Calcium and its role in myocardial cell injury during ischemia and reperfusion.

Direct measurements of intracellular free Ca2+ concentration ([Ca2+]i) were obtained during ischemia and reperfusion in ferret hearts loaded with the Ca2+ indicator, the 5,5'-difluoro derivative of 1,2-bis(o-aminophenoxy)ethane-N,N,N',N',-tetraacetic acid. During 15 minutes of ischemia at 37 degrees C, time-averaged [Ca2+]i increased significantly and decreased rapidly during reperfusion. In contrast to metabolic inhibition in isolated muscle or cells, the increase in [Ca2+]i during true ischemia occurs in the absence of a mechanical contracture. After ischemia, contractile function does not recover completely: the hearts are "stunned." Our results support the hypothesis that an increase in cellular calcium-loading causes dysfunction in the form of myocardial stunning while leaving unresolved the precise mechanism of the calcium-mediated injury.