Cardiac stunning in the clinic: the full picture
Valdeci J. Pomblum 1,
Bernhard Korbmacher 2,
Sinclair Cleveland 3,
Ullrich Sunderdiek 4,
Rainhard C. Klocke 5,
Jochen D. Schipke 6*
1 Federal University of Santa Maria, RS, Brazil
2 University Hospital, Dusseldorf, Germany
3 Heinrich-Heine-University, Dusseldorf, Germany
4 Ruhruniversity, Bochum, Germany
5 Marienhospital, Vechta, Germany
6 University Hospital Dusseldorf, Germany
* To whom correspondence should be addressed. E-mail: schipke{at}med.uni-duesseldorf.de.
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Abstract |
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Cardiac stunning refers to different dysfunctional levels occurring after an episode of acute ischaemia, despite blood flow is near normal or normal. The phenomenon was initially identified in animal models, where it has been very well characterized. After being established in the experimental setting, it remained unclear, whether a similar syndrome occurs in humans. In addition, it remained controversial, whether stunning was of any clinical relevance as it is spontaneously reversible. Hence, many studies continue to focus on the properties and mechanisms of stunning, although therapies seem more relevant for attenuating and treating myocardial ischemia/reperfusion (I/R) injury, i.e. to bridge until recovery. This article reviews the different facets of cardiac stunning, i.e. myocardial, vascular/microvascular/endothelial, metabolic, neural/neuronal, and electrical stunning. This review also displays where these facets exist and which clinical relevance they might have. Particular attention is directed to the different therapeutic interventions that the various facets of this I/R-induced cardiac injury might require. A final outlook displays possible alternatives to further reduce the detrimental consequences of brief episodes of ischaemia and reperfusion. Keywords: Myocardial; Electrical; Metabolic; Neural; Vascular; Endothelial stunning
