Myocardial Stunning (Stunned Myocardium)

Prolonged dysfunction of the myocardium after a brief episode of severe ischemia, with gradual return of contractile activity. It occurs frequently, both in the experimental laboratory and in clinical medicine. Since stunned myocardium occurs adjacent to necrotic tissue after prolonged coronary occlusion, many myocardial infarcts may be a mixture of necrotic and stunned tissue. (Braunwald, Heart Disease, 1992, p1176)

Also Known As:

Networked: 916 relevant articles (78 outcomes, 131 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Ischemia
2.	Reperfusion Injury
3.	Myocardial Infarction
4.	Infarction
5.	Myocardial Ischemia (Ischemic Heart Diseases)

Experts

1.	McIntyre, Christopher W: 8 articles (01/2013 - 01/2008)
2.	Weiss, Harvey R: 7 articles (01/2007 - 05/2002)
3.	Hara, Tetsuya: 6 articles (02/2013 - 01/2005)
4.	Cho, Sungsam: 6 articles (02/2013 - 01/2005)
5.	Yoshitomi, Osamu: 6 articles (02/2013 - 01/2005)
6.	Sumikawa, Koji: 6 articles (02/2013 - 01/2005)
7.	Gelpi, Ricardo J: 6 articles (09/2012 - 01/2003)
8.	Scholz, Peter M: 6 articles (01/2007 - 05/2002)
9.	Burton, James O: 5 articles (01/2013 - 01/2008)
10.	Donato, Martín: 5 articles (09/2012 - 01/2003)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Myocardial Stunning:

