Exact(2)
Although it is well established that coronary revascularization can reverse exercise-induced ischemic dysfunction, the effects on resting ventricular performance are controversial.
We have previously used a model of hyperinsulinemic euglycemic clamping (HEC) during dobutamine stress echocardiography (DSE) to demonstrate that alteration of the myocardial metabolic environment in patients with obstructive coronary artery disease (CAD) can attenuate left ventricular (LV) ischemic dysfunction, especially in those with insulin resistance [ 17].
Similar(58)
Hence, NGF can protect against post-ischemic dysfunction of sympathetic innervations and ischemia-reperfusion myocardial injury [49], [50].
It also suggests that subjects with IR may benefit more in terms of increased cardiac performance and reduced post-ischemic dysfunction compared insulin sensitive subjects.
In the study of Itoh et al. [ 21], captopril did not protect WT mice against post-ischemic dysfunction and myocardial enzyme release.
Overall, though, the effects are fairly modest and whilst the sample size is small, the improvements observed in the clamped DSE in IR group, in particular the reduction in post-ischemic dysfunction are likely to have clinical significance.
This study shows that in subjects with flow-limiting CAD alteration of myocardial substrate utilization improves LV function during DSE in both IR and IS subjects and lessens post-ischemic dysfunction in IR subjects.
At peak DSE and in recovery in both groups the clamp resulted in fewer segments exhibiting new PSS (i.e. segments that did not have PSS at baseline), but this effect was most marked, and achieved statistical significance, in the recovery stage in the IR subjects (15 segments in the clamp vs. 30 in the control, p = 0.03), suggesting less post-ischemic dysfunction.
Matsui T, Rosenzweig A. Targeting ischemic cardiac dysfunction through gene transfer.
This study was designed to assess the relationship between tetrofosmin uptake after nitrate administration and metabolic activity as assessed by positron emission tomography (PET) in patients with ischemic LV dysfunction.
Extent of coronary and myocardial disease and benefit from surgical revascularization in ischemic LV dysfunction [Corrected].
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