Heusch Gerd
Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School , Essen , Germany.
Am J Physiol Heart Circ Physiol. 2019 Jun 1;316(6):H1439-H1446. doi: 10.1152/ajpheart.00139.2019. Epub 2019 Apr 19.
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.
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。