1.	DobutamineFDA LinkGeneric 10/01/1996 - "Despite lower heart rate (HR) and significant reduction of lipid peroxidation in treated dogs, myocardial stunning and recruitment of contractile reserve by dobutamine infusion in the postischemic myocardium were not modified by TMZ. " 07/01/1994 - "We report a case of regional ventricular improvement during high-dose dobutamine therapy, which may represent relief from myocardial hibernation or changes in regional loading conditions." 10/01/2004 - "Low-dose dobutamine stress echocardiography (LDDE) has become a useful and safe method for identifying hibernating or stunned myocardium and for predicting improvement in wall motion after coronary revascularization. " 01/01/1996 - "(1) Low dose dobutamine echocardiography early after thrombolytic treatment identifies dysfunctional myocardium with potential late spontaneous improvement (stunned myocardium). " 04/01/2005 - "We assessed the efficacy of low-dose dobutamine stress echocardiography (DSE), performed early in the course of a reperfused RVI, to predict the recovery of RV systolic and diastolic function in 3 months, documenting the recovery of stunned myocardium. "
2.	simendan (Levosimendan)IBA 01/01/2006 - "Levosimendan: a promising treatment for myocardial stunning?" 08/01/1999 - "The aim of the present study was to examine whether the depressed contractile function and Ca2+ responsiveness of the stunned myocardium may be restored by a new Ca2+ sensitizer (levosimendan), which has been shown to improve the Ca2+ response of the myofilaments. " 06/16/2004 - "Levosimendan improved the function of stunned myocardium without obvious impairment of diastolic function." 01/01/2009 - "This review includes studies with levosimendan in cases not recovering due to myocardial stunning in the acute phase despite mechanical approaches applied." 01/01/2014 - "Levosimendan can significantly improve the myocardium function of patients with myocardial stunning after PCI."
3.	Adenosine Triphosphate (ATP)IBA 01/01/2012 - "Post-ATP stress myocardial stunning is superior to the TID ratio for detecting multivessel CAD." 07/01/1998 - "Therefore the major aim of our study was to determine the dose-related effect of MLA to enhance contractile function in stunned myocardium and to determine the role of the K(ATP) channel in mediating its cardioprotective effect. " 10/01/2009 - "The percent recovery of WMSI on day 10, which was defined as WMSI on day 10 normalized by improvement of WMSI for 6 months, was 63.8% in ATP group and 65.7% in controls, implying ATP administration could not reduce myocardial stunning by day 10 after primary PCI. " 02/01/2006 - "Thus stunned myocardium still maintains ATP consumption in spite of lower force development, rationalizing the long-standing paradox of decreased force but unchanged oxygen consumption in the postischemic heart." 11/01/2005 - "Post-stress myocardial stunning occurred in 24 patients (13%): 22 after exercise and 2 after ATP stress. "
4.	AdenosineFDA LinkGeneric 06/19/1997 - "These findings are consistent with the hypothesis that adenosine is effective in attenuating myocardial stunning in humans." 08/01/1998 - "The purpose of this study was to determine whether adenosine-mediated attenuation of in vivo myocardial stunning is associated with improved myocardial phosphorylation potential. " 02/01/2006 - "The aims of the present study were to determine whether the transitory systolic overshoot (TSO) that occurs in the early reperfusion (R) of the stunned myocardium is accompanied by diastolic alterations, and to determine whether the R with low Ca2+ Krebs-Henseleit's solution or with adenosine modifies these alterations. " 12/01/2004 - "The purpose of this study was to determine whether the adenosine A1/A2a receptor agonist AMP-579 induces acute and delayed preconditioning against in vivo myocardial stunning. " 08/01/1994 - "In this study, we tested the hypothesis that delay of administration of inhibitors until reperfusion would similarly prevent myocardial stunning in the absence of entrapped adenosine. "
5.	CalciumIBA 06/01/1999 - "Preservation of myofilament calcium responsiveness underlies protection against myocardial stunning by ischemic preconditioning." 06/01/1998 - "The major challenge for future studies will be to identify the specific molecular targets of ROS-mediated damage and to decipher the pathways whereby ROS and calcium interact in the genesis of myocardial stunning." 07/01/1995 - "This study characterizes the energy state and the influence of calcium on myocardial stunning and chronic hibernation via the quantification of a calcium-sensitive phenomenon known as mitochondrial contact sites. " 07/01/1993 - "The beneficial effects of calcium antagonists in preventing post-ischaemic myocardial stunning have been tested in experimental studies, showing that when administered before or during ischaemia, they inhibit post-ischaemic myocardial dysfunction. " 12/01/1992 - "The purpose of this study was to test the hypothesis that abnormal intracellular calcium handling characterizes myocardial stunning. "
