Effects of beta adrenoceptor down-regulation on the cardiovascular responses to the stereoisomers of dobutamine

Effects of prolonged in vivo infusion of either saline (control) or isoproterenol (beta adrenoceptor desensitization) on acute cardiovascular responses to (+) (beta agonist)-, (-) (alpha agonist)- and (+/-)-dobutamine were studied in pithed rats. Each form of dobutamine resulted in comparable dose-dependent increases in maximum left ventricular dP/dt (LVdP/dtmax) in control animals. Effects of (+)-dobutamine were blocked by propranolol whereas those of l-dobutamine were sensitive to prazosin; both alpha and beta antagonists were required to block the inotropic effects of the racemic mixture. Contractile responses to (+)- and (+/-)-dobutamine were accompanied by tachycardia (characteristic of beta adrenoceptor stimulation) whereas (-)-dobutamine enhanced LVdP/dtmax without altering heart rate (characteristic of alpha adrenoceptor stimulation). Isoproterenol infusion resulted in a pronounced desensitization to the inotropic effects (LVdP/dtmax) of (+/-)- and (+)-dobutamine. Ed30 values for (+/-)- and (+)-dobutamine were increased by approximately 15- and 50-fold, respectively, and maximal responses to both drugs were severely attenuated. Prazosin further blunted remaining inotropic responses to (+/-)-dobutamine and propranolol resulted in a complete block. Responses to (+)-dobutamine were only sensitive to propranolol. Attenuation of heart rate responses paralleled those observed for LVdP/dtmax. By contrast, the inotropic effects of (-)-dobutamine in either control or desensitized rats were both qualitatively and quantitatively comparable; responses were blocked by the alpha-1 antagonist, prazosin.(ABSTRACT TRUNCATED AT 250 WORDS)     

Selective desensitization of cardiac beta adrenoceptors by prolonged in vivo infusion of catecholamines in rats

The effects of prolonged in vivo infusion of isoproterenol (400 micrograms/kg/hr) or norepinephrine (200 micrograms/kg/hr) from a minipump on the physiological reactivity and binding properties of cardiac beta and alpha-1 adrenoceptors were tested in rats. Infusion of either catecholamine significantly reduced the in vitro inotropic and chronotropic potency of isoproterenol in isolated left and right atria, respectively; desensitization was near maximal as early as after 2 hr of infusion. No significant change in the density of [3H]dihydroalprenolol-labeled beta receptors was evident at this time point in either atrial or ventricular tissue, although isoproterenol did decrease binding site density after 7 days of infusion. There was no change in the binding affinity or physiological blocking potency of dihydroalprenolol after isoproterenol infusion. The inotropic potency of phenylephrine in the presence of dihydroalprenolol was unaffected by infusion of either isoproterenol or norepinephrine and methoxamine failed to increase right atrial rate either in control or in isoproterenol-infused rats. There was also no change in the density and affinity of [3H]prazosin binding sites after isoproterenol infusion. These results indicate selective desensitization of cardiac beta receptors without changes in alpha-1 receptors by prolonged in vivo stimulation with catecholamines. This reaction pattern is different from the well documented effects of hypothyroidism, which include decreased sensitivity of cardiac beta and increased sensitivity of cardiac alpha-1 receptor-mediated responses in rats. Thus, the mechanisms responsible for altered receptor function in the two conditions appear to be different.     

Cardiovascular responses to the stimulation of alpha-1 and alpha-2 adrenoceptors in the conscious dog

Hemodynamic responses to the selective stimulation of alpha-1 and alpha-2 adrenoceptors were examined in chronically instrumented, conscious dogs. Norepinephrine (0.02-0.1 micrograms/kg/min), a mixed alpha-1/alpha-2 adrenoceptor agonist, phenylephrine (0.2-1.0 micrograms/kg/min), a selective alpha-adrenoceptor agonist and B-HT 920 (0.5-2.0 micrograms/kg/min), a selective alpha-2 adrenoceptor agonist, were infused i.v. after ganglionic (hexamethonium, 30 mg/kg i.v.), beta adrenoceptor (propranolol, 1, mg/kg i.v.) and muscarinic receptor (atropine methylbromide, 0.1 mg/kg i.v.) antagonism. Each of the alpha adrenoceptor agonists increased mean arterial pressure and total peripheral resistance but had no significant effect on cardiac output, stroke volume or heart rate. Equipressor doses of the alpha adrenoceptor agonists caused similar increases in left ventricular systolic and end-diastolic pressure, but there were no significant changes in left ventricular dP/dt or heart rate with any of the alpha adrenoceptor agonists. Selective antagonism of alpha-1 adrenoceptors with prazosin (1 mg/kg i.v.) abolished the pressor and vasoconstrictor responses to phenylephrine but had a lesser effect on the response to B-HT 920. Antagonism of alpha-2 adrenoceptors with rauwolscine (0.1 mg/kg i.v.) caused a significantly greater attenuation of the pressor and vasoconstrictor responses to B-HT 920 than to phenylephrine. The responses to norepinephrine were significantly attenuated by antagonism of either alpha-1 or alpha-2 adrenoceptors. Thus, in the conscious dog with reflex pathways blocked, selective stimulation of either postsynaptic alpha-1 or alpha-2 adrenoceptors increases arterial pressure and total peripheral resistance but does not significantly change heart rate, left ventricular dP/dt, stroke volume or cardiac output.     

Role of the alpha agonist activity of dobutamine in mediating cardiac output: effects of prolonged isoproterenol infusion

Hemodynamic activities of dobutamine enantiomers were studied in either control rats or those infused with isoproterenol (400 micrograms/kg/hr) for 4 days. In control animals prazosin attenuated the effects of (+/-)-dobutamine on cardiac output by approximately 50%; remaining activity was blocked by propranolol. After isoproterenol infusion (+/-)-dobutamine was less efficacious and the blocking effects of prazosin were greater than 90%. Isoproterenol infusion had no effect on (-)-dobutamine-mediated (alpha-1 adrenoceptor agonist) increases in cardiac output and these actions were blocked by prazosin. By contrast, compared to (+/-)- and (-)-dobutamine, effects of (+)-dobutamine (beta adrenoceptor agonist) on cardiac output were modest, not altered by prazosin and were blocked by propranolol; (+)-dobutamine was inactive after isoproterenol infusion. (-)-Dobutamine increased systemic vascular resistance in both control and isoproterenol infused rats, whereas (+)-dobutamine was inactive. (+/-)-Dobutamine increased systemic vascular resistance only in isoproterenol-infused rats. All increases in systemic vascular resistance were blocked by prazosin. Neither (+/-)- nor (+)-dobutamine significantly altered stroke volume. By contrast, (-)-dobutamine resulted in prazosin-sensitive increases in stroke volume in both control and isoproterenol-infused rats. In control animals, (+/-)-, (+)- and (-)-dobutamine increased heart rate in a dose-dependent manner; chronotropic effects of (-)-dobutamine were less than those of either (+/-)- or (+)-dobutamine. Chronotropic effects were not demonstrable in isoproterenol-infused animals. These data support the notion that in control rats cardiac output may be increased by either alpha or beta adrenoceptor stimulation.(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparative haemodynamic effects of dobutamine and isoproterenol in man

Dobutamine was infused at a rate of 8 mcg/kg/min in 17 patients with or without congestive heart failure. Cardiac output increased from an average 2.92 to 4.45 1/min/m2 (p<0.001) with no change in mean aortic pressure (93.4 to 97.8 mmHg) and only a slight increase in heart rate (78 to 87 beats/min). Left ventricular end-diastolic pressure decreased from an average 19 to 13.7 mmHg (p<0.01). Peak left ventricular dp/dt was doubled (1147 to 2370 mmHg/sec, p<0.001) and Vmax increased from 1.08 to 2.18 circ/sec (p<0.001). In 10 patients given equi-inotropic doses (100 per cent increase in peak dp/dt) Isoproterenol produced a greater increase in cardiac output (71 percent) than Dobutamine (51 percent). isoproterenol caused mean aortic pressure to fall significantly (8 percent) while no change was noted with Dobutamine. Accordingly, peripheral vascular resistances were reduced to a greater extent with Isoproterenol than with Dobutamine (p<0.05). Mean pulmonary arterial pressure decreased significantly (25±5.9 to 22±5.7 mmHg, p<0.05) with Isoproterenol infusion and remained unchanged with Dobutamine infusion. Dobutamine increased both stroke work (57 percent) and minute work (83 percent). With Isoproterenol however, only minute work was significantly increased (90 percent). Dobutamine therefore is a potent inotropic drug, with mild chronotropic and peripheral vascular effects and may be valuable in the management of severe heart failure not associated with hypotension.     

Effects of prolonged isoproterenol infusion on cardiac and vascular responses to adrenoceptor agonists

In vitro responses of cardiac and vascular smooth muscle to both adrenoceptor agonists and phosphodiesterase inhibitors were studied in tissues from either saline- or isoproterenol-infused rats. After chronic isoproterenol infusion the sigmoidal relationship between concentration of acutely administered isoproterenol and inotropic response of cardiac muscle was shifted to the right; the maximum response was decreased by approximately 40%. Inotropic responses were attenuated further by the beta adrenoceptor antagonist, propranolol. By contrast, quantitatively comparable inotropic responses to phenylephrine were not altered after isoproterenol infusion. However, they were blocked by the selective alpha adrenoceptor antagonist, prazosin, but were not affected by propranolol. Inotropic effects of the phosphodiesterase inhibitor, isobutylmethylxanthine, were comparable in tissues from either saline- or isoproterenol-infused rats. Similar results were obtained in vascular tissues. Portal veins and aortas from isoproterenol-infused rats were less responsive to the acute relaxant properties of the beta adrenoceptor agonists, isoproterenol and salbutamol. However, as in cardiac muscle, relaxant effects to phosphodiesterase inhibitors (isobutylmethylxanthine and papaverine) were not attenuated. In addition, contraction to norepinephrine was comparable in tissues from either saline- or isoproterenol-infused rats. These data indicate that isoproterenol infusion attenuates beta adrenoceptor-mediated responses of vascular and cardiac muscle to similar degrees but does not alter responses to either alpha adrenoceptor agonists or phosphodiesterase inhibitors.     

Pharmacology of LY175326: a potent cardiotonic agent with vasodilator activities

Compound LY175326 is one of a series of novel cardiovascular agents with both inotropic and vasodilator activities. In cat papillary muscles, LY175326 increased contractility in a concentration-dependent manner; these actions were not blocked by prazosin, propranolol or cimetidine. Inotropic responses were observed in unpaced, perfused guinea-pig hearts and these effects were associated with modest increases in heart rate and coronary flow. An i.v. dose of 0.1 mg/kg of LY175326 caused 54 and 95% increases in contractility in either the anesthetized cat or dog, respectively; corresponding heart rates were increased by less than 10%. Oral administration of 0.5 mg/kg to dogs was associated with an inotropic response that was maximal between 60 and 90 min and lasted in excess of 3 hr. These effects were not accompanied by increases in heart rate, gross behavioral changes or emesis. The pharmacology of LY175326 was evaluated in a propranolol-induced heart failure model using anesthetized beagle dogs. A bolus injection of 0.15 mg/kg of LY175326 followed by an infusion of 0.4 mg/kg/hr reversed the hemodynamic symptoms of heart failure by increasing left ventricular dP/dt60, cardiac output and stroke volume and reducing left atrial filling pressure and vascular resistance; heart rate was unchanged and calculated myocardial oxygen consumption was reduced. This balance of inotropic:vasodilator activities may provide a means of improving cardiac function while maintaining the myocardial oxygen supply:demand.     

Effect of inhibition of lipolysis on myocardial oxygen consumption in the presence of isoproterenol

The effect of intravenous infusion of isoproterenol on myocardial oxygen consumption (MVo(2)) was studied in 10 intact and anesthetized dogs before and after inhibition of lipolysis. In five dogs lipolysis was inhibited by nicotinic acid or beta pyridyl carbinol and in five other dogs by high plasma glucose concentrations. In spite of similar mechanical responses to isoproterenol, as evidenced by left ventricular pressure, maximal rate of rise of left ventricular pressure (dP/dt), heart rate and cardiac output, augmentation of MVo(2) was larger before (on average 7.6 ml/min.100 g) than after inhibition of lipolysis either by antilipolytic drugs (on average 4.5 ml/min.100 g) (P < 0.005), or by high plasma glucose concentrations (on average 4.3 ml/min.100 g) (P < 0.02). As mechanical responses to isoproterenol were similar before and after inhibition of lipolysis, it is concluded that the additional rise in MVo(2) with intact lipolysis was caused by a metabolic stimulation by high concentrations of free fatty acids.     

Effects of ketamine on left ventricular performance.

The cariac response to anesthetic doses of ketamine hydrochloride was studied in dogs, initially in the absence of other drugs and subsequently during beta adrenergic block with propranolol and combined beta adrenergic and cholinergic blockade with propranolol and atropine. Ketamine (4 mg/kg) was injected into the left atrium or the jugular vein. Administration of ketamine alone resulted in increases in heart rate (61 beats/min, P smaller than .001), cardiac output and left ventricular systolic pressure, but left ventricular end-diastolic pressure and dP/dt max (maximum rate of change of left ventricular isovolumic pressure development) were unchanged. After propranolol, the increase in heart rate produced by ketamine was attenuated, and a transient fall in dP/dt max occurred. After propranolol and atropine, heart rate was not changed by ketamine, but dP/dt max fell and left ventricular end-diastolic pressure rose. Systemic vascular resistance was not altered by ketamine. It is concluded that administration of ketamine increases sympathetic discharge and reduces vagal discharge to the heart. In the absence of sympathetic and vegal control over the heart, the drug depresses myocardial contractility.     

Inotropic selectivity of dobutamine enantiomers in the pithed rat

The inotropic selectivities of the (-)- and (+)-enantiomers of dobutamine were assessed in pithed rat by comparing the relative ability of each enantiomer to increase left ventricular contractility (left ventricular dp/dt) and heart rate. The (-)-enantiomer of dobutamine, which is predominantly an alpha-1 adrenoceptor agonist, displayed greater inotropic selectivity than the (+)-enantiomer, which is predominantly a beta-1 and beta-2 adrenoceptor agonist. Pretreatment with the alpha-1 adrenoceptor antagonist prazosin significantly inhibited the effect of (-)-dobutamine on left ventricular dp/dt, but did not affect the chronotropic activity of this enantiomer. As such, pretreatment with prazosin decreased the inotropic selectivity of (-)-dobutamine. In contrast, the inotropic activity and selectivity of (+)-dobutamine were not affected by prazosin pretreatment. These results indicate that the inotropic effects of (-)-dobutamine are mediated, at least in part, by alpha-1 adrenoceptors. We conclude, based on the marked inotropic activity of (-)-dobutamine and the greater inotropic selectivity of (-)-dobutamine over (+)-dobutamine, that alpha-1 adrenoceptors may play a role in the inotropic activity and selectivity of racemic dobutamine used clinically. The possible involvement of both myocardial alpha-1 and beta-1 adrenoceptors in the inotropic activity of dobutamine must be considered.     

Effects of Catecholamines, Exercise, and Nitroglycerin on the Normal and Ischemic Myocardium in Conscious Dogs

The effects of isoproterenol, norepinephrine, dobutamine, exercise, and nitroglycerin on left ventricular diameter, pressure, velocity of shortening, dP/dt, dP/dt/P, arterial pressure, left circumflex coronary blood flow, and coronary vascular resistance were examined in healthy conscious dogs with normal coronary perfusion and in the same animals after moderate global ischemia had been induced by partial occlusion of the left main coronary artery. In the normal nonischemic heart, all interventions improved left ventricular performance, as evidenced by increases in dP/dt/P and velocity at the same or lower left ventricular end-diastolic diameter. Interventions, which in the normal heart caused large increases in heart rate and myocardial contractility, e.g. isoproterenol and exercise, or which decreased coronary perfusion pressure, e.g. nitroglycerin or isoproterenol, elicited paradoxical responses in moderate global ischemia, i.e., left ventricular enddiastolic diameter and pressure rose, and dP/dt/P and velocity fell substantially. On the other hand, norepinephrine, which increased coronary perfusion pressure along with myocardial contractility but did not increase heart rate, improved left ventricular function. Dobutamine, which did not alter heart rate or arterial pressure substantially while improving myocardial contractility, produced an intermediate response between that of norepinephrine and isoproterenol in the presence of moderate global myocardial ischemia. Thus, interventions that increase myocardial O(2) requirements, by increasing heart rate and myocardial contractility without augmenting coronary perfusion pressure, can produce a paradoxical depression of ventricular function in the presence of global myocardial ischemia.     

Desensitization to the inotropic effect of isoproterenol in cultured ventricular cells

To determine whether monoalyers of cultured chick embryo ventricular cells would show tachyphylaxis to chronotropic and inotropic effects of a beta adrenergic agonist, spontaneously contracting monolayers of primary cell cultures were studied using a phase-contrast microscope-video motion detector system that permitted quantitation of the chronotropic and inotropic state. The monoalyers were chronotropically unresponsive to isoproterenol between 10(-9) to 10(-6) M and chronotropically unresponsive to a 6-fold increase in perfusate calcium concentration. However, the cells were very inotropically responsive to calcium and to isoproterenol. Expressing the isoproterenol inotropic response as a percentage of response to 3.6 mM Ca, the response to 10(-6) M isoproterenol was 79 +/- 4% of the Ca response and the EC50 for isoproterenol was 3 x 10(-9) M. The monolayers rapidly developed dose-dependent desensitization to the inotropic effect of isoproterenol; after a 30-min exposure to 1 x 10(-6) M isoproterenol, the inotropic response was 40 +/- 5% of the initial response; desensitization was long-lasting and could be prevented by propranolol. Response to calcium remained unchanged after exposure to 10(-6) M isoproterenol. Thus, the cultured cell preparation shows rapid, sustained, beta receptor specific desensitization to the inotropic effects of a catecholamine.     

Inhibition by 5-hydroxytryptamine of the beta adrenoceptor-mediated positive inotropic responses to catecholamines in rabbit papillary muscles: direct interaction with beta adrenoceptors.

The effects of 5-hydroxytryptamine (5-HT) on the positive inotropic responses to catecholamines were investigated in isolated rabbit papillary muscles. 5-HT produced a concentration-dependent positive inotropic effect, an effect which was antagonized by prazosin, but not by propranolol. The positive inotropic effect of 5-HT diminished greatly in muscles from rabbits pretreated with 6-hydroxydopamine. Thus, it is likely that 5-HT causes a release of norepinephrine and increases force of contraction indirectly through alpha-1 adrenoceptors. In the presence of prazosin, 5-HT exerted a concentration-dependent inhibition of the positive inotropic response to isoproterenol. The positive inotropic responses to tyramine and a beta-1 adrenoceptor agonist T-1583 were also inhibited by the addition of 5-HT. The inhibitory effect of 5-HT on the beta adrenoceptor-mediated responses was unaffected by methysergide, ketanserin, ICS 205-930 or atropine. Pretreatment with pertussis toxin did not block the inhibitory effect of 5-HT on the inotropic response to isoproterenol, while abolishing the cholinergic interaction against the isoproterenol response. In contrast to its antagonizing effect on the inotropic response to isoproterenol, 5-HT produced an additive effect on the positive inotropic response to norepinephrine. However, when neuronal amine uptake was blocked by cocaine, the positive intropic response to norepinephrine was suppressed by the addition of 5-HT. 5-HT inhibited (-)-[125I]iodocyanopindolol binding to the membranes from rabbit ventricles with a monophasic displacement curve.(ABSTRACT TRUNCATED AT 250 WORDS)     

Responses of coronary vessels to adrenergic stimuli

Coronary responses to adrenergic stimuli were determined in the intact beating heart before and after administration of practolol, 4-(2-hydroxy-3-isopropylaminoproproxy) acetanilide, which in low doses blocks myocardial but not vascular beta receptors. The left circumflex coronary artery of dogs was perfused with arterial blood at constant flow, and coronary perfusion pressure was measured.Before practolol, intracoronary injections of isoproterenol and norepinephrine and electrical stimulation of left cardiac sympathetic nerves caused reductions in perfusion pressure or vasodilatation associated with increases in left ventricular dp/dt, heart rate, and systolic pressure.After practolol, the coronary vasodilator response to isoproterenol was reduced by about 30% and occurred without significant changes in dp/dt, heart rate, and pressures. The addition of propranolol blocked completely the coronary responses to isoproterenol. Vascular responses to isoproterenol in the paw were not altered by practolol.Practolol antagonized the increases in dp/dt, heart rate, and systolic pressure and reversed coronary responses to norepinephrine and nerve stimulation from dilatation to constriction. The constriction, in turn, was reduced or reversed by phentolamine, an alpha receptor antagonist. Propranolol did not augment the constriction seen in response to norepinephrine and nerve stimulation after practolol.These results indicate that the coronary vasodilator action of norepinephrine and sympathetic nerve stimulation is indirect and caused by stimulation of myocardial beta receptors. The direct effect of these two stimuli on coronary vessels is minimal and is mediated through stimulation of alpha (vasoconstrictor) receptors. In contrast, the coronary vasodilator response to isoproterenol is both direct and indirect, resulting from stimulation of vascular and myocardial beta receptors; the direct vascular effect predominated in this study.     

