Comparison of acute electrophysiological effects of amiodarone and its metabolite desethylamiodarone in Langendorff perfused guinea pig hearts

Summary During long-term treatment with amiodarone, slowing of conduction through the atrioventricular node, a prolongation of the QT-interval, and a prolongation of the atrial and ventricular myocardial refractoriness always developed. During short-term treatment, these effects were not found, except for depression of the AV-nodal conduction. This led to the suggestion that the electrophysiological effects of amiodarone during long-term treatment might be partly the result of the accumulation of its metabolite desethylamiodarone. Therefore, we examined the electrophysiological effects of amiodarone and desethylamiodarone on conduction and refractoriness in isolated spontaneously beating guinea pig hearts perfused by the method of Langendorff. Within 1 h of perfusion, desethyl-amiodarone caused a more pronounced prolongation of the AV-nodal, His-bundle, and intraventricular conduction intervals than did amiodarone. Desethylamiodarone, but not amiodarone led to a prolongation of the QT-interval. The refractoriness of sinoatrial-, AV-nodal conduction, and of the atrial myocardium were significantly more prolonged by amiodarone than by desethylamiodarone. Both compounds showed a comparable strong rate-dependent effect on AV-nodal refractoriness. The ventricular refractoriness was similarily prolonged by either compound. These results show that for the class-III effects (i.e., prolongation of repolarization period) observed under chronic treatment of amiodarone the metabolite desethylamiodarone may be responsible. Desethylamiodarone also exerts more pronounced effects on the fast-channel-dependent parts of the conduction system than does amiodarone, a fact indicated by a higher prolongation of His-bundle and intraventricular conduction.Supported by the Austrian Research Foundation, grant P 7141 and by the Austrian Development Fund, grant 5/545 and grant Z13/7098/513     

The synthesis, release and action of leukotrienes in the isolated, unstimulated, buffer-perfused rat heart

When the perfusion medium of an isolated, non-recirculating, Langendorff rat heart is changed from Krebs buffer to coronary effluent, a significant vasoconstriction (23%, P less than 0.005) is observed. In this study we have investigated the involvement of leukotrienes in this phenomenon. We have extracted and quantified leukotrienes C4, D4 and E4 in samples of coronary effluent taken at different times during the first 2 h of perfusion; the total amounts released during this time were 9, 5 and 32 pmol of LTC4, LTD4 and LTE4 respectively. We have used two different methods to prevent the action of the effluent leukotrienes on the heart. Firstly, we have blocked the leukotriene receptors in the heart, with FPL 55712 (3.8 microM), during perfusion with effluent and, secondly, we have perfused with coronary effluent which was collected in the presence of a leukotriene synthesis inhibitor, AA861 (1 microM). The addition of FPL 55712 to the effluent decreased the normally observed vasoconstriction such that after 30 min the coronary flow rate (CFR) was 114 +/- 3% (n = 6) compared with 66 +/- 1% (n = 7) with effluent alone (P less than 0.005). Effluent collected in the presence of AA861 also caused a decrease in the normally observed vasoconstriction such that by 30 min the CFR was still 88 +/- 2% (n = 6, P less than 0.005 compared to controls). We have confirmed the proposed involvement of leukotrienes in the effluent-induced vasoconstriction by investigating the effect of a mixture of the synthetic leukotrienes C4, D4 and E4, when each of them was present at the same concentration as measured in the coronary effluent; the vasoconstriction observed was superimposable upon that seen with effluent. This vasoactive effect of the leukotriene mixture was not secondary to a change in contractility, since this only decreased to 97 +/- 5% (n = 9) during the 30 min of the leukotriene infusion. Finally, we have studied the effects of the same two leukotriene blockers in normal, buffer-perfused hearts after an initial perfusion of either 30 or 120 min. Application of either AA861 or FPL 55712 resulted in a dramatic vasodilatation (25 to 45% increase), a larger effect always being observed after the shorter initial period of perfusion. Our conclusions are two-fold. Firstly, isolated, buffer-perfused rat hearts synthesize leukotrienes C4, D4 and E4 in considerable amounts and release them into the coronary effluent and secondly, the coronary flow rates of isolated, buffer-perfused rat hearts are partly controlled by the action of internally produced leukotrienes.     

