[PDF][PDF] Myocardial reperfusion: a double-edged sword?

E Braunwald, RA Kloner - The Journal of clinical …, 1985 - Am Soc Clin Investig
E Braunwald, RA Kloner
The Journal of clinical investigation, 1985Am Soc Clin Investig
Both the duration and severity of myocardial ischemia are important determinants ofcell
death (10); indeed, the product of the deficit of myocardial blood flow and the duration of isch-
emia has been shown to correlate well with the ultimate extent of myocardial necrosis (11).
Reimer and Jennings (10) demonstrated in the dog that following coronary occlusion a"
wave-front" of myocardial necrosis advances progressively from the subendocardium
through the myocardial wall to the subepicardium, and as the time interval between coronary …
Both the duration and severity of myocardial ischemia are important determinants ofcell death (10); indeed, the product of the deficit of myocardial blood flow and the duration of isch-emia has been shown to correlate well with the ultimate extent of myocardial necrosis (11). Reimer and Jennings (10) demonstrated in the dog that following coronary occlusion a" wave-front" of myocardial necrosis advances progressively from the subendocardium through the myocardial wall to the subepicardium, and as the time interval between coronary occlusion and reperfusion lengthens, the salvagable tissue becomes confined to the subepicardium. In theabsence of substantial collateral blood flow, necrosis of cardiac tissue occurs rapidly, eg, in the subendocardium of the anesthetized dog, which has relatively little collateral flow; it commences about 20 min after after coronary occlusion and it is essentially complete in the subepicar-dium, which has greater collateral flow in3 h (12). Similar con-siderations apply to patients in whom the subendocardium also
The Journal of Clinical Investigation