Effects of cardiac depression and of anesthesia on the myocardial action of a cardiac glycoside

The effects of ouabain (G-strophanthin) 20 mug/kg, on left ventricular (LV) pressure (P), diameter (D), velocity of contraction (dD/dt), and dP/dt were studied in conscious dogs instrumented with ultrasonic diameter gauges and miniature pressure gauges. The effects of ouabain were compared on separate occasions in the same dogs after cardiac depression with propranolol, 3.0 mg/kg, and also after general anesthesia with Na pentobarbital, 30 mg/kg. Maximal pressor effects were observed in the first 10 min, but maximal effects on the contractile state occurred at 30 min after ouabain. At this time, in conscious dogs, ouabain had increased LV isolength systolic pressure by 5%, LV isolength velocity by only 9%, and LV (dP/dt)/P by 21%, while end systolic diameter (ESD) decreased slightly and end diastolic diameter (EDD) and heart rate (HR) were unchanged. After anesthesia, ouabain increased LV systolic pressure by 8%, velocity 32%, (dP/dt)/P by 47%, and ESD decreased by 1.2 mm while EDD rose slightly and HR fell by 26 beats/min. Returning HR to control with atrial pacing decreased EDD 0.9 mm below control. After cardiac depression with propranolol, ouabain caused responses similar to those observed in the anesthetized dogs. Thus, the cardiac glycoside was found to exert only minor inotropic effects on the nonfailing heart of conscious dogs but far more striking inotropic responses in the anesthetized state.     

Nonadrenergic effects of isoproterenol in dogs with hypoxic pulmonary vasoconstriction. Possible role of prostaglandins

To determine whether the pulmonary vasodilation produced by isoproterenol is mediated solely by its beta adrenergic effects, we studied the hemodynamic responses to isoproterenol in three groups of dogs with pulmonary vasoconstriction produced by continuous ventilation with 10% oxygen: (a) hypoxia alone, (b) hypoxia and propranolol 0.3 mg/kg i.v. bolus followed by an infusion of 5 micrograms/kg per min, and (c) hypoxia after pretreatment with an inhibitor of cyclooxygenase, either indomethacin or meclofenamate 5 mg/kg s.c. twice daily for 2 d prior to study. All groups had similar values for mean pulmonary artery pressure (PAPm) and pulmonary vascular resistance (PVR) during room air and hypoxic ventilation. Isoproterenol in doses of 0.0025, 0.005, and 0.05 micrograms/kg per min produced a dose-related decline in PAPm and PVR during hypoxia in group 1. Despite beta-blockade with propranolol (group 2), isoproterenol at all three doses significantly reduced PAPm and PVR. The responses to isoproterenol were comparable in the presence or absence of propranolol; at 0.05 micrograms/kg per min the effects of isoproterenol were blunted, but not abolished, by propranolol. Similar results were observed even when five times the dose of propranolol was given. Isoproterenol at all three doses had no effect, however, on PAPm and PVR in the cyclooxygenase inhibitor-pretreated group. These data suggest that the pulmonary vasodilator effects of isoproterenol are not mediated solely by pulmonary vascular beta adrenergic receptors, and that vasodilator prostaglandins may play a role in the responses to this drug.     

Reflex vagal withdrawal and the hemodynamic response to intravenous isoproterenol in the presence of beta-antagonists

To investigate the contribution of reflex vagal tone to the hemodynamic response after intravenous isoproterenol, 12 healthy subjects received isoproterenol by both bolus injection and continuous infusion before and after atropine, and during intravenous infusion of the beta 1-selective antagonist atenolol and the nonselective beta-antagonist, propranolol. With bolus injections, atropine displaced the heart rate dose-response curve for atenolol to the right, implying reflex withdrawal of cardiac vagal tone, but did not alter the heart rate dose-response curve for propranolol. With continuous infusions of isoproterenol, atropine displaced the heart rate dose-response curves for both atenolol and propranolol to the left, implying the presence of a reflex increase rather than withdrawal in cardiac vagal tone. These reflex changes in cardiac vagal tone can be partly understood by changes in mean arterial pressure and pulse pressure. As the two methods of isoproterenol administration are associated with contrasting contributions from reflex vagal tone, dose ratios obtained for the displacement of the heart rate dose-response curve by beta-antagonists may differ.     

Cardiac effects of 3,5-diiodothyropropionic acid, a thyroid hormone analog with inotropic selectivity.

