Key result
A concept of myocardial ischemia focusing on the reduction of coronary blood flow to below 8-10 µl/g per beat is advocated over the prevailing oxygen-supply-demand imbalance paradigm.
Why the study?
The prevailing paradigm of myocardial oxygen supply-demand imbalance faces criticism because demand cannot be measured and data support flow-function matching, warranting a review of current concepts of myocardial ischemia.
This article proposes redefining myocardial ischemia based on absolute coronary blood flow reduction rather than the traditional, unmeasurable oxygen supply-demand imbalance.
Answers are grounded in this paper and cite their sources.
Challenges traditional ischemia paradigm; leaves open clinical utility pending prospective validation.
This opinionated article reviews current concepts of myocardial ischemia. Specifically, the historical background is briefly presented. Then, the prevailing paradigm of myocardial oxygen-supply-demand imbalance is criticized since demand is a virtual parameter that cannot be measured and data on measurements of myocardial blood flow and contractile function rather support matching between flow and function. Finally, a concept of myocardial ischemia that focusses on the reduction of coronary blood flow to below 8-10 µl/g per beat with consequences for myocardial electrical, metabolic, contractile and morphological features is advocated.
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Gerd Heusch (2019) conducted a review in Myocardial ischemia. A concept of myocardial ischemia focusing on the reduction of coronary blood flow to below 8-10 µl/g per beat is advocated over the prevailing oxygen-supply-demand imbalance paradigm.
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