Enhancement of mitochondrial oxidative phosphorylation capability by hypoperfusion in isolated perfused rat heart

To define alterations in myocardial mitochondrial function due to hypoperfusion, oxidative phosphorylation was simultaneously studied in 17 control (stable perfusion pressure) rat hearts and 17 hypoperfused isolated rat hearts. Hypoperfusion for 30 minutes was achieved by a reduction in coronary perfusion pressure from 77.8 +/- 1.2 mm Hg (mean +/- SEM) to 20.2 +/- 1.8 mm Hg in the experimental group (control perfusion pressure after 30 minutes 75.6 +/- 1.2). Hypoperfusion caused a reduction in left ventricular developed pressure to 20.5 +/- 1.5 mm Hg (versus control 74.8 +/- 3.3, p less than 0.0001), a reduction of coronary flow rate to 4.9 +/- 0.3 ml/min (versus control 19.4 +/- 1.2, p less than 0.0001), and a drop in myocardial oxygen consumption to 0.06 +/- 0.005 ml O2/min (versus control 0.17 +/- 0.01, p less than 0.0001). Myocardial lactate production was increased by hypoperfusion (3.0 +/- 0.6 mumol/min) compared with controls (0.7 +/- 0.5, p less than 0.02), but myocardial creatine kinase release was similar in the hypoperfused and control groups. Hypoperfusion was associated with an augmentation of state 3 mitochondrial respiration with glutamate and malate as respiratory substrates (448.8 +/- 14.0 ng atoms O/min/mg mitochondrial protein versus controls 290.7 +/- 13.4, p less than 0.001). When rates were normalized for mitochondrial malate dehydrogenase (MDHm), state 3 respiration was still increased in hypoperfused hearts (24.1 +/- 2.1 ng atoms O/min/IU MDHm) compared with controls (15.5 +/- 1.6, p less than 0.02). The rates of dinitrophenol-uncoupled electron transport were similar to the rates of state 3 respiration in both the hypoperfused and control groups.(ABSTRACT TRUNCATED AT 250 WORDS)     

Reduction of hyperacute rejection and protection of metabolism and function in hearts of human decay accelerating factor (hDAF)-expressing pigs

OBJECTIVE: The use of pig hearts can solve the problem of shortage of donor hearts for transplantation. However, targeting rejection by single genetic modification was proven to be ineffective, highlighting the requirement for complex genetic modifications and more effective methods for transgenic animal production. We evaluated here whether hearts of hDAF transgenic pigs generated using our technique sperm-mediated gene transfer (SMGT) will be protected from structural damage, metabolic changes, and mechanical dysfunction during perfusion with human blood. METHODS: Hearts from control (C, n = 6) or transgenic (T, n = 5) pigs were perfused ex vivo for 4 h with fresh human blood using the ex vivo working mode system allowing monitoring of the function, metabolism, and structure. RESULTS: Cardiac output (mean+/-SEM) was maintained in T constant throughout the experiment, at 3.58+/-0.36 and 3.83+/-0.14 l/min after 30 min and 4 h, respectively, while cardiac output decreased to 1.95+/-0.35 l/min in C after 30 min of perfusion (p < 0.01 vs. T). The maximum increase in coronary perfusion pressure was reduced in T to 154+/-16% as compared to C (237+/-10%, p < 0.001). Myocardial ATP after 4 h was 21.1+/-1.1 nmol/mg dry wt (similar to initial) in T, while it decreased in C to 17.2+/-1.4 (p < 0.05). Deposition of complement factors C3 and C5b9 was present in C but not in T after perfusion. CONCLUSION: We have shown that hearts from hDAF transgenic pigs produced by SMGT are protected during perfusion with human blood and are metabolically stable and maintain mechanical function above the threshold level for life support.     

Adenine nucleotide release from isolated perfused guinea pig hearts and extracellular formation of adenosine.

