ascorbic-acid and Ventricular-Dysfunction--Left

The positive effect of vitamin C on left ventricular (LV) inotropic responses to dobutamine, observed in patients with preserved LV function, is lost in heart failure (HF). We tested the hypothesis that in HF, endogenous nitric oxide (NO) opposes the positive effect of vitamin C on adrenergically stimulated contractility by examining the effects of vitamin C on dobutamine responses during NO synthase inhibition. In 11 HF patients, a micromanometer-tipped catheter was inserted into the LV and an infusion catheter was positioned in the left main coronary artery. The peak positive rate of change of LV pressure (LV +dP/dt) was measured in response to intravenous dobutamine (Dob-1). After recontrol, intracoronary N(G)-monomethyl-L-arginine (l-NMMA) was infused before reinfusion of dobutamine (L-NMMA + Dob-2). Finally, intracoronary vitamin C was infused in addition to intracoronary L-NMMA and dobutamine (L-NMMA + Dob-2 + vitamin C). Intracoronary L-NMMA alone had no effect on LV +dP/dt. After a stable inotropic response to intracoronary L-NMMA and dobutamine was established, the addition of intracoronary vitamin C resulted in a modest but significant increase in LV +dP/dt. The change in LV +dP/dt in response to dobutamine alone was 25 +/- 5%, with intracoronary L-NMMA, 27 +/- 6%, and with intracoronary L-NMMA plus vitamin C, 37 +/- 5% (P < 0.05 vs. Dob-1 and L-NMMA + Dob-2). These findings demonstrate that an interaction between endogenous NO and redox environment exists and exerts some influence on stimulated contractility in HF.

Topics: Ascorbic Acid; Blood Pressure; Cardiotonic Agents; Dobutamine; Drug Combinations; Heart Failure; Heart Rate; Humans; Male; Middle Aged; Myocardial Contraction; Nitric Oxide; Nitric Oxide Synthase; omega-N-Methylarginine; Treatment Outcome; Ventricular Dysfunction, Left

What is the central question of this study? We aimed to examine oxidative stress, antioxidant capacity and macro- and microvascular function in response to 30 days of oral antioxidant administration in patients with heart failure with reduced ejection fraction. What is the main finding and its importance? We observed an approximately twofold improvement in macrovascular function, assessed via brachial artery flow-mediated dilatation, and a reduction in oxidative stress after antioxidant administration in patients with heart failure with reduced ejection fraction. The improvement in macrovascular function was reversed 1 week after treatment cessation. These findings have identified the potential of oral antioxidant administration to optimize macrovascular health in this patient group.. Heart failure with reduced ejection fraction (HFrEF) is characterized by macrovascular dysfunction and elevated oxidative stress that may be mitigated by antioxidant (AOx) administration. In this prospective study, we assessed flow-mediated dilatation (FMD) and reactive hyperaemia responses in 14 healthy, older control participants and 14 patients with HFrEF, followed by 30 days of oral AOx administration (1 g vitamin C, 600 I.U. vitamin E and 0.6 g α-lipoic acid) in the patient group. Blood biomarkers of oxidative stress (malondialdehyde) and AOx capacity (ferric reducing ability of plasma) were also assessed. Patients with HFrEF had a lower %FMD (2.63 ± 1.57%) than control participants (5.62 ± 2.60%), and AOx administration improved %FMD in patients with HFrEF (30 days, 4.90 ± 2.38%), effectively restoring macrovascular function to that of control participants. In a subset of patients, we observed a progressive improvement in %FMD across the treatment period (2.62 ± 1.62, 4.23 ± 2.69, 4.33 ± 2.24 and 4.97 ± 2.56% at days 0, 10, 20 and 30, respectively, n = 12) that was abolished 7 days after treatment cessation (2.99 ± 1.78%, n = 9). No difference in reactive hyperaemia was evident between groups or as a consequence of the AOx treatment. Ferric reducing ability of plasma levels increased (from 6.08 ± 2.80 to 6.70 ± 1.59 mm, day 0 versus 30) and malondialdehyde levels decreased (from 6.81 ± 2.80 to 6.22 ± 2.84 μm, day 0 versus 30) after treatment. These findings demonstrate the efficacy of chronic AOx administration in attenuating oxidative stress, improving AOx capacity and restoring macrovascular function in patients with HFrEF.

Topics: Aged; Antioxidants; Ascorbic Acid; Biomarkers; Case-Control Studies; Female; Heart Failure; Humans; Hyperemia; Male; Middle Aged; Oxidative Stress; Prospective Studies; Thioctic Acid; Ventricular Dysfunction, Left; Vitamin E

Supplementary oxygen is commonly administered in current medical practice. Recently it has been suggested that hyperoxia causes acute oxidative stress and produces prompt and substantial changes in coronary resistance in patients with ischemic heart disease. In this report, we examined whether the effects of hyperoxia on coronary blood velocity (CBV) would be associated with a reduction in myocardial function. We were also interested in determining if the postulated changes in left ventricular (LV) function seen with tissue Doppler imaging (TDI) could be reversed with intravenous vitamin C, a potent, acute anti-oxidant. LV function was determined in eight healthy subjects with transthoracic echocardiography and TDI before and after hyperoxia and with and without infusing vitamin C. Hyperoxia compared with room air promptly reduced CBV by 28 ± 3% (from 23.50 ± 2.31 cm/s down to 17.00 ± 1.79 cm/s) and increased relative coronary resistance by 34 ± 5% (from 5.63 ± 0.88 up to 7.32 ± 0.94). Meanwhile, LV myocardial systolic velocity decreased by 11 ± 6% (TDI). These effects on flow and function were eliminated by the infusion of vitamin C, suggesting that these changes are mediated by vitamin C-quenchable substances acting on the coronary microcirculation.

