phosphocreatine and Myocardial-Ischemia

Alterations in myocardial energy metabolism have been implicated in the pathophysiology of cardiac diseases such as heart failure and diabetic cardiomyopathy.

Topics: Adenosine Triphosphate; Animals; Biomarkers; Creatine Kinase; Diabetic Cardiomyopathies; Energy Metabolism; Heart Failure; Humans; Magnetic Resonance Spectroscopy; Myocardial Ischemia; Myocardium; Phosphocreatine; Phosphorus Isotopes

Creatine is of paramount importance for maintaining and managing cellular ATP stores in both physiological and pathological states. Besides these "ergogenic" actions, it has a number of additional "pleiotropic" effects, e.g., antioxidant activity, neurotransmitter-like behavior, prevention of opening of mitochondrial permeability pore and others. Creatine supplementation has been proposed for a number of conditions, including neurodegenerative diseases. However, it is likely that creatine's largest therapeutic potential is in those diseases caused by energy shortage or by increased energy demand; for example, ischemic stroke and other cerebrovascular diseases. Surprisingly, despite a large preclinical body of evidence, little or no clinical research has been carried out in these fields. However, recent work showed that high-dose creatine supplementation causes an 8-9 % increase in cerebral creatine content, and that this is capable of improving, in humans, neuropsychological performances that are hampered by hypoxia. In addition, animal work suggests that creatine supplementation may be protective in stroke by increasing not only the neuronal but also the endothelial creatine content. Creatine should be administered before brain ischemia occurs, and thus should be given for prevention purposes to patients at high risk of stroke. In myocardial ischemia, phosphocreatine has been used clinically with positive results, e.g., showing prevention of arrhythmia and improvement in cardiac parameters. Nevertheless, large clinical trials are needed to confirm these results in the context of modern reperfusion interventions. So far, the most compelling evidence for creatine and/or phosphocreatine use in cardiology is as an addition to cardioplegic solutions, where positive effects have been repeatedly reported.

Topics: Animals; Dietary Supplements; Humans; Hypoxia, Brain; Myocardial Ischemia; Phosphocreatine; Stroke

Creatine (Cr) is essential in safeguarding ATP levels and in moving ATP from its production site (mitochondria) to the cytoplasmic regions where it is used. Moreover, it has effects unrelated to energy metabolism, such as free radical scavenging, antiapoptotic action, and protection against excitotoxicity. Recent research has studied Cr-derived compounds (Cr benzyl ester and phos-pho-Cr-magnesium complex) that reproduce the neuroprotective effects of Cr while better crossing the neuronal plasma membrane and, hopefully, the blood-brain barrier (BBB). Intracellular levels of Cr can be increased by incubation with Cr or some of its derivatives, and this increase is protective against anoxic or ischemic damage. A large amount of experimental evidence shows that pretreatment with Cr is capable of reducing the damage induced by ischemia or anoxia in both heart and brain, and that such treatment may also be useful even after stroke or myocardial infarction (MI) has already occurred. Cr has been safely administered to patients affected by several neurological diseases, yet it has never been tested in human brain ischemia, the condition where its rationale is strongest. Phosphocreatine (PCr) has been administered after human MI, where it proved to be safe and probably helpful. Cr should be tested in the prophylactic protection against human brain ischemia and either Cr or PCr should be further tested in MI. Moreover, Cr- or PCr-derived drugs should be developed in order to overcome these molecules' limitations in crossing the BBB and the cell plasma membrane.

Topics: Blood-Brain Barrier; Brain Ischemia; Cardiotonic Agents; Creatine; Female; Forecasting; Humans; In Vitro Techniques; Male; Myocardial Infarction; Myocardial Ischemia; Neuroprotective Agents; Phosphocreatine; Stroke; Treatment Outcome

The creatine kinase system, the central regulatory system of cellular energy metabolism, provides ATP in situ at ATP-ases involved in ion transport and muscle contraction. Furthermore, the enzyme system provides relative protection from tissue ischaemia and acidosis. The system could therefore be a target for pharmacologic intervention.. To systematically evaluate evidence regarding the effectiveness of interventions directly targeting the creatine kinase system as compared to placebo control in adult patients with essential hypertension or cardiovascular disease.. Electronic databases searched: Medline (1950 - Feb 2011), Embase (up to Feb 2011), the Cochrane Controlled Trials Register (issue 3, Aug 2009), Latin-American/Caribbean databank Lilacs; references from textbooks and reviews; contact with experts and pharmaceutical companies; and searching the Internet. There was no language restriction.. Randomized controlled trials comparing creatine, creatine phosphate, or cyclocreatine (any route, dose or duration of treatment) with placebo; in adult patients with essential hypertension, heart failure, or myocardial infarction. We did not include papers on the short-term use of creatine during cardiac surgery.. The outcomes assessed were death, total myocardial infarction (fatal or non-fatal), hospitalizations for congestive heart failure, change in ejection fraction, and changes in diastolic and systolic blood pressure in mm Hg or as percent change.. Full reports or abstracts from 1164 papers were reviewed, yielding 11 trials considering treatment with creatine or creatine analogues in 1474 patients with heart failure, ischemic heart disease or myocardial infarction. No trial in patients with hypertension was identified. Eleven trials (1474 patients, 35 years or older) comparing add-on therapy of the creatine-based drug on standard treatment to placebo control in patients with heart failure (6 trials in 1226 / 1474 patients ), or acute myocardial infarction (4 trials in 220 / 1474 patients) or 1 in ischemic heart disease (28 / 1474 patients) were identified. The drugs used were either creatine, creatine phosphate (orally, intravenously, or intramuscular) or phosphocreatinine. In the trials considering heart failure all three different compounds were studied; creatine orally (Gordon 1995, Kuethe 2006), creatine phosphate via intravenous infusion (Ferraro 1996, Grazioli 1992), and phosphocreatinine orally (Carmenini 1994, Maggi 1990). In contrast, the acute myocardial infarction trials studied intravenous creatine phosphate only. In the ischemic heart disease trial (Pedone 1984) creatine phosphate was given twice daily through an intramuscular injection to outpatients and through an intravenous infusion to inpatients. The duration of the study intervention was shorter for the acute patients, from a two hour intravenous infusion of creatine phosphate in acute myocardial infarction (Ruda 1988, Samarenko 1987), to six months in patients with heart failure on oral phosphocreatinine therapy (Carmenini 1994). In the acute myocardial infarction patients the follow-up period varied from the acute treatment period (Ruda 1988) to 28 days after start of the symptoms (Samarenko 1987) or end of the hospitalization period (Zochowski 1994). In the other trials there was no follow-up after discontinuation of treatment, except for Gordon 1995 which followed the patients until four days after stopping the intervention.Only two out of four trials in patients with acute myocardial infarction reported mortality outcomes, with no significant effect of creatine or creatine analogues (RR 0.73, CI: 0.22 - 2.45). In addition, there was no significance on the progression of myocardial infarction or improvement on ejection fraction. The main effect of the interventions seems to be on improvement of dysrhythmia.. This review found inconclusive evidence to decide on the use of creatine analogues in clinical practice. In particular, it is not clear whether there is an effect on mortality, progression of myocardial infarction and ejection fraction, while there is some evidence that dysrhythmia and dyspnoea might improve. However, it is not clear which analogue, dose, route of administration, and duration of therapy is most effective. Moreover, given the small sample size of the discussed trials and the heterogeneity of the population included in these reports, larger clinical studies are needed to confirm these observations.

Topics: Cardiovascular Diseases; Creatine; Creatine Kinase; Heart Failure; Humans; Hypertension; Molecular Targeted Therapy; Myocardial Infarction; Myocardial Ischemia; Phosphocreatine

There is convincing evidence that alterations in myocardial substrate use play an important role in the normal and diseased heart. In this review, insights gained by using quantitative molecular imaging by positron emission tomography and magnetic resonance spectroscopy in the study of human myocardial metabolism will be discussed, and attention will be paid to the effects of nutrition, gender, aging, obesity, diabetes, cardiac hypertrophy, ischemia, and heart failure. The heart is an omnivore organ, relying on metabolic flexibility, which is compromised by the occurrence of defects in coronary flow reserve, insulin-mediated glucose disposal, and metabolic-mechanical coupling. Obesity, diabetes, and ischemic cardiomyopathy appear as states of high uptake and oxidation of fatty acids, that compromise the ability to utilize glucose under stimulated conditions, and lead to misuse of energy and oxygen, disturbing mechanical efficiency. Idiopathic heart failure is a complex disease frequently coexisting with diabetes, insulin resistance and hypertension, in which the end stage of metabolic toxicity manifests as severe mitochondrial disturbance, inability to utilize fatty acids, and ATP depletion. The current literature provides evidence that the primary events in the metabolic cascade outlined may originate in extra-cardiac organs, since fatty acid, glucose levels, and insulin action are mostly controlled by adipose tissue, skeletal muscle and liver, and that a broader vision of organ cross-talk may further our understanding of the primary and the adaptive events involved in metabolic heart toxicity.

Topics: Adenosine Triphosphate; Aging; Diabetes Mellitus; Energy Metabolism; Fatty Acids; Female; Glucose; Heart Diseases; Humans; Magnetic Resonance Spectroscopy; Male; Middle Aged; Myocardial Ischemia; Myocardium; Obesity; Oxygen Consumption; Phosphocreatine; Positron-Emission Tomography; Sex Factors

The requirement of chemical energy in the form of ATP to support systolic and diastolic work of the heart is absolute. Because of its central role in cardiac metabolism and performance, the subject of this review on energetics in the failing heart is ATP. We briefly review the basics of myocardial ATP metabolism and describe how this changes in the failing heart. We present an analysis of what is now known about the causes and consequences of these energetic changes and conclude by commenting on unsolved problems and opportunities for future basic and clinical research.

Topics: Adenosine Triphosphate; Adenylate Kinase; Animals; Cardiomyopathy, Hypertrophic, Familial; Creatine Kinase; Diastole; Energy Metabolism; Forecasting; Heart Failure; Humans; Hypertrophy, Left Ventricular; Isoenzymes; Mice; Mitochondria, Heart; Myocardial Ischemia; Phosphocreatine; Stress, Physiological

Topics: Acute Disease; Coronary Artery Disease; Cytokines; Humans; Inflammation; Myocardial Ischemia; Phosphocreatine

31P-NMR spectroscopy has the potential to assess myocardial damage directly and noninvasively by ascertaining the relative abundances of phosphorus-containing compounds relevant to metabolism under stress conditions. Decrease in the PCr/ATP ratio during exercise is an indicator of the level of stress to which the myocardium is subject. This ratio will remain constant under mild to moderate exercise conditions in a healthy subject, but may show a precipitous decrease even under mild exercise when regions of the myocardium are ischemic. The studies examined here indicate that cardiac patients with some forms of ischemia showed a PCr/ATP ratio decrease even under light exercise, while no decrease was observed in patients whose heart disease was known to be nonischemic. Hypertension and nonstenotic chest pain in women can, in some cases, produce a decrease in PCr/ATP ratio. Only the hypertensive patients showed a significant difference in the prestress PCr/ATP ratio when compared with controls. These studies suggest that 31P-NMR spectroscopy before and during mild exercise in the bore of the magnet can be a useful indicator of the presence or absence of an ischemic component to myocardial disorder.

Topics: Adenosine Triphosphate; Exercise Test; Female; Hand Strength; Humans; Isometric Contraction; Magnetic Resonance Spectroscopy; Male; Myocardial Ischemia; Phosphocreatine; Phosphorus Isotopes; Predictive Value of Tests

The article reviews cardiac magnetic resonance spectroscopy (MRS) in Canada. 31P MRS has been used to study cardiac energetics and intracellular pH in hearts subjected to ischemia-reperfusion and to evaluate the effects of pharmacological interventions. 23Na, 87Rb, and 7Li MRS have provided unique probes to study ion balance and fluxes in intact tissue under normal and stressful physiological conditions. 1H MRS has been used to monitor the accumulation of lactate and lipids in hearts subjected to ischemia-reperfusion and follow the effects of diet on cardiac lipid levels and function. The isolated rat heart has been used most commonly to study the effects of pharmacological agents on energy balance, pH, ion fluxes, and contractile function of the heart subjected to ischemia-reperfusion. The pig heart has been developed as an alternative to the rodent heart because its metabolism is more similar to that of the human heart. Human atrial appendages have been useful in evaluating the effects of preservation strategies (temperature, composition of preservation solutions) on energy levels. The pig heart model has been useful in evaluating the effects of preservation solutions on cardiac function of hearts destined for transplantation. An isolated blood-perfused pig heart model has been developed to assess the effects of cardioplegic strategies on the preservation of contractile function of hearts following surgery on the heart. An in vivo canine model has been used to study myocardial infarction and the effects of therapies to reduce the infarct zones and areas of the heart at risk of infarction. Studies of human hearts in vivo have provided insight into the metabolic adaptations that occur in individuals living at high altitudes.

Topics: Adenosine Triphosphate; Animals; Biomarkers; Cardiac Surgical Procedures; Cardioplegic Solutions; Cations, Monovalent; Dogs; Energy Metabolism; Heart Transplantation; Humans; Hydrogen-Ion Concentration; Intracellular Fluid; Lactates; Lipid Metabolism; Magnetic Resonance Spectroscopy; Myocardial Contraction; Myocardial Infarction; Myocardial Ischemia; Myocardial Reperfusion Injury; Myocardium; Organ Preservation; Phosphocreatine; Rats; Swine

In contrast to the established nuclear imaging techniques magnetic resonance imaging (MRI) is only in the early phase of its application to detect viable myocardium after myocardial infarction. Although MRI techniques have only recently been employed to assess residual myocardial viability three approaches have been described to achieve this purpose: First, the use of signal intensity changes on spin-echo images with and without the application of contrast media to define irreversible injury to the myocardium in acute and subacute infarcts; second, measurement of metabolite concentrations within the infarct area using magnetic resonance spectroscopy, and third quantitation of myocardial thickness and systolic wall thickening in chronic infarcts with and without positive inotropic stimulation. When applying magnetic resonance techniques to detect viable myocardium by imaging techniques, it is useful to distinguish between acute infarcts and chronic infarcts that are more than 16 weeks old. After the time, practically all infarcts have healed and the necrotic myocardium has been transformed into scar tissue. MRI seems ideally suited to detect and characterize chronic myocardial scar and distinguish it from viable but hibernating myocardium because it clearly depicts the regional wall thinning which is a typical feature of transmural infarcts (Figure 1). In contrast, more recent infarcts, even if they are transmural and fail to show any contraction during systole, may not yet exhibit myocardial thinning. Therefore, simply depicting the acutely injured myocardium by MRI is not sufficient to differentiate between necrotic and stunned, but viable myocardium. On the other hand, an increase in signal intensity of acutely infarcted myocardium, which appears on T2 weighted spin-echo MR images only a few hours after occlusion of a coronary artery, can be used to determine the extent of irreversible myocardial damage (Figure 2). It is not clear, however, whether this area of increased myocardial signal intensity that is seen within the first week after the event only represents necrotic myocardium or incorporates some edematous viable myocardium in the infarct border zone. After three weeks, true infarct size may be more closely approximated by the area of increased signal intensity because the edema surrounding the infarct has presumably regressed and signal abnormalities are restricted to the pathologically determined infarct area. More recently, new pulse sequence

Topics: Adenosine Triphosphate; Coronary Disease; Energy Metabolism; Heart Ventricles; Humans; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Myocardial Contraction; Myocardial Infarction; Myocardial Ischemia; Myocardium; Phosphocreatine; Ventricular Function, Left