The quantification of adenine nucleotides released from the heart is hampered by their rapid dephosphorylation to adenosine in the extracellular space catalyzed by highly active ectonucleotidases. To determine the total release of adenine nucleotides from isolated Langendorff-perfused guinea pig hearts, ecto 5'-nucleotidase was effectively blocked by infusion of alpha, beta-methylene-ADP (AOPCP, 50 microM). Adenine nucleotides were measured in the coronary venous effluent by the luciferin-luciferase method after enzymatic rephosphorylation to ATP. In hearts perfused at a constant flow rate (10 ml/min) with normoxic buffer (95% O2, 5% CO2) the release +/- SEM of adenine nucleotides and adenosine was 0.06 +/- 0.01 (n = 11) and 0.04 +/- 0.01 (n = 13) nmol/min. In the presence of AOPCP, the release of adenine nucleotides increased to 0.43 +/- 0.04 nmol/min (n = 9; p less than 0.05), whereas adenosine remained unchanged. Hypoxic perfusion (10% O2, 85% N2, 5% CO2) caused a threefold increase in adenine nucleotide release but a 40-fold increase in adenosine. In contrast, global ischemia (30 seconds) caused adenine nucleotide and adenosine release to rise to similar values of 1.06 +/- 0.10 and 0.80 +/- 0.14 nmol/min (n = 9). Stimulation of hearts with isoproterenol (4 nM) likewise increased the release of adenine nucleotides (0.50 +/- 0.04 nmol/min) and adenosine (0.87 +/- 0.21 nmol/min) (n = 6). To determine the cellular source of adenine nucleotides released from the heart, the coronary endothelial adenine nucleotide pool was selectively prelabeled by [3H]adenosine. Global ischemia increased the specific radioactivity of released adenine nucleotides by 57%. The findings indicate that 1) adenine nucleotides and adenosine are released at the same order of magnitude from the well-oxygenated heart; 2) beta-adrenergic stimulation and ischemia stimulate the release of adenine nucleotides and adenosine, both purines reaching vasoactive concentrations in the effluent perfusate; 3) during hypoxic perfusion only the release of adenosine is greatly enhanced; and 4) the coronary endothelium preferentially contributes to the ischemia-induced adenine nucleotide release.     

Endothelium bound extracellular superoxide dismutase type C reduces damage in reperfused ischaemic rat hearts.

OBJECTIVE: The aim was to determine if endothelium associated extracellular superoxide dismutase type C (EC-SOD C) exerts any protective effect against cardiac damage induced by ischaemia and reperfusion. METHODS: Langendorff perfused rat hearts were subjected to 15 min global ischaemia followed by reperfusion. Prior to the ischaemia the hearts were perfused for 15 min with a buffer containing recombinant human EC-SOD C (rh-EC-SOD C, 20 mg.litre-1), or the corresponding vehicle, followed by extensive perfusion with SOD free medium. RESULTS: In hearts receiving the vehicle, reperfusion was associated with a marked release of creatine kinase into the effluent [28 (SEM 1.5) IU.15 min-1, n = 5] and coronary flow measured 15 min after initiation of reperfusion was reduced by 68% compared to preischaemic flow. In hearts pretreated with EC-SOD C but washed with enzyme free buffer before being subjected to ischaemia, the creatine kinase release was significantly smaller, at 14(2.1) IU.min-1, n = 5 (p less than 0.001), and the reduction in coronary flow less extensive (54%, p less than 0.05, v vehicle). To demonstrate the binding of EC-SOD C to the endothelium, heparin, which releases EC-SOD C from the endothelial surfaces, was added to the perfusate 30 min after initiation of reperfusion. The same amount of EC-SOD C was released to the effluent from previously ischaemic hearts [(12.4(2) micrograms)] as from hearts not subjected to ischaemia [(13.8(1.4) micrograms)]. CONCLUSIONS: Recombinant human EC-SOD type C bound to the endothelial surface reduces the cardiac damage associated with ischaemia and reperfusion. The protective effect was evident both in terms of a reduction of biochemical markers of injury and a better preservation of postischaemic coronary flow. Furthermore, ischaemia and subsequent reperfusion did not cause any alteration in the binding capacity of EC-SOD C to the cardiac vasculature.     

Ischemic threshold and myocardial stunning in the aging heart

The aging heart appears to be more susceptible to ischemia-reperfusion injury than the adult heart. There is no evidence of an age-related difference in the threshold of myocardial ischemia and myocardial stunning. We studied the effects on mechanical, hemodynamic, and metabolic parameters of graded reduction of coronary perfusion pressure from 66 to 29 mmHg in isolated and perfused hearts from adult and senescent rats. Cardiac function was also assessed during recovery following ischemic period. In both adult and senescent hearts developed pressure and +dP/dt linearly decreased and end-diastolic pressure linearly increased with decreasing perfusion pressure. However, all mechanical parameters were more severely impaired in senescent than in adult hearts at 37 mmHg and 29 mmHg perfusion pressure, respectively (p < 0.01 vs. adult). At 29 mmHg, in both adult and senescent hearts lactate production similarly increased whereas creatine kinase leakage did not differ from controls. Developed pressure recovered more slowly in senescent than in adult hearts (p < 0.001) in the absence of cellular damage and in the presence of restoration of coronary flow. Lactate production observed at the same step of coronary perfusion pressure suggests that the ischemic threshold is similar in adult and senescent hearts. The slow recovery of myocardial contractility after the ischemic period observed in senescent hearts suggests an age-related increase in myocardial stunning.     

