou M, Theodorakos A, et al. Stronger correlation with myocardial ischemia of highsensitivity troponin T than other biomarkers. J Nucl Cardiol. 2018. https://doi.org/10.1007/s12350-018-1199-6.

  93. Januzzi JL Jr, Filippatos G, Nieminen M, Gheorghiade M. Troponin elevation in patients with heart failure: on behalf of the third Universal Definition of Myocardial Infarction Global Task Force: Heart Failure Section. Eur Heart J. 2012;33:2265–71.

    Article  CAS  PubMed  Google Scholar 

  94. Eisen A, Bonaca MP, Jarolim P, Scirica BM, White HD, Tendera M, et al. High-sensitivity troponin I in stable patients with atherosclerotic disease in the TRA 2°P – TIMI 50 trial. Clin Chem. 2017;63:307–15.

    Article  CAS  PubMed  Google Scholar 

  95. Ahmed W, Schlett CL, Uthamalingam S, Truong QA, Koenig W, Rogers IS, et al. Single resting hsTnT level predicts abnormal myocardial stress test in acute chest pain patients with normal initial standard troponin. JACC Cardiovasc Imaging. 2013;6:72–82.

    Article  PubMed  PubMed Central  Google Scholar 

  96. Seydelmann N, Liu D, Krämer J, Drechsler C, Hu K, Nordbeck P, et al. High-sensitivity troponin: a clinical blood biomarker for staging cardiomyopathy in fabry disease. J Am Heart Assoc. 2016;5(6). pii: e002839.

    Google Scholar 

  97. Depre C, Vatner SF. Cardioprotection in stunned and hibernating myocardium. Heart Fail Rev. 2007;12:307–17.

    Article  CAS  PubMed  Google Scholar 

  98. García González MJ, Domínguez RA. Pharmacologic treatment of heart failure due to ventricular dysfunction by myocardial stunning: potential role of levosimendan. Am J Cardiovasc Drugs. 2006;6:69–75.

    Article  PubMed  Google Scholar 

  99. García-González MJ, Domínguez-Rodríguez A, Ferrer-Hita JJ. Utility of levosimendan, a new calcium sensitizing agent, in the treatment of cardiogenic shock due to myocardial stunning in patients with ST-elevation myocardial infarction: a series of cases. J Clin Pharmacol. 2005;45:704–8.

    Article  PubMed  CAS  Google Scholar 

  100. Sun JZ, Tang XL, Knowlton AA, Park SW, Qiu Y, Bolli R. Late preconditioning against myocardial stunning. An endogenous protective mechanism that confers resistance to postischemic dysfunction 24 h after brief ischemia in conscious pigs. J Clin Invest. 1995;95:388–403.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  101. Gross GJ, Kersten JR, Warltier DC. Mechanisms of postischemic contractile dysfunction. Ann Thorac Surg. 1999;68:1898–904.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Heart and Vessel Department, Biomedical Research Foundation, Academy of Athens - Gregory Skalkeas, Athens, Greece

    Dennis V. Cokkinos

Authors
  1. Dennis V. Cokkinos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dennis V. Cokkinos .

Editor information

Editors and Affiliations

  1. Heart and Vessel Department, Biomedical Research Foundation of the Academy of Athens - Gregory Skalkeas, Athens, Greece

    Dennis V. Cokkinos

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Cokkinos, D.V. (2019). Myocardial Stunning. In: Cokkinos, D. (eds) Myocardial Preservation. Springer, Cham. https://doi.org/10.1007/978-3-319-98186-4_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-98186-4_9

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-98185-7

  • Online ISBN: 978-3-319-98186-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation