Spatial and temporal characteristics of circumferential flow-function relations during acute myocardial ischemia in...

In the anesthetized open-chest dog the ischemic area produced by coronary occlusion is surrounded by an area of nonischemic contractile dysfunction, identified as the functional border zone. To establish whether a similar functional border zone exists in the conscious animal during acute regional ischemia and to determine its spatial dimensions and temporal changes, we performed simultaneous two-dimensional echocardiography and radioactive microsphere studies in nine chronically instrumented dogs. We produced circumferential flow-function maps at 22.5-degree intervals over the full circumference of the left ventricle at the midpapillary muscle level during control conditions, 5 minutes after left circumflex occlusion, and 2.5 hours after left circumflex occlusion. After occlusion there was no change in left ventricular end-diastolic area, an increase in left ventricular end-systolic area (p less than 0.01), and a decrease in left ventricular area ejection fraction (p less than 0.01). The circumferential extent of left ventricular dysfunction was 197 +/- 11 degrees (mean +/- SEM) at 5 minutes of left circumflex occlusion, whereas the extent of subendocardial hypoperfusion was 144 +/- 6 degrees (p less than 0.0005). This produced a functional border zone measuring 54 +/- 8 degrees, or 25% of the nonischemic myocardium, which did not change over the 2.5-hour occlusion period. Despite a modest but significant decrease in wall thickening (70 +/- 6% to 43 +/- 6%; p less than 0.01) in the functional border zone, there was no difference in subendocardial blood flow between the functional border zone and the control nonischemic area. We conclude that a discrete functional border zone exists in the conscious dog during acute regional ischemia produced by circumflex coronary occlusion, which does not change during the early evolution of myocardial infarction. The functional border zone likely contributes to minor overestimation of infarct size in the early hours after myocardial infarction if extent of left ventricular dysfunction is used as an index of infarction in humans.