Impaired ventricular relaxation during myocardial ischemia and after reperfusion in isolated perfused canine hearts

The goal of this study was to investigate the mechanisms of impaired relaxation in ischemic and reperfused hearts without asynergic wall motion. To test the hypothesis that muscle elongation during ischemia does not improve the slowed relaxation, the time constant (T) of the isovolumic left ventricular pressure decay was obtained during volume loading in 14 isolated perfused canine hearts. In the nonischemic condition (coronary perfusion pressure: 107 +/- 3 mmHg), T progressively decreased as the peak left ventricular pressure was increased by volume loading. In contrast, in the ischemic condition (coronary perfusion pressure: 51 +/- 3 mmHg), T did not decrease despite an increase in peak left ventricular pressure by volume loading. These results indicate that during ischemia the impaired relaxation is not improved by an increase in preload. Moreover, reperfusion after a brief ischemia also increased T despite an increase in the contractile force, i.e., left ventricular pressure. The maximal change in the relaxation rate occurred much earlier than the maximal overshoot of the contractile force and coincided with an increase in coronary blood flow. These results indicate that prolongation of relaxation immediately after reperfusion is partly attributable to an increase in the electile force induced by the refilling of the coronary arteries. These mechanisms of impaired relaxation during ischemia and reperfusion may deteriorate ventricular filling and hence, cardiac output.     

Coronary venous perfusion of the ischemic myocardium during acute coronary artery occlusion in isolated rat hearts

Effects of retrograde coronary venous perfusion on oxygen supply and energy metabolism of ischemic myocardium of the isolated perfused rat heart were examined by means of NADH fluorescence photography. Occlusion of the left coronary artery produced regional ischemia of the left ventricular free wall, as evidenced by the sharply demarcated increase in NADH fluorescence. During ischemia, a narrow area of minimal fluorescence (140 +/- 10 microns), indicating sufficient oxygenation for oxidative phosphorylation, was observed around the epicardial coronary veins in the ischemic lesion. Retrograde perfusion was introduced through the coronary vein (left cardiac vein) that drained off the ischemic area, which resulted in a marked reduction of the area of increased NADH fluorescence in the epicardial surface. In the cross-sectional view, although the myocardium of the entire ischemic area induced by left coronary artery occlusion could be perfused by venous retroperfusion, the effect on reduction of the area of increased NADH fluorescence was seen only in the epicardial half of the myocardium. Retrograde coronary venous perfusion also resulted in a small increase in tension development (P less than 0.05), a decrease in resting tension (P less than 0.01), and partial preservation of myocardial high energy phosphate content (P less than 0.01). We propose that coronary venous retroperfusion improves oxygenation, partially preserves oxidative phosphorylation in the epicardium, and improves contractile function in the ischemic region.     

Load dependency of end-systolic pressure-volume relations in isolated, ejecting canine hearts

If characteristic muscle properties such as myocardial viscosity and/or shortening deactivation influence left ventricular ejection in the whole heart, the slope of the left ventricular end-systolic pressure-volume relation should be a function of both the contractile state and the loading mode. Thus, the load dependence of the end-systolic pressure-volume relation was examined using isolated, perfused canine hearts ejecting saline into a hydraulic loading system. The instantaneous left ventricular volume was measured with a plethysmograph. Under constant coronary flow and heart rate, two regression lines for end-systolic pressure-volume relations in two sets of loading modes were obtained: (1) Preload (left ventricular end-diastolic pressure; 4-15 mmHg) changes under fixed afterload impedance (preload changes); (2) Afterload impedance (peripheral resistance; 1.9-9.6 x 10(3) dyn sec cm-5) changes under fixed left ventricular end-diastolic volume (afterload changes). The slope of the end-systolic pressure-volume relation with afterload changes was steeper than that with preload changes (6.3 +/- 0.7 vs 4.8 +/- 0.6 mmHg/ml, p less than 0.05). Accordingly, under constant coronary flow, the slope of the end-systolic pressure-volume relation depended on loading conditions within the physiological range of afterload impedance and preload. This finding supports our hypothesis and implies that the slope change is of limited value as a contractile index in the ejecting heart.     

Characteristics of left-ventricular isovolumic pressure waves in isolated dog hearts

Summary The peak pressure which a chamber would develop in isovolumic contraction at end-diastolic distention (peak source pressure) is an expression of contractile vigor and a determinant of systolic performance. One can predict source pressure of an ejecting beat by fitting its isovolumic phases with a model isovolumic-wave function. Characteristics of the left-ventricular isovolumic pressure wave (amplitude, duration, shape) were studied in isolated, perfused, artificially loaded dog hearts, where strictly isovolumic conditions could be obtained over a wide range of cavity volumes at constant heart rate and approximately constant contractile state. The characterization involved two steps: (1) beginning and ending points were identified by a transition-locating algorithm, and (2) Fourier analysis was performed on points in between. The amplitude of the isovolumic pressure wave increased with cavity volume as expected, the duration of contraction increased with cavity volume, and the shape of the wave (normalized Fourier coefficients) depended slightly on the cavity volume. Duration of contraction declined slightly with increasing heart rate, but the shape of the isovolumic pressure wave was independent of heart rate. The mean shape was similar to that found in dog hearts subjected to one-beat aortic-root clamping in vivo — the wave being less sharply peaked than a cosine wave and tilted to the left because relaxation was slower than contraction. When ejecting beats were produced with a Windkessel model, ejecting-beat duration declined linearly with increasing ejection fraction. This relation could be used to predict the duration of the isovolumic beat corresponding to the duration of an ejecting beat. Source pressure could then be predicted by fitting a model isovolumic wave of predicted duration to the isovolumic contraction phase of the ejecting beat. In 270 comparisons, the ratio of predicted peak source pressure to observed peak source pressure was 1.04 ± 0.10 (SD). This method provides a reasonably accurate prediction of an important determinant of systolic performance.This work was supported by BRSG grant 2S07 RR-05424 and grant R29 HL-44555 of the National Institutes of Health.     

An increase in afterload augments ventricular relaxation rate in isolated perfused canine hearts

The afterload dependency of relaxation rate was reappraised in isolated canine hearts both in isovolumic and isobaric contractions by using the reliable exponential method in which the asymptote LV pressure (P chi) is variable. This method provided a closer correlation (r = 0.999 +/- 0.001) between the measured LV pressure decay and the model estimate than the semilogarithmic method assuming P chi = 0 (r = 0.992 +/- 0.001). Time constants of isovolumic LV pressure decay obtained by the exponential method demonstrated a significant (p less than 0.01) decrease during volume loading both in isovolumic and isobaric contractions, indicating that the relaxation rate is augmented as afterload increases. In contrast, if we assume P chi = 0, the time constant of LV pressure decay was independent of peak LV pressure as previously reported. Thus, we conclude that the load insensitive relaxation rate implied by the semilogarithmic method (P chi = 0) may be erroneous due to an invalid assumption, ie, P chi = 0, but the relaxation rate is augmented as afterload increases both in isovolumically contracting and isobarically ejecting isolated canine hearts.     

Accuracy of volume measurement by conductance catheter in isolated, ejecting canine hearts

We evaluated the accuracy of the recently reported technique of estimating intraventricular volume by measurement of intracavitary electrical conductance in six isolated, ejecting, canine left ventricles. Left ventricular volumes were measured directly by a previously validated servosystem that employed an electroconductive balloon placed in the left ventricular cavity. The volume measured continuously by the balloon method (Vbal) was compared with that estimated by the conductance method (Vcath). For this test, the hearts were made to eject and fill physiologically by the use of a previously described computer-simulated arterial loading system. Complex ejection and filling patterns were created by stimulating the atrium mechanically, which resulted in irregular arrhythmatic contractions spanning a wide range of volumes. We found that there was a highly linear relationship (r2 = .982 +/- .014) between Vbal and Vcath: Vcath = 0.82 (+/- .05) Vbal + 26.7 (+/- 11.8) ml. Despite the wide variation in the offset term of this relationship among the different hearts, the offset within a given heart was predicted within 3.5 ml by a previously detailed "dilution" method that is applicable to the heart in situ within a closed thorax. Thus, since the offset term is obtainable in situ, the conductance method provides a signal that is proportional to the actual volume. To determine whether right ventricular volume influenced the accuracy of left ventricular measurement, we compared the relationship between Vcath and Vbal obtained with right ventricular volumes of 0 and 30 ml. Increasing the right ventricular volume shifted the relationship upward by less than 3 ml in the working range.(ABSTRACT TRUNCATED AT 250 WORDS)     

Delayed end ejection increases isovolumic ventricular relaxation rate in isolated perfused canine hearts

We sought to determine the ejection variables that are principally responsible for increases in isovolumic ventricular relaxation rate observed with increases in stroke volume. In nine isolated canine hearts, left ventricular ejection was controlled by patterns specially designed to isolate the ejection parameters most critical to isovolumic relaxation rate. When stroke volume was augmented by increases in end-diastolic volume (EDV) with end-systolic volume (ESV) held constant, isovolumic ventricular relaxation rate was unchanged, as gauged by the time constants of single-exponential fits to decaying pressure. In contrast, when ESV was decreased with EDV held constant, isovolumic relaxation time constants decreased significantly, from approximately 100 to 70 msec (protocol I). The important difference in these two situations might have been that the time of end ejection was delayed in the case with faster isovolumic relaxation. To rule out other parameters that may have influenced isovolumic relaxation, ejection velocity was varied in another protocol (protocol II) by either delays in time of the onset of ejection or advances in end-ejection time, always with constant ESV and EDV. Here isovolumic relaxation was progressively slowed as end ejection occurred earlier, whereas isovolumic relaxation rate was insensitive to changes in the onset of ejection, consistent with the unique importance of end ejection to isovolumic relaxation. In fact, our analysis reveals the remarkable finding that changes in isovolumic relaxation time constant produced by either protocol I or protocol II could be related quantitatively to end ejection by a single curve.(ABSTRACT TRUNCATED AT 250 WORDS)     

Mechanically induced action potential changes and arrhythmia in isolated and in situ canine hearts

Stretch of excised myocardial tissue causes electrophysiological and potentially arrhythmogenic changes in transmembrane action potentials but corresponding data of the intact mammalian heart are lacking. The effects of increases in ventricular volume and pressure on epicardial monophasic action potentials were therefore investigated in isolated, cross circulated and in situ canine hearts. In seven isolated hearts, increases in ventricular volume and pressure resulted in (1) a linearly related decrease in action potential amplitude (r = 0.988; slope = 0.41% amplitude.ml-1; volume intercept = 17.6 ml), mainly due to a decrease in maximum diastolic potential; (2) a decrease in action potential plateau duration (at 20% repolarisation) by 19 (SD 8)%; and (3) appearance of early afterdepolarizations, reaching up to 18% of total action potential amplitude. Afterdepolarizations occurred only when ventricular outflow was obstructed at end diastole but not at end systole. In eight in situ hearts, increase in left intraventricular pressure produced by transient occlusions of the ascending aorta was also accompanied by decrease in maximum diastolic potential and action potential plateau duration, and by appearance of early afterdepolarizations. In both isolated and in situ intact ventricles, the loading induced electrophysiological changes were associated with occurrence of ectopic ventricular beats. These data show that mechanical overload produces significant electrophysiological changes in the intact canine ventricle which may lead to arrhythmia.     

Effects of calcium and EMD-53998 on oxygen consumption in isolated canine hearts.

BACKGROUND. Most positive inotropic agents increase cardiac contractility by increasing the amount of Ca2+ cycled with each beat. The additional amount of oxygen that is consumed by the heart to cycle this additional Ca2+ is believed to reduce myocardial efficiency. On the other hand, it has been suggested that the agent EMD-53998 increases the Ca2+ sensitivity of the contractile proteins without affecting the intracellular Ca2+ transient in cardiac muscle. Therefore, application of this agent may increase cardiac contractility without decreasing myocardial efficiency. The purpose of the present study was to test this hypothesis. METHODS AND RESULTS. We measured myocardial oxygen consumption (MVO2) in six isolated, isovolumically beating blood-perfused canine hearts. The hearts were paced at 120 beats per minute. Contractility was varied in each heart by infusion of either CaCl2 or EMD-53998. With infusion of either agent, MVO2 was a linearly proportional function of contractility. No significant difference between CaCl2 and EMD-53998 could be detected in the interrelation between contractility and MVO2. CONCLUSIONS. We conclude that the "calcium-sensitizing agent" EMD-53998 is a potent positive inotropic agent in the isolated, blood-perfused canine heart. However, EMD-53998 does not provide an energetic advantage over currently used positive inotropic agents.     