冠状动脉内干细胞灌注对载脂蛋白E基因缺陷小鼠离体心脏血液动力学影响的实验研究

目的 评估冠状动脉内细胞灌注对载脂蛋白（apo）E基因缺陷小鼠离体心脏血液动力学的影响。方法 应用Langendorff离体心脏灌注模型,观察apoE基因缺陷小鼠心脏接受不同剂量干细胞[低剂量细胞组（1．0×10^6细胞）,n=10;高剂量细胞组（2．5×10^6细胞）,n=10]灌注时的血液动力学变化。选用WT小鼠心脏作为对照[低剂量细胞组（1．0×10^6细胞）,n=10;高剂量细胞组（2．5×10^6细胞）,n=10],比较各组离体心脏细胞注射后5、15和30min时的血液动力学指标（包括心率、左心室最大压力、左心室等容收缩期压力最大变化速率、左心室舒张期压力下降最大变化速率、左心室舒张末压变化,同时观察各组冠状动脉血流及漏出液中细胞含量。结果 基础状态下apoE基因缺陷小鼠离体心脏各项血液动力学指标与V汀小鼠相似。apoE基因缺陷小鼠各组及对照高剂量细胞注射组离体心脏在接受细胞灌注后30min心率显著减慢,左心室舒张末压明显升高,且左心室等容收缩期压力最大变化速率明显降低（与基础测值比较,P均〈0．01）,对照低剂量细胞注射组心率明显下降（P〈0．05）,其他指标变化不明显（P〉0．05）。与对照组V汀小鼠离体心脏比较,apoE基因缺陷小鼠离体心脏在细胞灌注后各项血液动力学指标显著变差,高剂量细胞灌注组更为明显（P均〈0．01）。细胞灌注后各组冠状动脉流量均明显低于基础状态（P均〈0．01）,灌注后30min apo E基因缺陷小鼠高剂量细胞注射组冠状动脉流量变化最为显著（与其他各组比较P〈0．05）。灌注后30min,大多数从细胞冠状动静脉循环排出心脏（63．2％～77．0％）。结论经冠状动脉干细胞灌注对离体小鼠心脏血液动力学有不良影响,这一不良影响在使用高剂量细胞灌注及对动脉粥样硬化性心脏应用时更为显著。     

Local Inhibition of Angiotensin II Formation and Bradykinin Degradation in Isolated Hearts

ABSTRACT

The interaction of the converting enzyme (CE)-inhibitor ramipril and the bradykinin (BK)-antagonist D-Arg-[Hyp⁵,Thi^5,8,D-Phe⁷]BK with angiotensin I (ANG), ANG II and BK were studied in isolated hearts of rats and guinea pigs.

In isolated working rat hearts perfusion with ANG I and ANG II reduced cardiac function and coronary flow, increased the activities of lactate dehydrogenase (LDH) and creatine kinase (CK) in the perfusate, decreased high-energy rich phosphates and glycogen in the myocardium and increased duration and incidence of postischemic reperfusion arrhythmias. BK on the other hand reduced LDH and CK activities, improved metabolic parameters in the myocardium and reduced reperfusion arrhythmias.

In isolated rat hearts pretreatment with ramipril protected against reperfusion arrhythmias and reduced enzyme activities of LDH and CK in the coronary effluent. Cardiodynamic parameters and coronary flow improved and myocardial tissue levels of glycogen, ATP and creatine phosphate (CP) were elevated. Almost identical changes were seen during perfusion with BK. The cardioprotective effects produced by both, the CE-inhibitor and BK, were completely abolished when the BK-antagonist was added to the perfusate, while a smaller inhibition was obtained by indomethacin perfusion.

In isolated guinea pig hearts BK increased coronary flow. Single-dose oral pretreatment with ramipril potentiated, whereas perfusion with the BK-antagonist abolished this effect.