6.	CatalaseIBA 06/01/1989 - "This study shows that (i) SOD and catalase are highly effective in blocking free radical reactions in vivo, (ii) the radicals generated in the "stunned" myocardium are derived from univalent reduction of O2, and (iii) inhibition of radical reactions improves functional recovery. " 04/01/2004 - "On the basis of the time course of the loss of cardioprotection and the return of HSP72 and catalase to preexercise levels, we conclude that HSP72 and catalase are not essential for exercise-induced protection during myocardial stunning. " 10/06/1998 - "The results demonstrate that in vivo gene transfer of the cDNA encoding Ec-SOD provides the heart with substantial protection against myocardial stunning without the need for concomitant administration of catalase. " 09/01/1990 - "Effect of superoxide dismutase and catalase, given separately, on myocardial "stunning"." 03/01/1986 - "Beneficial actions of superoxide dismutase and catalase in stunned myocardium of dogs."
7.	OxygenIBA 07/01/1993 - "An improved contractile response to retrograde delivery of oxygen by SRP appears to document the reversibility of myocardial hibernation. " 06/01/2006 - "The aim of the present study was to examine if it is possible to discriminate between hibernating and stunned myocardium in vivo by determining the ratio between diastolic and systolic coronary arterial inflow and by measuring oxygen saturation in draining coronary venous blood. " 09/01/1994 - "To study the effect of stunning, myocardial oxygen consumption, oxygen extraction, and functional indices of contractility were measured before and after isolated rabbit hearts were subjected to 10, 20, or 45 minutes of normothermic 37 degrees C global ischemic stun intervals. " 09/01/1990 - "Thus, the study indicates that anaerobic glycolysis, in addition to occurring in ischemic or "stunned" myocardium (as has been shown in recent PET studies), occurs normally in specific cardiac regions, despite the presence of abundant oxygen." 04/01/1988 - "In this study we used microspectrophotometry to measure the oxygen saturations within arteries and veins of less than 100 micron diameter in quick-frozen biopsy samples from normal and regionally stunned myocardium of 10 open-chest anesthetized dogs. "
8.	Free RadicalsIBA 01/01/1990 - "The results demonstrate that 1) free radicals are produced in the stunned myocardium in intact animals; 2) inhibition of free radical production results in improved contractile recovery; and 3) the free radicals important in causing dysfunction are produced in the first few minutes of reperfusion. " 10/01/1991 - "Many studies have demonstrated the potential involvement of free radicals in the etiology of myocardial stunning. " 06/01/1998 - "Myocardial stunning--we do not know the mechanism nor is there "overwhelming evidence" for a major role of free radicals." 08/01/1996 - "Intracellular Ca overload at reperfusion and decreased intracellular Ca level, which have the effect of suppressing the CICR channel, which plays a role in Ca release into the sarcoplasmic reticulum at contraction, are important causative factors in the development of myocardial stunning, as are free radicals. " 08/01/1993 - "The results demonstrate (a) that free radicals are generated in the stunned myocardium in the absence of the artificial or abnormal conditions associated with previously used models (isolated hearts, open-chest preparations), and (b) that both the severity of postischemic dysfunction and the magnitude of the attendant free radical production are greatly exaggerated in the open-chest dog, implying that previous conclusions derived from this model may not be applicable to conscious animals or to humans. "
9.	Free Radical ScavengersIBA 08/01/1987 - "Free radical scavengers improve functional recovery of stunned myocardium in a model of surgical coronary revascularization." 07/01/1992 - "Inhibiting free radical accumulation during myocardial ischemia/reperfusion with free radical scavengers and inhibitors has been demonstrated to reduce the severity of myocardial stunning, irreversible injury, and reperfusion arrhythmias in many, but not all, studies. " 10/01/1991 - "Although the fundamental mechanism(s) responsible for myocardial stunning has not been elucidated, in experimental preparations calcium antagonists, free-radical scavengers, and neutrophil depletion have each been found to be helpful in minimizing it." 10/01/1989 - "In the case of myocardial stunning, the phenomenon may be mediated, at least in part, by a burst of free radicals formed within the first minute of reperfusion and improved by free radical scavengers given at the time of reperfusion. " 11/01/1989 - "Whether oxygen free radical scavengers administered only during reperfusion enhance recovery of stunned myocardium in models of brief ischemia remains to be determined. "
10.	IsofluraneFDA LinkGeneric 05/01/1994 - "This study was conducted to determine isoflurane's coronary vasodilation potency in stunned myocardium and to compare the results obtained with normal myocardium. " 12/10/2012 - "Isoflurane produced late preconditioning against myocardial stunning. " 12/10/2012 - "Isoflurane has been demonstrated to produce late preconditioning against myocardial stunning. " 01/01/2012 - "Isoflurane late preconditioning against myocardial stunning is associated with enhanced antioxidant defenses." 05/01/1995 - "Isoflurane may improve the recovery of regional myocardial contractility in stunned myocardium. "

