心肌缺血：是冠状动脉血流缺乏、心肌氧供需失衡，还是其他原因？
Myocardial ischemia: lack of coronary blood flow, myocardial oxygen supply-demand imbalance, or what?
作者信息
Heusch Gerd
机构信息
Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School , Essen , Germany.
出版信息
Am J Physiol Heart Circ Physiol. 2019 Jun 1;316(6):H1439-H1446. doi: 10.1152/ajpheart.00139.2019. Epub 2019 Apr 19.
Abstract
This opinionated article reviews current concepts of myocardial ischemia. Specifically, the historical background is briefly presented. Then, the prevailing paradigm of myocardial oxygen-supply-demand imbalance is criticized since demand is a virtual parameter that cannot be measured and data on measurements of myocardial blood flow and contractile function rather support matching between flow and function. Finally, a concept of myocardial ischemia that focusses on the reduction of coronary blood flow to below 8-10 µl/g per beat with consequences for myocardial electrical, metabolic, contractile and morphological features is advocated.
摘要
这篇观点鲜明的文章回顾了当前关于心肌缺血的概念。具体而言，简要介绍了其历史背景。然后，对心肌氧供需失衡这一主流范式提出了批评，因为需求是一个无法测量的虚拟参数，而关于心肌血流和收缩功能测量的数据更支持血流与功能之间的匹配。最后，提倡一种心肌缺血的概念，该概念侧重于将冠状动脉血流量减少至低于每搏8 - 10微升/克，并阐述了其对心肌电、代谢、收缩和形态特征的影响。
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[Hibernation, stunning, ischemic preconditioning--new paradigms in coronary disease?].
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3
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4
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6
[Pathophysiology of ischemic myocardial dysfunction].
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7
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8
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9
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10
[Pathophysiology of myocardial ischemia].
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本文引用的文献
1
Early intravenous beta-blockers in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: A patient-pooled meta-analysis of randomized clinical trials.
Eur Heart J Acute Cardiovasc Care. 2020 Aug;9(5):469-477. doi: 10.1177/2048872619830609. Epub 2019 Feb 14.
2
Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017.
Lancet. 2018 Nov 10;392(10159):1736-1788. doi: 10.1016/S0140-6736(18)32203-7. Epub 2018 Nov 8.
3
The coronary circulation in acute myocardial ischaemia/reperfusion injury: a target for cardioprotection.
Cardiovasc Res. 2019 Jun 1;115(7):1143-1155. doi: 10.1093/cvr/cvy286.
4
Practical guidelines for rigor and reproducibility in preclinical and clinical studies on cardioprotection.
Basic Res Cardiol. 2018 Aug 17;113(5):39. doi: 10.1007/s00395-018-0696-8.
5
Coronary microembolization and microvascular dysfunction.
Int J Cardiol. 2018 May 1;258:17-23. doi: 10.1016/j.ijcard.2018.02.010. Epub 2018 Feb 3.
6
Guidelines for experimental models of myocardial ischemia and infarction.
Am J Physiol Heart Circ Physiol. 2018 Apr 1;314(4):H812-H838. doi: 10.1152/ajpheart.00335.2017. Epub 2018 Jan 12.
7
International standardization of diagnostic criteria for microvascular angina.
Int J Cardiol. 2018 Jan 1;250:16-20. doi: 10.1016/j.ijcard.2017.08.068. Epub 2017 Sep 8.
8
Brief Myocardial Ischemia Produces Cardiac Troponin I Release and Focal Myocyte Apoptosis in the Absence of Pathological Infarction in Swine.
JACC Basic Transl Sci. 2017 Apr;2(2):105-114. doi: 10.1016/j.jacbts.2017.01.006. Epub 2017 Mar 29.
9
There Is More to β-Blockade Than Just Blockade of β-Receptors: A Case for Cardioprotective Cross-Signaling.
J Am Coll Cardiol. 2017 Jul 11;70(2):193-195. doi: 10.1016/j.jacc.2017.05.017.
10
Neutrophil stunning by metoprolol reduces infarct size.
Nat Commun. 2017 Apr 18;8:14780. doi: 10.1038/ncomms14780.
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