These data add support to the hypothesis that local inhibition of CE = kininase II contributes to the beneficial effects of CE-inhibitors in the heart.     

The beneficial effect of a calcium channel blocker, Diltiazem, on the ischemic-reperfused heart

Diltiazem-HCl,^® a potent calcium channel blocker, was found to be effective in moderating the harmful effects of reperfusion on the severely ischemic myocardium. In isolated working rat heart preparations it was found that 120 min of global ischemia followed by 15 min of reperfusion resulted in a massive leakage of creatine phosphokinase into the coronary effluent, and in many cases, in fibrillation and/or contracture. Left ventricular end-diastolic pressure increased sharply during reperfusion in these hearts. Reperfusion did not affect tissue ATP levels, but did increase creatine phosphate somewhat. When Diltiazem was added to the perfusate (final concentration 0.4 μm) 5 min prior to re-establishment of flow, the deleterious effects of reperfusion were greatly reduced. None of the hearts fibrillated on reperfusion, and none developed contracture. Left-ventricular end-diastolic pressure was increased only slightly in these hearts. The amount of creatine phosphokinase released into the coronary effluent during re-flow was only one-half that which was released by hearts reperfused in the absence of Diltiazem. In the Diltiazem-treated hearts reperfusion restored creatine phosphate to near-normal levels, although ATP levels were not increased. The beneficial effects of Diltiazem are probably related to its ability to reduce the rapid and massive mitochondrial calcium overloading which normally accompanies reperfusion of severely ischemic myocardium.     

Preservation of ventricular function by treatment of ventricular fibrillation with phenylephrine

Epinephrine promotes resuscitation from ventricular fibrillation because of its peripheral vasoconstrictive effects. However, the beta-adrenergic effects of epinephrine may be detrimental because of the stimulation of myocardial oxygen demand. To test whether functional recovery from fibrillation in hearts treated with a selective alpha-adrenergic agent is greater than in hearts treated with epinephrine, ventricular fibrillation was induced in eight isolated dog hearts while coronary perfusion pressure was maintained at 30 mm Hg. In random order, epinephrine (5 micrograms/min), phenylephrine (50 micrograms/min) or no drug was infused for 5 min. The heart was then defibrillated, the drug infusion stopped and coronary perfusion pressure increased to 100 mm Hg. Coronary blood flow (ml/min per 100 g), arteriovenous oxygen difference (ml O2/dl) and myocardial oxygen consumption (ml O2/min per 100 g) measured after 4 min of ventricular fibrillation were greater with epinephrine (mean +/- SD 30.9 +/- 11.7, 17.5 +/- 1.6 and 5.4 +/- 1.9, respectively) than with phenylephrine (24.4 +/- 6.0, 15.7 +/- 2.6 and 3.8 +/- 1.1, respectively) or no drug (19.8 +/- 5.2, 12.8 +/- 1.8 and 2.6 +/- 0.7, respectively) (p less than 0.05, p less than 0.05 and p less than 0.05, respectively). The slope of the end-systolic pressure-volume relation 10 min after defibrillation and restoration of normal coronary perfusion pressure was depressed (percent of prefibrillation value) most by epinephrine infusion (72 +/- 17%, n = 6), less by no drug infusion (82 +/- 12%, n = 4) and was increased after phenylephrine infusion (143 +/- 17%, n = 6) (p less than 0.002).(ABSTRACT TRUNCATED AT 250 WORDS)     

葡萄糖酸镁对离体大鼠心肌缺血再灌注细胞凋亡和Fas及FasL的影响

目的观察葡萄糖酸镁对离体大鼠心肌缺血再灌注细胞凋亡和Fas/FasL水平是否存在影响及其可能机制。方法48只雄性SD大鼠随机分为3组:对照组,缺血再灌注组(I/R组),葡萄糖酸镁组。实验1:每组取8只大鼠,对照组用改良的K-H液持续灌注110 min;I/R组用改良的K-H液灌流20 min后,停灌30 min,再灌注60 min;葡萄糖酸镁组改良的K-H液中加入葡萄糖酸镁2.4 mmol/L,余同I/R组。检测心肌灌流液中肌酸激酶(CK),乳酸脱氢酶(LDH)含量,心肌组织中总超氧化物歧化酶(T-SOD)、丙二醛(MDA)含量。实验2:取每组其余8只大鼠,实验过程类似实验1,不同点是其再灌注时间改为120 min。实验结束检测心肌Fas和FasL蛋白表达及心肌细胞凋亡指数。观察实验1、2再灌注20min内心律失常发生情况。结果与I/R组比较,葡萄糖酸镁组心律失常发生率显著下降(P<0.01);再灌流出液中CK、LDH含量明显降低(P<0.01);心肌组织T-SOD活性显著升高(P<0.01),MDA含量、Fas/FasL蛋白表达及细胞凋亡指数明显降低(P<0.01)。结论葡萄糖酸镁可清除氧自由基,干预Fas/FasL的表达从而减少心肌细胞凋亡。     