苯那普利对离体大鼠缺血再灌注心肌的保护作用

目的观察苯那普利对离体大鼠缺血再灌注心肌的保护作用,初步探讨其作用机制。方法应用Langendorff装置,采用完全停灌复灌的方法制作离体大鼠心肌缺血再灌注模型。将24只SD大鼠随机等分3组:对照组(KH液持续灌注110 min),缺血再灌注组(KH液灌流20 min,停灌30 min,再灌注60 min),苯那普利组(缺血30 min,再灌注60 min,灌注液加入苯那普利10-6mol/L)。观察再灌注心律失常发生情况、血流动力学、光镜下心肌结构改变、心肌肿瘤坏死因子-α(TNF-α)免疫组织化学染色。结果与缺血再灌注组比,苯那普利组再灌注60 min内室性心动过速、心室颤动发生率降低;血流动力学指标明显改善;光镜可见炎症损伤减轻。免疫组织化学染色可见TNF-α蛋白阳性表达主要在心肌细胞胞浆苯那普利组呈弱阳性;对照组阴性;缺血再灌注组强阳性。结论苯那普利对缺血再灌注心肌具有保护作用,其机制可能与抑制TNF-α表达、减轻炎症有关。     

Ventricular fibrillation during no-flow global ischemia in isolated rabbit hearts

Introduction: The dominant frequency (DF) during ventricular fibrillation (VF) in Langendorff-perfused guinea pig hearts is higher in left ventricle (LV) than in right ventricle (RV). However, the onset of VF invariably leads to global ischemia. Whether or not a high DF source exists in LV during global ischemia is unknown.
Methods and Results: By using a two-camera optical mapping system, epicardial activation patterns of VF were studied in 12 isolated rabbit hearts during baseline, no-flow global ischemia, and reperfusion. Simultaneous endocardial electrode recording was performed in 4 of the 12 hearts. Optical mapping showed type 1 VF at baseline, with multiple wandering and short-lived wavelets. After the onset of global ischemia, VF showed progressively increased spatiotemporal periodicity. The majority (65%) of VF recorded after 7 minutes of global ischemia showed type 2 VF, containing a single epicardial site with stable (≥3.85 seconds in duration) repetitive activities. Among the 33 sites with these activities, 24 were located near the interventricular septum, and 27 showed an epicardial breakthrough pattern with centrifugal propagation and wavebreaks distant from the focal site. After 10 minutes of global ischemia, the DF was lower on LV epicardium (5.0 ± 1.4 Hz) than on RV epicardium (8.6 ± 2.5 Hz, P < 0.001). However, there was no DF gradient between RV and LV endocardium (9.7 ± 1.0 vs 9.6 ± 0.9 Hz).
Conclusions: VF during prolonged global ischemia is consistent with type 2 VF with a single subepicardial source of rapid activation, mostly near the interventricular septum. The DF in LV is not higher than in RV.     

Restitution dynamics during pacing and arrhythmias in isolated pig hearts

INTRODUCTION: The dependence of action potential duration (APD) on the preceding diastolic interval (DI), i.e., restitution, has been purported to predict the development of alternans and reentrant arrhythmias. However, restitution depends on the history of activation (i.e., memory), and its relevance to arrhythmia induction and maintenance is unknown. METHODS AND RESULTS: Using a dual-camera video imaging system, we recorded action potentials from thousands of sites on the surface of the isolated pig heart. A steady-state pacing (SSP) protocol was performed to generate the SSP APD restitution curve. During SSP, the minimum DI and APD were 57 +/- 6 ms and 107 +/- 6 ms, respectively. The restitution slope was >1 for DIs <85 +/- 5 ms; however, alternans were not observed. Abrupt decreases in cycle length (CL) resulted in a rapid (<5 beats) decrease in APD followed by a slower decrease to "steady state." DI, APD pairs for the initial beats following these rate changes were significantly above the SSP restitution curve. DI, APD pairs measured during sustained ventricular fibrillation clustered significantly below the SSP restitution curve, at significantly shorter APDs (57 +/- 4 ms) and DIs (49 +/- 6 ms) than could be achieved during SSP. In addition, abrupt increases in CL following SSP resulted in APDs significantly shorter than those predicted from the SSP restitution curve. CONCLUSION: Our results indicate that the responses of APD and DI to sudden rate changes and during arrhythmias are not predicted by the SSP restitution relationship. Acute dynamics act to damp out the proarrhythmic oscillations predicted from the SSP restitution curve.     

