Author + information
- Received August 7, 2014
- Revision received November 5, 2014
- Accepted November 11, 2014
- Published online February 24, 2015.
- Brian J. Page, MD∗,
- Michael D. Banas, MD∗,
- Gen Suzuki, MD, PhD∗,
- Brian R. Weil, PhD∗,
- Rebeccah F. Young, MS∗,
- James A. Fallavollita, MD∗,†,
- Beth A. Palka, BS∗ and
- John M. Canty Jr., MD∗,†,‡∗ ()
- ∗UB Clinical and Translational Research Center and Department of Medicine, University at Buffalo, Buffalo, New York
- †VA Western New York Health Care System, Buffalo, New York
- ‡Department of Physiology and Biophysics and Department of Biomedical Engineering, University at Buffalo, Buffalo, New York
- ↵∗Reprint requests and correspondence:
Dr. John M. Canty, Jr., Division of Cardiovascular Medicine, University at Buffalo, Clinical and Translational Research Center, Suite 7030, 875 Ellicott Street, Buffalo, New York 14203.
Background The time course and extent of recovery after revascularization of viable dysfunctional myocardium are variable. Although fibrosis is a major determinant, myocyte structural and molecular remodeling may also play important roles.
Objectives This study sought to determine whether persistent myocyte loss and/or irreversibility of protein changes that develop in hibernating myocardium have an impact on functional recovery in the absence of infarction.
Methods Swine implanted with a chronic left anterior descending artery (LAD) stenosis to produce hibernating myocardium underwent percutaneous revascularization, with serial functional recovery evaluated for 1 month (n = 12). Myocardial tissue was evaluated to assess myocyte size, nuclear density, and proliferation indexes in comparison with those of normal animals and nonrevascularized controls. Proteomic analysis by 2-dimensional differential in-gel electrophoresis was used to determine the reversibility of molecular adaptations of hibernating myocytes.
Results At 3 months, physiological features of hibernating myocardium were confirmed, with depressed LAD wall thickening and no significant infarction. Revascularization normalized LAD flow reserve, with no immediate change in LAD wall thickening. Regional LAD wall thickening slowly improved but remained depressed 1 month post–percutaneous coronary intervention. Surprisingly, revascularization was associated with histological evidence of myocytes re-entering the growth phase of the cell cycle and increases in the number of c-Kit+ cells. Myocyte nuclear density returned to normal, whereas regional myocyte hypertrophy regressed. Proteomic analysis demonstrated heterogeneous effects of revascularization. Up-regulated stress and cytoskeletal proteins normalized, whereas reduced contractile and metabolic proteins persisted.
Conclusions Delayed recovery of hibernating myocardium in the absence of scar may reflect persistent reductions in the amounts of contractile and metabolic proteins. Although revascularization appeared to stimulate myocyte proliferation, the persistence of small immature myocytes may have contributed to delayed functional recovery.
This project was supported by National Heart, Lung, and Blood Institute grants HL-55324 and HL-61610 and by the Albert and Elizabeth Rekate Fund. All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 7, 2014.
- Revision received November 5, 2014.
- Accepted November 11, 2014.
- American College of Cardiology Foundation