Deferoxamine, an iron chelator, reduces myocardial injury and free radical generation in isolated neonatal rabbit hearts subjected to global ischaemia-reperfusion.

The protective action of deferoxamine, an iron chelator, against functional and metabolic deteriorations of ventricular muscle, induced by ischaemia-reperfusion, was investigated in Langendorff-perfused hearts of neonatal rabbits in comparison with superoxide dismutase (SOD) plus catalase. The perfused hearts were subjected to normothermic (37 degrees C) global ischaemia for 45 min following cardiac arrest with St Thomas cardioplegic solution and then reperfused with oxygenated Krebs-Henseleit solution. In control hearts, the recovery of the left ventricular developed pressure (LVDP) after 30 min reperfusion was 50.7 +/- 3.1% (mean +/- SE, n = 5) of the pre-ischaemic value. The LVDP recovery was significantly improved in the hearts treated with deferoxamine at 10-100 microM (89.4 +/- 1.4% at 30 microM, P < 0.01 vs. control). The improvement in LVDP was less prominent when treated with 30 x 10(4) U/l SOD plus 30 x 10(4) U/l catalase (67.9 +/- 2.0%, P < 0.01 vs. deferoxamine at 30 microM). CPK leakage into the coronary effluent during the initial 5 min of reperfusion was reduced to around half of the control value with 30 microM deferoxamine (P < 0.05 vs. control), while unaffected by the addition of SOD plus catalase. Free radicals in the coronary effluent were measured with electron spin resonance spectroscopy in separate experiments by using a spin-trapping agent, 5,5-dimethyl-1-pyrroline-N-oxide (DMPO). A burst of DMPO-OH signal was detected during the initial minutes of reperfusion. The intensity of DMPO-OH signal was significantly reduced by 30 microM deferoxamine to about one-third of control.(ABSTRACT TRUNCATED AT 250 WORDS)     

Regional effects of verapamil on recovery of excitability and conduction time in experimental ischemia

This study was designed to test the hypothesis that verapamil has an effect on ischemia-initiated arrhythmias related to its regional influences on recovery of excitability and conduction time. Using a coronary perfused preparation of cat left ventricle that allows simultaneous electrophysiologic monitoring of both endocardium and epicardium, we studied the effect of verapamil on ischemia-induced changes in transmembrane action potentials, conduction properties, and refractory periods of endocardial and epicardial muscle cells. Oxygenated Tyrode's solution was perfused through the left anterior descending coronary artery, while the preparation was superfused with Tyrode's solution gassed with 95% N2 and 5% CO2. "Ischemia" was produced by stopping coronary perfusion. During 30 min of ischemia, resting potential, action potential amplitude (APA), and action potential duration (APD) were reduced, and conduction time was prolonged in both endocardial and epicardial cells, but the changes were greater in the epicardial cells. Endocardial refractory periods shortened in parallel with APD shortening throughout 30 min of ischemia, whereas epicardial refractory periods shortened for the first 10 min and then increased due to development of longer postrepolarization refractoriness. As a result, there were significant differences in refractory periods between endocardial and epicardial cells at 10 and 30 min of ischemia, and rapid ventricular activity could be induced at these times. Exposure to verapamil (1 mg/liter) before cessation of coronary perfusion significantly limited the reduction of APA and the prolongation of conduction time during the first 10 min of ischemia in epicardial cells, but did not influence endocardial cells. During the remaining 20 min of ischemia, verapamil enhanced the reduction of APD of both epicardial and endocardial cells.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of repeated brief episodes of ischemia and reperfusion in isolated perfused rat hearts