Thyroid hormone exerts a strong positive inotropic action on the heart and induces alpha-myosin heavy chain (MHC) gene expression. 3,5-Diiodothyropropionic acid (DITPA), a carboxylic acid analog with low metabolic activity, was observed to induce alpha-MHC mRNA in heart cell culture with EC50 approximately 5 x 10(-7) M. To determine if the compound has positive inotropic actions, the effects of DITPA and L-thyroxine on heart rate, left ventricular pressures, left ventricular dP/dt, myosin isoenzymes and hepatic alpha-glycerolphosphate dehydrogenase activity were compared in hypothyroid rats. Binding affinities of DITPA and triiodothyronine for bacterially expressed alpha-1 and beta-1 thyroid hormone receptors (TRs) also were determined. Over the dosage range of 150 to 1500 micrograms/100 g, DITPA produced increases in left ventricular dP/dt comparable to those obtained with L-thyroxine at dosages of 1.5 to 15 micrograms/100 g, but with significantly less tachycardia. The increase in alpha-MHC mRNA was about the same with both compounds whereas alpha-MHC protein content and GPDH activity increased less with DITPA. These differences could not be explained by preferential binding of DITPA to TR subtypes. Because heart rate is a major determinant of myocardial oxygen consumption, DITPA is able to achieve increased cardiac performance at lower myocardial oxygen costs.     

Epinephrine and left ventricular function in humans: effects of beta-1 vs nonselective beta-blockade

Changes in cardiac performance in response to epinephrine administered by graded infusion were assessed by M-mode echocardiography in normotensive healthy subjects after pretreatment with placebo, the beta 1-selective blocker atenolol, or the nonselective beta-blocker propranolol. Epinephrine alone increased heart rate and left ventricular end diastolic dimension and decreased left ventricular end systolic dimension. Left ventricular performance as assessed by fractional shortening and systolic blood pressure/end-systolic volume (P/V) ratio was also increased. Atenolol pretreatment did not significantly affect the increase in heart rate by epinephrine. However, atenolol did prevent the effects of epinephrine on left ventricular dimensions and left ventricular performance at the lower infusion rates and significantly blunted these effects at the highest infusion rate. After propranolol, epinephrine significantly decreased left ventricular end diastolic dimension despite decreasing heart rate and left ventricular emptying (associated with a high afterload). P/V ratio remained unchanged. These results indicate that beta 2-receptors may play a major role in the increase in heart rate caused by epinephrine. In contrast, epinephrine's positive inotropic effect appears to be mediated primarily via beta 1-receptors and, at higher concentrations, possibly also through beta 2-receptors. The pattern of changes in left ventricular end diastolic dimension suggests that epinephrine increases venous return via both beta 1- and beta 2-receptor stimulation and that alpha-receptor stimulation (epinephrine after propranolol) may actually decrease venous return.     

Arterial hypoxemia in awake dogs. Role of the sympathetic nervous system in mediating the systemic hemodynamic and regional blood flow responses

The role of the sympathetic nervous system in the systemic hemodynamic and regional blood flow responses to hypoxia was studied in awake dogs by pre-exposing the animals to phentolamine alone (alpha block) or to phentolamine plus propranolol (alpha + beta block). Hypoxia was produced by switching from room air to either an 8% or 5% oxygen-nitrogen mixture. During 8% oxygen breathing, cardiac output, heart rate, left ventricular dP/dt, dP/dt/P, myocardial oxygen consumption, and myocardial blood flow increased, and both total peripheral and coronary vascular resistance fell. These changes were similar in all groups with and without adrenergic blockade. However, during 5% oxygen breathing, the rises in cardiac output, heart rate, left ventricular dP/dt, myocardial oxygen consumption, and myocardial blood flow and the decrease in coronary vascular resistance were less marked in the group given alpha + beta block than the intact animals or group given alpha block. Coronary blood flow correlated with myocardial metabolic demands. Adrenal and skeletal muscle blood flows increased during hypoxia. Breathing 5% oxygen also increased flow to the brain, but renal and splanchnic flows showed only minor changes. These changes in organ vascular resistance were unaffected by the adrenergic blockade. Our results indicate that although the sympathetic nervous system plays an important role in the systemic hemodynamic responses to hypoxia, the dominant local metabolic factors probably are primarily responsible for hypoxic vasodilation in the awake dog.