Top

Published in:

01-11-2013 | Editorial

Myocardial infarction and coronary microvascular obstruction: an intimate, but complicated relationship

Authors: Gerd Heusch, Petra Kleinbongard, Andreas Skyschally

Published in: Basic Research in Cardiology | Issue 6/2013

Excerpt

Timely reperfusion is the only way to rescue ischemic myocardium from impending infarction. However, reperfusion also adds a component of injury to that incurred during ischemia and thus contributes to final infarct size [6, 20, 28]. It appears that all conditioning strategies which delay infarct size development and/or reduce infarct size act through attenuation of such reperfusion injury [7]. Apart from its contribution to cardiomyocyte necrosis, reperfusion is frequently also characterized by the development of areas of no-reflow within the previously ischemic myocardium [10]. Evidence for microvascular no-reflow by angiography or MRI despite successfully reopened epicardial coronary arteries in patients with myocardial infarction is associated with impaired recovery of ventricular function and worse survival [19]. …

Ambrosio G, Weisman HF, Mannisi JA, Becker LC (1989) Progressive impairment of regional myocardial perfusion after initial restoration of postischemic blood flow. Circulation 80:1846–1861. doi:10.1161/01.CIR.80.6.1837 PubMedCrossRef

Barrabes JA, Inserte J, Agullo L, Alonso A, Mirabet M, Garcia-Dorado D (2010) Microvascular thrombosis: an exciting but elusive therapeutic target in reperfused acute myocardial infarction. Cardiovasc Hematol Disord Drug Targets 10:273–283. doi:10.2174/187152910793743797 PubMedCrossRef

Garcia-Dorado D, Piper HM (2006) Postconditioning: reperfusion of “reperfusion injury” after hibernation. Cardiovasc Res 69:1–3. doi:10.1016/j.cardiores.2005.11 PubMedCrossRef

Gregorini L, Marco J, Kozàkovà M, Palombo C, Anguissola GB, Marco I, Bernies M, Cassagneau B, Distante A, Bossi IM, Fajadet J, Heusch G (1999) α-Adrenergic blockade improves recovery of myocardial perfusion and function after coronary stenting in patients with acute myocardial infarction. Circulation 99:482–490. doi:10.1161/01.CIR.99.4.482 PubMedCrossRef

Hale SL, Dae MW, Kloner RA (2003) Hypothermia during reperfusion limits ‘no-reflow’ injury in a rabbit model of acute myocardial infarction. Cardiovasc Res 59:715–722. doi:10.1016/S0008-6363(03)00456-5 PubMedCrossRef

Heusch G (2004) Postconditioning: old wine in a new bottle? J Am Coll Cardiol 44:1111–1112. doi:org/10.1016/j.jacc2004.06.013 PubMedCrossRef

Heusch G (2013) Cardioprotection: chances and challenges of its translation to the clinic. Lancet 381:166–175. doi:10.1016/S0140-6736(12)60916-7 PubMedCrossRef

Heusch G, Baumgart D, Camici P, Chilian W, Gregorini L, Hess O, Indolfi C, Rimoldi O (2000) α-Adrenergic coronary vasoconstriction and myocardial ischemia in humans. Circulation 101:689–694. doi:10.1161/01.CIR.101.6.689 PubMedCrossRef

Heusch G, Kleinbongard P, Böse D, Levkau B, Haude M, Schulz R, Erbel R (2009) Coronary microembolization: from bedside to bench and back to bedside. Circulation 120:1822–1836. doi:10.1161/CIRCULATIONAHA.109.888784 PubMedCrossRef

10.

Heusch G, Kleinbongard P, Skyschally A, Levkau B, Schulz R, Erbel R (2012) The coronary circulation in cardioprotection: more than just one confounder. Cardiovasc Res 94:237–245. doi:10.1093/cvr/cvr271 PubMedCrossRef

11.