Topics: Adult; Antioxidants; Ascorbic Acid; Coronary Stenosis; Female; Humans; Hyperoxia; Male; Treatment Outcome; Vasoconstriction; Ventricular Dysfunction, Left

The insulin-like action of metal complexes on target tissues, including the heart, has been reported in experimental diabetes mellitus. Since streptozotocin-induced diabetes is associated with insulin deficiency and left ventricular dysfunction, this study was designed to determine whether the novel metal complex molybdenum ascorbate [MoO(2)(aa)(2)] would improve cardiac function in this model of diabetes.. Diabetes was induced in Sprague-Dawley rats (n = 6) following an intravenous injection of streptozotocin (60 mg/kg). After 8 weeks of diabetes, cardiac function was determined in isolated working hearts perfused with 11 mmol/L glucose, 1.2 mmol/L palmitate and 3% albumin. MoO(2)(aa)(2 )was added directly into the perfusate of working hearts at a concentration of 200 micromol/L for a period of 30 minutes. Age-matched control rats served as controls (n = 6).. Cardiac function, expressed as heart rate (HR) and aortic flow, was significantly decreased in diabetic hearts compared with control hearts. The diabetic state was associated with 23% and 60% reductions in HR and aortic flow, respectively. Short-term addition of MoO(2)(aa)(2) was beneficial and partially prevented the attenuation in diabetic rat heart function. MoO(2)(aa)(2 )increased HR by 15%, while aortic flow was increased by 85%. In control hearts, MoO(2)(aa)(2) had no effect on HR and increased aortic flow by 12%.. This study extends previous observations on the benefit of metal complexes in experimental diabetes. Our results indicate that short-term treatment with MoO(2)(aa)(2) partially reversed the left ventricular dysfunction associated with the streptozotocin model of diabetes.

Topics: Animals; Aorta; Ascorbic Acid; Blood Pressure; Body Weight; Coronary Circulation; Diabetes Mellitus, Experimental; Heart; Heart Rate; In Vitro Techniques; Male; Molybdenum; Organ Size; Rats; Rats, Sprague-Dawley; Ventricular Dysfunction, Left; Vitamins

It has been suggested that oxidative stress contributes to impaired left ventricular (LV) contractility in the setting of heart failure (HF). To test this hypothesis, we studied the effect of an antioxidant on contractility at rest and in response to dobutamine in 10 HF patients. We hypothesized that vitamin C would augment contractility in HF and that this effect would be of a greater magnitude in HF patients compared with patients with normal LV (NLV) function. Data from 10 patients with NLV function who participated in this study are included in this report and have been published elsewhere. A micromanometer-tipped catheter was introduced into the LV. In the experimental protocol, an infusion catheter was positioned in the left main coronary artery. The peak positive rate of change of LV pressure (LV +dP/dt) was measured in response to the intravenous infusion of dobutamine before and during the intracoronary infusion of vitamin C (96 mg/min). Vitamin C had no effect on basal LV +dP/dt in either HF or NLV groups. The infusion of vitamin C augmented the LV +dP/dt response to dobutamine by 22 +/- 4% in the NLV function group. In contrast, vitamin C had no effect on the inotropic response to dobutamine in the HF group. In the control protocol, without vitamin C, no differences were observed between responses to two sequential dobutamine infusions in either group (HF, n = 11; NLV, n = 9). Therefore, a positive effect of vitamin C on contractility was limited to patients with NLV function. The absence of this effect in HF patients may suggest that normal redox responsiveness is lost in this disease state.

Topics: Ascorbic Acid; Cardiotonic Agents; Dobutamine; Female; Heart; Heart Failure; History, Early Modern 1451-1600; Humans; Male; Middle Aged; Myocardial Contraction; Oxidation-Reduction; Reference Values; Ventricular Dysfunction, Left

Contractility alterations and LV hypertrophy after chronic cocaine administration have been shown to be accompanied by an increase in oxidative stress. This study was carried out to investigate whether the production of reactive oxygen species is an early event of primary importance in cocaine-induced myocardial injury or simply occurs as a consequence of the ventricular dysfunction itself.. After 2 days of cocaine administration to rats, no differences were observed in echocardiographic parameters between the cocaine-treated group and the control group. However, an increase in oxidative stress in the myocardium was indicated by an increase in lipid peroxidation (+35%, cocaine vs. control), an increase in antioxidant enzymes (catalase +110%, glutathione peroxidase +40% and superoxide dismutase +38%) and of NADPH-driven superoxide production (assessed by chemiluminescence). Furthermore, higher gp91phox and p22phox mRNA expression, measured by quantitative real-time RT-PCR, was found in the cocaine group. On day 8, cocaine administration induced a cardiac dysfunction, characterized by a decrease in cardiac index (-30%, cocaine vs. controls) and left ventricular (LV) fractional shortening (-23%, cocaine vs. controls). This LV dysfunction was prevented by antioxidant treatment (100 mg/kg/day vitamin C and 100 U/kg/day vitamin E). Moreover, in these animals, antioxidant treatment decreased lipid peroxides and decreased the activity of NADPH oxidase, associated with the downregulation of gp91phox.. These data indicate that cocaine administration induces early NADPH-driven O2-. release which may play an important role in the development and progression of the LV dysfunction observed after chronic cocaine abuse.

Topics: Animals; Antioxidants; Ascorbic Acid; Cocaine; Echocardiography; Glutathione Peroxidase; Lipid Peroxidation; Male; Myocardium; NADPH Oxidases; Random Allocation; Rats; Rats, Wistar; Reactive Oxygen Species; RNA, Messenger; Superoxide Dismutase; Vasoconstrictor Agents; Ventricular Dysfunction, Left; Vitamin E