Summary The effects of ischemia and reperfusion on the coronary endothelium and myocardium as well as tolerance to ischemia/reperfusion injury were assessed using isolated retrogradely perfused rat hearts. Repeated brief episodes of myocardial ischemia followed by reperfusion is known to have a protective effect against subsequent myocardial infarction. However, no studies have been performed with perfusion in the absence of blood cells to determine the effect of repeated ischemia and reperfusion on the coronary endothelium and myocardium. Using the Langendorff perfusion technique, rat hearts were subjected to a 30-, 10-, 5-, or 2-min period of low-flow perfusion by reducing the coronary flow to 3ml/min followed by reperfusion at 20ml/min for the same period of time. Control perfusion was then performed at a constant flow rate of 20 ml/min for 60min. Acetylcholine-induced coronary vasodilation was significantly (P < 0.05) lower in hearts subjected to 30min of ischemia and 30min of reperfusion when compared with the control hearts. Myocardial creatinine kinase (CK) activity was significantly reduced (P < 0.01) in hearts subjected to ischemia and reperfusion for either 30, 10, or 5min. To assess the effect of repeated episodes of ischemia and reperfusion, the following protocols were used: a control study with constant perfusion for 60min (group A), 30min of ischemia and 30min of reperfusion (group B), three 10min episodes of ischemia and reperfusion (group C), six 5-min episodes of ischemia and reperfusion (group D), and 15 2-min episodes of ischemia and reperfusion (group E). Acetylcholine-induced coronary vasodilation was significantly inhibited in group B (80% ± 12%,P < 0.05) and group C (70% ± 13%,P < 0.01), but did not change significantly in either group D (123% ± 19%) or group E (142% ± 15%), compared with the control group (group A; 127% ± 15%, mean ± SEM). Nitroglycerin-induced coronary vasodilation was not altered by ischemia/reperfusion in any group. In contrast, myocardial CK activity was significantly lower in group B (3.6 ± 0.6IU/mg protein,P < 0.01), group C (3.2 ± 0.1IU/mg protein,P < 0.01), and group D (3.3 ± 0.2IU/mg protein,P < 0.01) than in group A (47 ± 6.7 IU/mg protein). The myocardial CK activity of group E was not significantly different from that of group A, but was significantly higher than in groups B, C, and D (P < 0.01). In isolated perfused rat hearts, both the coronary endothelium and myocardium are damaged by repeated episodes of ischemia and reperfusion. However, the coronary endothelium is more resistant to such damage than is the myocardium.     

Species variation in anoxic-induced damage of heart muscle

Substrate-free anoxic perfusion of isolated rat hearts results in the release of creatine phosphokinase (CPK) into the coronary effluent. To test the specificity of this response a series of experiments was undertaken, using isolated rabbit and guinea-pig hearts instead of rat hearts. A marked species variation was found not only in the CPK release pattern but also in the protective effect of glucose, and the effect of reoxygenation.     

Use dependence of amiodarone during the sinus tachycardia of exercise in coronary artery disease

The QRS duration at rest and during exercise was studied in 19 patients with coronary artery disease before and after oral amiodarone therapy to determine if this drug produces detectable rate-dependent conduction slowing during physiologic increases in heart rate. QRS duration did not change significantly during exercise in the absence of the drug. However, after amiodarone, QRS duration at rest increased from 99 to 114 ms (p less than 0.001), and increased further from 114 to 127 ms (p less than 0.001) during the 45 beats/min mean increase in heart rate produced by exercise. The magnitude of this effect was related to the resting QRS duration. After amiodarone therapy, the QRS increased during exercise by only 6% in 8 patients with QRS less than 110 ms, while in 12 patients with QRS greater than or equal to 110 ms, the QRS increased by 15% (p less than 0.05). Rate-dependent conduction slowing occurs during the sinus tachycardia of exercise in patients treated with amiodarone, presumbably due to use-dependent sodium channel blockade. This result is most pronounced in patients with abnormal ventricular conduction at rest.     

