Publication: The pathological basis of myocardial hibernation
Authors
Frangogiannis, N.G.
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Publisher
Murcia : F. Hernández
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DOI
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info:eu-repo/semantics/article
Description
Abstract
Myocardial hibernation refers to a state of
persistent regional ventricular dysfunction, in patients
with coronary artery disease that is reversible with
revascularization. It is part of the spectrum of
pathophysiological responses to myocardial ischemia
and is a particularly important concept in understanding
the development and progression of ischemic
cardiomyopathy. Hibernating myocardium may be
associated with chronic hypoperfusion, or result from
repetitive episodes of ischemia with a cumulative effect
on contractile function. Mechanistic studies on
myocardial hibernation have been hampered by the
difficulty in developing a reproducible and reliable
animal model. This review describes the pathologic
changes found in hibernating myocardial segments
discussing the potential mechanisms involved in their
development. Depletion of cardiomyocyte contractile
elements, loss of myofilaments and disorganization of
cytoskeletal proteins are among the most consistently
reported morphological alterations found in hibernating
myocardial segments. In addition, the cardiac intersitium
exhibits inflammatory changes, leading to fibrotic
remodeling. Induction of cytokines and chemokines
suggests an active continuous inflammatory process
leading to fibrosis and dysfunction. Although, the initial
response may be adaptive to ischemia, if timely
revascularization is not performed, irreversible tissue
injury, fibrosis and myocyte degeneration may develop.
Understanding the role of inflammatory mediators in the
development and progression of the cardiomyopathic
process may lead to the development of specific
therapeutic strategies aiming at preventing irreversible
fibrosis and dysfunction.
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