Гибернация миокарда: молекулярные механизмы, клиническая значимость и методы диагностики

Гибернация миокарда – стойкое угнетение сократимости жизнеспособного миокарда левого желудочка, возникающее вследствие его гипоперфузии. Важнейшим проявлением гибернации является сохранение жизнеспособности миокарда на тканевом уровне. В основе этого явления лежат три основных механизма: 1) метаболическая адаптация миокарда, проявляющаяся усиленным захватом глюкозы; 2) активация генетической программы выживания кардиомиоцитов; 3) программируемая клеточная гибель, т. е. аутофагия и апоптоз кардиомиоцитов. Методы диагностики жизнеспособного миокарда включают стресс-эхокардиографию с добутамином, однофотонную эмиссионную компьютерную томографию миокарда, позитронно-эмиссионную томографию, магнитно-резонансную томографию и электромеханическое картирование. В клиническом аспекте наличие и объем жизнеспособного миокарда учитываются при решении вопроса о реваскуляризации у пациентов с одно- и двухсосудистым поражением коронарных артерий без вовлечения передней нисходящей артерии, а также у больных со значительным снижением глобальной сократительной функции миокарда, когда оперативное вмешательство может привести к увеличению фракции выброса левого желудочка.

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