EDRF increases cyclic GMP in platelets during passage through the coronary vascular bed

It was investigated whether endothelium-derived relaxing factor (EDRF) increases cyclic GMP (cGMP) content in platelets passing through the coronary bed. Boluses of washed platelets from healthy human donors were injected into the aortic perfusion line of isolated, saline-perfused rabbit hearts under constant flow conditions (28 +/- 2 ml/min). The coronary effluent was collected over 5 seconds, and the cGMP content of platelets was determined by radioimmunoassay. Platelet cGMP amounted to 0.34 +/- 0.11 pmol/mg protein after passage through the unstimulated coronary bed. During stimulation with acetylcholine (1 microM), it increased to 1.6 +/- 0.5 pmol/mg (p less than 0.01; n = 14). Simultaneously, the platelet recovery (measured over 20 seconds after injection) was enhanced (by 45 +/- 11%; p less than 0.01) during endothelial stimulation with acetylcholine. Treatment with the EDRF inhibitor hemoglobin (6 microM) completely abolished the increase in platelet cGMP (p less than 0.01; n = 11) as well as the enhanced platelet recovery (n = 8). Inhibition of EDRF by hemoglobin reduced also the basal platelet cGMP content to 0.17 +/- 0.11 pmol/mg (p less than 0.01). The data indicate that basally released EDRF is able to increase cGMP in platelets during a single passage through the coronary bed. The enhanced recovery of platelets after EDRF stimulation, which coincides with an increase of platelet cGMP, suggests that EDRF plays an important role as inhibitor of platelet activation in the coronary circulation.     

Thrombolysis in acute myocardial infarction: effect of intravenous followed by intracoronary streptokinase application on estimates of infarct size

The effect of pretreatment with intravenous infusion of streptokinase (SK) (16,700 U/min for 90 minutes), started after diagnosis and followed by intracoronary application (2000 U/min) (protocol 1), was assessed retrospectively in 55 consecutive patients with acute transmural myocardial infarction (MI). Another 46 patients with acute MI treated previously by intracoronary thrombolysis served as control subjects (protocol 2). Reperfusion at first coronary injection was observed after pretreatment in 25 patients (45%), but in no control patient (p less than 0.001). Fifteen patients with successful pretreatment (group A), 20 patients with successful treatment according to protocol 2 (group B) and 9 patients with unsuccessful thrombolysis (group C) were restudied after 4 weeks. Data from patients with reinfarction, coronary bypass surgery or percutaneous transluminal coronary angioplasty before restudy were excluded. Thallium-201 scintigraphy was performed before and 24 hours after treatment, serum creatine kinase activity was measured every 8 hours for 3 days and regional ejection fraction (EF) of acute MI was determined before and 4 weeks after treatment. The scintigraphic, enzymatic and hemodynamic data before treatment indicated severe and comparable ischemia among the 3 groups. The thallium-201 perfusion defect decreased in group A (from 41 to 21%, p less than 0.01) and in group B (from 38 to 26%, p less than 0.01), but did not change in group C (from 37 to 31%, difference not significant). Peak serum creatine kinase levels normalized by the perfusion area of acute MI was 20, 33 and 58 U/liter unit in groups A, B and C. The mean values of groups A and C were significantly different (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of amiodarone on conduction and refractoriness of the His-Purkinje system in the human heart

Although the antiarrhythmic aspect of amiodarone has been extensively studied, its effects on His-Purkinje system conduction and refractoriness have not been systematically investigated in human beings. In 24 patients, anterograde His-Purkinje system conduction (HV intervals) and variables of His-Purkinje system refractoriness using the ventricular extrastimulus (V2) technique were analyzed before and after long-term therapy with amiodarone. The mean duration of amiodarone therapy at the time of repeat study was 16.2 +/- 7.7 weeks (range 11 to 42). The anterograde His-Purkinje system conduction time (HV interval) measured 49.6 +/- 9.5 ms (range 40 to 80) before and 60.6 +/- 10.7 ms (range 45 to 90) after amiodarone (p less than 0.005). During retrograde refractory period studies, the longest V1V2 interval at which a retrograde His bundle potential (H2) emerged from the V2 electrogram (relative refractory period of the His-Purkinje system) was consistently longer after amiodarone as compared with the control period (376.4 +/- 46.6 versus 318.8 +/- 33.1 ms, p less than 0.005). Similarly, the shortest and longest His-Purkinje system conduction times ( V2H2 interval) at comparable V1V2 intervals were uniformly and significantly prolonged after administration of the drug. Amiodarone also abolished macroreentry in the His-Purkinje system in six of the nine patients who showed such reentry during the control period. The effective refractory period of the ventricular myocardium was also increased from a mean of 227.1 +/- 13.9 to 259.2 +/- 20.2 ms (p less than 0.005) in this series of patients.(ABSTRACT TRUNCATED AT 250 WORDS)