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J Thorac Cardiovasc Surg 2003;125:1516-1525
© 2003 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Reactive hyperemia during early reperfusion as a determinant of improved functional recovery in ischemic preconditioned rat hearts

From the Laboratoire de Préconditionnement et de Remodelage du Myocarde, UFR Sciences, Angers Cedex, France.

Received for publication July 26, 2002. Revisions requested Sept 27, 2002; revisions received Oct 8, 2002. Accepted for publication Oct 22, 2002. Address for reprints: Annie Rochetaing, Laboratoire de Préconditionnement et de Remodelage du Myocarde, UFR Sciences, 2 Boulevard Lavoisier, F-49045, Angers Cedex, France. (E-mail: annie.rochetaing{at}univ-angers.fr).

Objective: Our study was undertaken to clarify the impact of the shear stress-induced reactive hyperemia (associated with reperfusion) in preconditioning-mediated protection.
Methods: In control rat hearts, a 40-minute preischemic perfusion (constant pressure: 70 mm Hg) period was followed by 25-minute global low-flow ischemia (constant flow: 0.3 mL/min) and 30-minute reperfusion (constant pressure). As preconditioning protocol, hearts underwent 2 cycles of 5-minute no-flow ischemia/5-minute reperfusion.
Results: Although coronary vasodilation in response to shear stress is severely impaired after global low-flow ischemia and reperfusion, it is fully preserved by ischemic preconditioning concomitantly with an improvement of left ventricular developed pressure. Restricting coronary peak flow to 100% of baseline at reperfusion reduced left ventricular recovery to the control level. N^G-nitro-L-arginine methyl ester affects the restoration of reperfusion-reactive hyperemia and the improvement of contractile recovery afforded by ischemic preconditioning. However, if the time course of hyperemia was restored by forcibly reperfusing to 150% of baseline for 10 minutes and, therefore, by restricting final peak flow to 80% of baseline for 20 minutes, contractile function recovered to a high degree despite the presence of N^G-nitro-L-arginine methyl ester.
Conclusion: We conclude that wall stretch and shear stress during reperfusion are necessary for the mediation phase of preconditioning.

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