Therapies and Procedures

1.	Angioplasty (Angioplasty, Transluminal) 04/01/1988 - "Thus, left ventricular diastolic filling improved gradually after coronary angioplasty, possibly reflecting post-ischemic "stunned" myocardium. " 12/16/1993 - "Further studies are needed to assess the possibility of the myocardial stunning phenomenon occurring after angioplasty in those patients without left ventricular improvement." 07/01/1993 - "The present study was undertaken to verify the possible occurrence of myocardial stunning following transient ischaemia induced by coronary angioplasty. " 03/01/2012 - "Non-invasive assessment of coronary flow reserve with transthoracic Doppler echocardiography of the left anterior descending coronary artery allows to distinguish between necrotic and stunned myocardium and predicts ventricular remodelling following primary angioplasty. " 01/01/2005 - "Myocardial stunning is an acute derangement of contractility of ischemic myocardium at the moment of restoration of coronary blood flow by various interventions (bypass grafting, angioplasty, thrombolysis). "
2.	Off-Pump Coronary Artery Bypass (Coronary Artery Bypass, Off Pump) 12/01/2001 - "Myocardial stunning after off-pump coronary artery bypass grafting: safeguards and pitfalls." 01/01/2001 - "We report two cases of myocardial stunning after off-pump coronary artery bypass grafting using the Octopus tissue stabilizer. " 01/01/2001 - "Stunned myocardium after off-pump coronary artery bypass grafting." 04/01/2004 - "We evaluated the protective effects of retrograde coronary sinus perfusion to offset potential systolic and diastolic dysfunction (myocardial stunning) after temporary regional ischemia needed for off-pump coronary artery bypass grafting. "
3.	General Anesthesia 07/01/2013 - "We present a patient with cardiac arrest during general anesthesia, in whom speckle tracking-derived myocardial strain helped to distinguish between the inverted variant of stress cardiomyopathy and global postresuscitation myocardial stunning. "
4.	Induced Heart Arrest (Cardioplegia) 01/01/2006 - "Hyperkalemic cardioplegia (9 degrees C) results in significant myocyte swelling and reduced contractility, representing a possible mechanism of myocardial stunning. " 05/01/1994 - "All dogs in both treatment groups showed electron microscopic evidence of mild and reversible morphological injury indicative of stunned myocardium, with no difference between dogs that received warm versus cold cardioplegia. " 05/01/1994 - "Thus, in our canine model: (1) morphological injury and LV dysfunction induced by 3 hours of aortic cross-clamping is subtle; and (2) continuous retrograde infusion of warm blood cardioplegia during the cross-clamp period failed to preclude myocardial stunning following prolonged cardiopulmonary bypass." 05/01/1994 - "Moreover, despite the superb cardioprotection conferred by administration of cold cardioplegia during aortic cross-clamping, stunned myocardium is a well-recognized sequela of prolonged cardiopulmonary bypass. " 05/01/1994 - "Stunned myocardium following prolonged cardiopulmonary bypass: effect of warm versus cold cardioplegia in the canine model."
5.	Coronary Balloon Angioplasty (Percutaneous Transluminal Coronary Angioplasty) 01/01/1992 - "To observe the clinical course after reperfusion and recovery from myocardial stunning of the left ventricular anterior wall, we prospectively reviewed and analyzed cardiac enzymes, ECG changes, echocardiograms, and cineangiograms in 8 patients with the acute ischemic syndrome who fulfilled the following criteria: 1) no history of previous myocardial infarction, 2) repeated and/or prolonged episodes of chest pain, 3) critical stenosis of the left anterior descending artery with wall motion abnormalities, 4) successful emergency percutaneous transluminal coronary angioplasty, and 5) normal wall motion on repeat cineangiography 4 to 8 weeks later. " 01/01/2001 - "Percutaneous transluminal coronary angioplasty is associated with complications such as myocardial stunning and accelerated restenosis, which at least in part are mediated by oxygen free radicals. " 06/16/2004 - "The calcium sensitizer levosimendan improves the function of stunned myocardium after percutaneous transluminal coronary angioplasty in acute myocardial ischemia." 01/01/1992 - "The present study was undertaken to test and compare the protective effect of calcium antagonists [nisoldipine (NIS) and nifedipine (NIF)] and nitrates (NIT) against myocardial stunning in patients with coronary artery disease undergoing percutaneous transluminal coronary angioplasty (PTCA) with prolonged inflation as PTCA represents a model of induced acute and severe ischemia for a brief period and might cause myocardial stunning. "