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Rapid short-duration hypothermia with cold saline and endovascular cooling before reperfusion reduces microvascular obstruction and myocardial infarct size.

Götberg, Matthias LU ; Olivecrona, Göran LU ; Engblom, Henrik LU ; Ugander, Martin LU ; van der Pals, Jesper; Heiberg, Einar LU ; Arheden, Håkan LU and Erlinge, David LU (2008) In BMC Cardiovascular Disorders 8(Apr 10).
Abstract
BACKGROUND: The aim of this study was to evaluate the combination of a rapid intravenous infusion of cold saline and endovascular hypothermia in a closed chest pig infarct model. METHODS: Pigs were randomized to pre-reperfusion hypothermia (n = 7), post-reperfusion hypothermia (n = 7) or normothermia (n = 5). A percutaneous coronary intervention balloon was inflated in the left anterior descending artery for 40 min. Hypothermia was started after 25 min of ischemia or immediately after reperfusion by infusion of 1000 ml of 4 degrees C saline and endovascular hypothermia. Area at risk was evaluated by in vivo SPECT. Infarct size was evaluated by ex vivo MRI. RESULTS: Pre-reperfusion hypothermia reduced infarct size/area at risk by 43% (46... (More)
BACKGROUND: The aim of this study was to evaluate the combination of a rapid intravenous infusion of cold saline and endovascular hypothermia in a closed chest pig infarct model. METHODS: Pigs were randomized to pre-reperfusion hypothermia (n = 7), post-reperfusion hypothermia (n = 7) or normothermia (n = 5). A percutaneous coronary intervention balloon was inflated in the left anterior descending artery for 40 min. Hypothermia was started after 25 min of ischemia or immediately after reperfusion by infusion of 1000 ml of 4 degrees C saline and endovascular hypothermia. Area at risk was evaluated by in vivo SPECT. Infarct size was evaluated by ex vivo MRI. RESULTS: Pre-reperfusion hypothermia reduced infarct size/area at risk by 43% (46 +/- 8%) compared to post-reperfusion hypothermia (80 +/- 6%, p < 0.05) and by 39% compared to normothermia (75 +/- 5%, p < 0.05). Pre-reperfusion hypothermia infarctions were patchier in appearance with scattered islands of viable myocardium. Pre-reperfusion hypothermia abolished (0%, p < 0.001), and post-reperfusion hypothermia significantly reduced microvascular obstruction (10.3 +/- 5%; p < 0.05), compared to normothermia: (30.2 +/- 5%). CONCLUSION: Rapid hypothermia with cold saline and endovascular cooling before reperfusion reduces myocardial infarct size and microvascular obstruction. A novel finding is that hypothermia at the onset of reperfusion reduces microvascular obstruction without reducing myocardial infarct size. Intravenous administration of cold saline combined with endovascular hypothermia provides a method for a rapid induction of hypothermia suggesting a potential clinical application. (Less)
Please use this url to cite or link to this publication:
author
organization
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type
Contribution to journal
publication status
published
subject
keywords
Animals Disease Models, Animal Female Hemodynamics Hypothermia, Induced* Magnetic Resonance Imaging Male Myocardial Infarction/diagnosis Myocardial Infarction/physiopathology Myocardial Infarction/therapy* Myocardial Reperfusion/methods* Myocardial Reperfusion Injury/prevention & control* Random Allocation Swine
in
BMC Cardiovascular Disorders
volume
8
issue
Apr 10
publisher
BioMed Central
external identifiers
  • WOS:000266852600001
  • PMID:18402663
  • Scopus:42549129618
ISSN
1471-2261
DOI
10.1186/1471-2261-8-7
language
English
LU publication?
yes
id
ab519760-ae98-4651-8aa3-42472625cf1a (old id 1147505)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/18402663?dopt=Abstract
date added to LUP
2008-05-08 13:04:16
date last changed
2016-11-27 04:26:33
@misc{ab519760-ae98-4651-8aa3-42472625cf1a,
  abstract     = {BACKGROUND: The aim of this study was to evaluate the combination of a rapid intravenous infusion of cold saline and endovascular hypothermia in a closed chest pig infarct model. METHODS: Pigs were randomized to pre-reperfusion hypothermia (n = 7), post-reperfusion hypothermia (n = 7) or normothermia (n = 5). A percutaneous coronary intervention balloon was inflated in the left anterior descending artery for 40 min. Hypothermia was started after 25 min of ischemia or immediately after reperfusion by infusion of 1000 ml of 4 degrees C saline and endovascular hypothermia. Area at risk was evaluated by in vivo SPECT. Infarct size was evaluated by ex vivo MRI. RESULTS: Pre-reperfusion hypothermia reduced infarct size/area at risk by 43% (46 +/- 8%) compared to post-reperfusion hypothermia (80 +/- 6%, p &lt; 0.05) and by 39% compared to normothermia (75 +/- 5%, p &lt; 0.05). Pre-reperfusion hypothermia infarctions were patchier in appearance with scattered islands of viable myocardium. Pre-reperfusion hypothermia abolished (0%, p &lt; 0.001), and post-reperfusion hypothermia significantly reduced microvascular obstruction (10.3 +/- 5%; p &lt; 0.05), compared to normothermia: (30.2 +/- 5%). CONCLUSION: Rapid hypothermia with cold saline and endovascular cooling before reperfusion reduces myocardial infarct size and microvascular obstruction. A novel finding is that hypothermia at the onset of reperfusion reduces microvascular obstruction without reducing myocardial infarct size. Intravenous administration of cold saline combined with endovascular hypothermia provides a method for a rapid induction of hypothermia suggesting a potential clinical application.},
  author       = {Götberg, Matthias and Olivecrona, Göran and Engblom, Henrik and Ugander, Martin and van der Pals, Jesper and Heiberg, Einar and Arheden, Håkan and Erlinge, David},
  issn         = {1471-2261},
  keyword      = {Animals
Disease Models,Animal
Female
Hemodynamics
Hypothermia,Induced*
Magnetic Resonance Imaging
Male
Myocardial Infarction/diagnosis
Myocardial Infarction/physiopathology
Myocardial Infarction/therapy*
Myocardial Reperfusion/methods*
Myocardial Reperfusion Injury/prevention & control*
Random Allocation
Swine},
  language     = {eng},
  number       = {Apr 10},
  publisher    = {ARRAY(0x85ae1e8)},
  series       = {BMC Cardiovascular Disorders},
  title        = {Rapid short-duration hypothermia with cold saline and endovascular cooling before reperfusion reduces microvascular obstruction and myocardial infarct size.},
  url          = {http://dx.doi.org/10.1186/1471-2261-8-7},
  volume       = {8},
  year         = {2008},
}