Electron microscopic changes and edema after nine hours' perfusion of isolated canine hearts

In a comparative study, we investigated whether or not removed and non-beating hearts could be preserved in vitro by continuous perfusion with oxygen-carrying solutions (blood, perfluoro-carbon emulsion) and simultaneous substitution with specific substrates. We used 18 mongrel dogs subdivided into 2 groups (1st group: perfluorocarbon emulsion; 2nd group: blood); the perfusion time was 9 h. In addition to parameters to control the medium of the perfusion solution, we measured parameters that would allow us to assess the success of the extended perfusion. These parameters were high-energy phosphates and, in particular, electron optical analysis. At the end of the perfusion period, electron optical analysis revealed a mild and reversible ischemic reaction by the myocardial cells in both groups. However, statistical analysis showed (1) a significant increase in the ischemic reaction for both groups over the perfusion period (P=0.02), and (2) a significant, even more pronounced ischemic reaction in the subendocardial myocardium (P=0.025). It should be noted that distinctly interstitial edema developed during the perfusion period and that this would appear to be a fairly critical problem with extended continuous isolated heart perfusion.Supported by grants of the Deutsche Forschungsgemeinschaft     

Excitability of isolated hearts from rats during postnatal development

INTRODUCTION: After birth, cardiac myocytes undergo substantial growth and differentiation that affect their stimulation threshold. Cells from younger animals have a higher stimulation threshold than cells from adults. The aim of this work was to compare the excitability of isolated hearts of rats during postnatal development by measuring the stimulation threshold at several pulse durations. METHODS AND RESULTS: Stimulation threshold of isolated hearts were measured at eight different pulse durations between 0.1 to 20 msec. For each heart, a strength-duration curve was constructed and data were fitted using both Weiss-Lapicque and Blair models. Analysis of variance showed significant age-dependent differences in both rheobase field (E(reob)) and chronaxie (c). E(reob) decreased while c increased during development (E(reob) was 0.21, 0.16, 0.13, 0.10, and 0.09 V/cm and c was 2.0, 2.2, 2.3, 2.7, and 3.2 msec for rats aged 1, 2, 4, 8, and 20 weeks, respectively). There was a decrease in the threshold field with heart weight between 0.1 and 0.7 g, whereas the threshold was almost constant in the range from 0.7 to 2.0 g. Estimation of the energy density needed to defibrillate the heart was performed and appeared to be higher for younger than for adult animals. CONCLUSION: Hearts from younger animals have higher stimulation threshold than those from adults. This probably is due to changes in the cellular threshold as a result of maturation. The smaller excitability of younger hearts can have consequences with regard to the energy levels required for younger patients.     

Wedged hepatic venous pressure reflects portal venous pressure during vasoactive drug administration in nonalcoholic cirrhosis

Hepatic venous catheterization is widely used to assess portal pressure. However, it remains unclear whether wedged hepatic venous pressure is a close indicator of portal venous pressure during vasoactive drug administration in nonalcoholic cirrhosis. To address this issue, we analyzed the data from our previous published studies. Forty patients with nonalcoholic cirrhosis (HBV infection in five, HCV infection in 28, and cryptogenic in seven) were available in this analysis. A vasoconstrictor (N=14), vasodilator (N=10), or combination (N=16) was administered. The agreement of the changes between portal and wedged hepatic venous pressures during pharmacological manipulation was assessed by an intraclass correlation coefficient. The intraclass correlation coefficient in each subgroup was more than 0.60 (0.62 in vasoconstrictor group, 0.87 in vasodilator group, and 0.73 in combination group). When the analysis was performed according to the cause of liver disease, the values were 0.67 in HBV infection, 0.73 in HCV infection, and 0.74 in cryptogenic cirrhosis. These results suggest that wedged hepatic venous pressure reflects portal venous pressure during vasoactive drug administration in patients with nonalcoholic cirrhosis.