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Updated: Apr 5, 2026
In vitro Assessment of Myocardial Protection following Hypothermia-Preconditioning in a Human Cardiac Myocytes Model
Published on: October 27, 2020
Safety and feasibility of local myocardial hypothermia
Luuk C Otterspoor1,2, Marcel Van't Veer1,2, Lokien X van Nunen1,2
1Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.
Insights
Intracoronary infusion of room-temperature saline safely and quickly induces hypothermia in the heart, showing promise for improving outcomes in ST-elevation myocardial infarction (STEMI) patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- ST-elevation myocardial infarction (STEMI) requires rapid reperfusion to minimize infarct size.
- Systemic hypothermia has shown limited success in human trials for reducing myocardial damage.
- Local myocardial hypothermia via intracoronary infusion may overcome limitations of systemic approaches.
Purpose of the Study:
- To evaluate the safety and feasibility of rapid intracoronary myocardial hypothermia.
- To assess the efficacy of room-temperature saline infusion for inducing local hypothermia before reperfusion in STEMI patients.
Main Methods:
- Continuous selective intracoronary infusion of room-temperature saline at 10-30 ml/min.
- Thermodilution measurements of temperature changes at the infusion catheter tip and distally in the coronary artery.
- Study included patients with stable angina (SA) and STEMI undergoing measurements.
Main Results:
- Achieved significant temperature reductions: Ti -5.65°C (SA) and -7.45°C (STEMI); Td -0.78°C (SA) and -1.37°C (STEMI).
- Steady-state intracoronary hypothermia was achieved within 15 seconds.
- No noticeable complications were observed during the procedure.
Conclusions:
- Intracoronary hypothermia via saline infusion is safe and feasible in SA and STEMI patients.
- Rapid, easy, and safe achievement of hypothermia using standard PCI techniques.
- Further research is warranted to explore intracoronary hypothermia for enhanced myocardial salvage in acute myocardial infarction.
Background:
In ST-elevation myocardial infarction (STEMI), reduction in time to reperfusion of the occluded coronary artery reduces infarct size. In animal models, an additional reduction of infarct size was observed when hypothermia was induced before reperfusion, despite a longer ischemic time. However, several human studies did not corroborate this positive effect, which is believed to be in part due to the inability of systemic induced hypothermia to induce sufficient decrease of local myocardial temperature before reperfusion. Providing rapid local myocardial hypothermia by intracoronary infusion of saline before reperfusion in patients with STEMI may overcome this problem. In this study, we evaluate the safety and feasibility of providing rapid intracoronary myocardial hypothermia in patients undergoing intracoronary blood flow measurements based on thermodilution with continuous infusion of saline at room temperature.
Methods And Results:
In 53 patients with stable angina (SA) and 20 patients with STEMI, a total of 215 measurements were performed. The measurements consisted of continuous selective intracoronary infusion of saline at room temperature with rates between 10 ml/min and 30 ml/min. Temperature changes compared to initial blood temperature (Tb ) were measured at the tip of the infusion catheter (Ti ) and distally in the coronary artery (Td ). In patients with SA, Ti was -5.65 ± 1.41°C (range -9.27 to -2.28) and Td was -0.78 ± 0.51°C (range -3.27 to -0.23°C). In patients with STEMI, Ti was -7.45 ± 0.51°C (range -8.21 to -6.56) and Td was -1.37 ± 0.82°C (range -4.62 to -0.74°C). In all patients, steady-state intracoronary hypothermia was achieved within 15 sec and could be maintained without noticeable complications.
Conclusion:
This study demonstrates the safety and feasibility of inducing intracoronary hypothermia by selective infusion of saline at room temperature in patients with SA and STEMI. Steady-state hypothermia could be achieved and maintained quickly, easily, and safely using common PCI techniques. Therefore, our findings warrant further studies to the use of intracoronary hypothermia to enhance myocardial salvage in acute myocardial infarction.