Judd RM, Lugo-Olivieri CH, Arai M, Kondo T, Croisille P, Lima JA, Mohan V, Becker LC, Zerhouni EA (1995) Physiological basis of myocardial contrast enhancement in fast magnetic resonance images of 2-day-old reperfused canine infarcts. Circulation 92:1902–1910. doi:10.1161/01.CIR.92.7.1902 PubMedCrossRef

12.

Kleinbongard P, Böse D, Baars T, Möhlenkamp S, Konorza T, Schöner S, Elter-Schulz M, Eggebrecht H, Degen H, Haude M, Levkau B, Schulz R, Erbel R, Heusch G (2011) Vasoconstrictor potential of coronary aspirate from patients undergoing stenting of saphenous vein aortocoronary bypass grafts and its pharmacological attenuation. Circ Res 108:344–352. doi:10.1161/CIRCRESAHA.110.235713 PubMedCrossRef

13.

Kloner RA, Ganote CE, Jennings RB (1974) The “no-reflow” phenomenon after temporary coronary occlusion in the dog. J Clin Invest 54:1496–1508. doi:10.1172/JCI107898 PubMedCrossRef

14.

Kloner RA, Rude RE, Carlson N, Maroko PR, DeBoer LWV, Braunwald E (1980) Ultrastructural evidence of microvascular damage and myocardial cell injury after coronary artery occlusion: which comes first? Circulation 62:945–952. doi:10.1161/01.CIR.62.5.945 PubMedCrossRef

15.

Manciet LH, Poole DC, McDonagh PF, Copeland JG, Mathieu-Costello O (1994) Microvascular compression during myocardial ischemia: mechanistic basis for no-reflow phenomenon. Am J Physiol 266:H1541–H1550PubMed

16.

Mewton N, Rapacchi S, Augeul L, Ferrera R, Loufouat J, Boussel L, Micolich A, Rioufol G, Revel D, Ovize M, Croisille P (2011) Determination of the myocardial area at risk with pre- versus post-reperfusion imaging techniques in the pig model. Basic Res Cardiol 106:1247–1257. doi:10.1007/s00395-011-0214-8 PubMedCrossRef

17.

Mewton N, Thibault H, Roubille F, Lairez O, Rioufol G, Sportouch C, Sanchez I, Bergerot C, Cung TT, Finet G, Angoulvant D, Revel D, Bonnefoy-Cudraz E, Elbaz M, Piot C, Sahraoui I, Croisille P, Ovize M. Ischemic postconditioning attenuates no-reflow in STEMI patients. Basic Res Cardiol 108:383. doi:10.1007/s00395-013-0383-8

18.

Nassenstein K, Breuckmann F, Bucher C, Kaiser G, Konorza T, Schäfer L, Konietzka I, de Greiff A, Heusch G, Erbel R, Barkhausen J (2008) How much myocardial damage is necessary to enable detection of focal late gadolinium enhancement at cardiac MR imaging? Radiology 249:829–835. doi:10.1148/radiol.2493080457 PubMedCrossRef

19.

Niccoli G, Burzotta F, Galiuto L, Crea F (2009) Myocardial no-reflow in humans. J Am Coll Cardiol 54:281–292. doi:10.1016/j.jacc.2009.03.054 PubMedCrossRef

20.

Ovize M, Baxter GF, Di Lisa F, Ferdinandy P, Garcia-Dorado D, Hausenloy DJ, Heusch G, Vinten-Johansen J, Yellon DM, Schulz R (2010) Postconditioning and protection from reperfusion injury: where do we stand? Cardiovasc Res 87:406–423. doi:10.1093/cvr/cvq129 PubMedCrossRef

21.

Reffelmann T, Hale SL, Li G, Kloner RA (2002) Relationship between no reflow and infarct size as influenced by the duration of ischemia and reperfusion. Am J Physiol Heart Circ Physiol 282:H766–H772. doi:10.1152/ajpheart.00767.2001 PubMed

22.

Reffelmann T, Kloner RA (2002) Microvascular reperfusion injury: rapid expansion of anatomic no reflow during reperfusion in the rabbit. Am J Physiol Heart Circ Physiol 283:H1099–H1107. doi:ajpheart.00270.2002 PubMed

23.

Rochitte CE, Lima JAC, Bluemke DA, Reeder SB, McVeigh ER, Furuta T, Becker LC, Melin JA (1998) Magnitude and time course of microvascular obstruction and tissue injury after acute myocardial infarction. Circulation 98:1006–1014. doi:10.1161/01.CIR.98.10.1006 PubMedCrossRef

24.

Skyschally A, Walter B, Heusch G (2012) Coronary microembolization during early reperfusion: infarct extension, but protection by ischemic postconditioning. Eur Heart J. doi:10.1093/eurheartj/ehs434 PubMed

25.

Staat P, Rioufol G, Piot C, Cottin Y, Cung TT, L’Huillier I, Aupetit J-F, Bonnefoy E, Finet G, Andre-Fouet X, Ovize M (2005) Postconditioning the human heart. Circulation 112:2143–2148. doi:10.1161/CIRCULATIONAHA.105.558122 PubMedCrossRef

26.

Thibault H, Piot C, Staat P, Bontemps L, Sportouch C, Rioufol G, Cung TT, Bonnefoy E, Angoulvant D, Aupetit JF, Finet G, Andre-Fouet X, Macia JC, Raczka F, Rossi R, Itti R, Kirkorian G, Derumeaux G, Ovize M (2008) Long-term benefit of postconditioning. Circulation 117:1037–1044. doi:10.1161/CIRCULATIONAHA.107.729780 PubMedCrossRef

27.

Wince WB, Kim RJ (2010) Molecular imaging: T2-weighted CMR of the area at risk-a risky business? Nat Rev Cardiol 7:547–549. doi:10.1038/nrcardio.2010.124 PubMedCrossRef

28.

Yellon DM, Hausenloy DJ (2007) Myocardial reperfusion injury. N Engl J Med 357:1121–1135. doi:10.1056/NEJMra071667 PubMedCrossRef

29.

Zhao Z-Q, Corvera JS, Halkos ME, Kerendi F, Wang N-P, Guyton RA, Vinten-Johansen J (2003) Inhibition of myocardial injury by ischemic postconditioning during reperfusion: comparison with ischemic preconditioning. Am J Physiol Heart Circ Physiol 285:H579–H588. doi:10.1152/ajpheart.01064.2002 PubMed

Title: Myocardial infarction and coronary microvascular obstruction: an intimate, but complicated relationship
Authors: Gerd Heusch
Petra Kleinbongard
Andreas Skyschally
Publication date: 01-11-2013
Publisher: Springer Berlin Heidelberg
Published in: Basic Research in Cardiology / Issue 6/2013
Print ISSN: 0300-8428
Electronic ISSN: 1435-1803
DOI: https://doi.org/10.1007/s00395-013-0380-y

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

At a glance: The STEP trials

Springer Medicine

Myocardial infarction and coronary microvascular obstruction: an intimate, but complicated relationship

Excerpt

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The STEP trials

Springer Medicine

Excerpt

Please log in to get access to this content

Other articles of this Issue 6/2013

Exercise-induced cardioprotection: a role for eNOS uncoupling and NO metabolites

Redox balance and cardioprotection

Secretion of adiponectin from mouse aorta and its role in cold storage-induced vascular dysfunction

Anti-inflammatory and pro-angiogenic effects of beta blockers in a canine model of chronic ischemic cardiomyopathy: comparison between carvedilol and metoprolol

Enhanced stem cell migration mediated by VCAM-1/VLA-4 interaction improves cardiac function in virus-induced dilated cardiomyopathy

Ionizing radiation regulates cardiac Ca handling via increased ROS and activated CaMKII

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page