The purpose of the study was to characterize the functional and metabolic adjustments of a myocardial region subjected to low-flow ischemia. In addition, studies tested whether such myocardium retains an inotropic reserve.. Anesthetized swine were studied in which the left anterior descending coronary artery was cannulated and perfused at a constant low level causing regional contractile dysfunction (sonomicrometry for wall thickness) and the appearance of metabolic indicators of ischemia (decrease in creatine phosphate and lactate production) with only slight loss of ATP and glycogen (transmural biopsies). After 85 minutes of low-flow ischemia, dobutamine was infused into the hypoperfused artery as an inotropic challenge. Coronary hypoperfusion for 5 minutes resulted in a 54% reduction of regional systolic wall thickening, reversal of lactate consumption to lactate production, and a significant decrease in creatine phosphate. Subendocardial blood flow was reduced from 0.62 +/- 0.11 (+/- SD) to 0.16 +/- 0.07 mL.min-1.g-1. Prolonged hypoperfusion for 85 minutes resulted in no further change in regional blood flow but a partial recovery of metabolic parameters. Dobutamine infusion after 85 minutes of hypoperfusion increased regional myocardial work. However, again lactate production was significantly increase and creatine phosphate was decreased. Regional coronary hypoperfusion produces a downregulation of regional contractile function in proportion to the blood flow decrease. With prolonged hypoperfusion, after the initial adjustment phase, there is little further change in function, and metabolic markers of ischemia improve. Although the ischemic downregulated myocardium retains a significant inotropic reserve, primarily anaerobic energy production is utilized.. These data are consistent with downregulation being a protective mechanism for the ischemic myocardium to restore an energy supply-demand balance in the face of reduced blood flow. Inotropic stimulation of the downregulated myocardium enhances regional function but at the cost of worsening its metabolic status. Thus, inotropic stimulation of the hypoperfused and downregulated myocardium is probably detrimental to long-term viability.

Topics: Acute Disease; Adenosine Triphosphate; Animals; Coronary Circulation; Dobutamine; Glycogen; Heart; Myocardial Contraction; Myocardial Ischemia; Myocardium; Phosphocreatine; Swine; Time Factors

In the initial seconds after a sudden reduction in coronary blood flow, a temporary mismatch between myocardial energy demand and supply exists. The mechanisms underlying the rapidly ensuing reduction in contractile function in the ischemic myocardium are still unknown. In the presence of some residual blood flow, a state of "perfusion-contraction matching" develops. The metabolic status of such hypoperfused myocardium improves, since myocardial lactate production is attenuated and creatine phosphate (CP), after an initial reduction, returns toward control values. The hypoperfused myocardium responds to inotropic stimulation by dobutamine. The recruitment of an inotropic reserve implies increased energy utilization. During inotropic stimulation, after partial normalization, lactate production is again increased, and CP is decreased again. Thus, a supply-demand imbalance that had been at least partially corrected by the ischemia-induced decrease in regional contractile function is precipitated again. A situation of chronic contractile failure in viable myocardium that normalizes upon reperfusion has been termed myocardial "hibernation." Myocardial "stunning" is characterized by a reversible postischemic contractile dysfunction despite full restoration of blood flow. The details of the underlying mechanisms are not clear. An inadequate energy supply and impaired sympathetic neurotransmission have been excluded. Potential mechanisms, which are not mutually exclusive, may include (a) damage of membranes by free radicals, (b) an increase in free cytosolic calcium during ischemia and reperfusion, and (c) a decrease in the calcium sensitivity of the myofibrils. The equally pronounced increases in regional contractility in normal and "stunned" myocardium during postextrasystolic potentiation and the infusion of calcium or the calcium-sensitizing agent AR-L-57, however, suggest an unchanged calcium sensitivity of reperfused myocardium.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Calcium; Calcium Channel Blockers; Coronary Circulation; Humans; Lactates; Lactic Acid; Myocardial Contraction; Myocardial Ischemia; Myocardial Reperfusion; Myocardial Reperfusion Injury; Myocardium; Phosphocreatine

The present state of investigations on molecular and cellular mechanisms of cardioprotective effects of phosphocreatine (PCr) is reviewed. The protective effect of PCr is manifested as significant improvement of heart contractile function recovery, lowering of diastolic pressure elevation and myocardial enzymes release during postischemic reperfusion as well as better preservation of high energy phosphates in comparison with control. Data from multidisciplinary studies using physico-chemical, physiological, pharmacological etc. approaches suggest that one of the key mechanisms of PCr action is its interaction with the sarcolemmal membrane. The authors own data obtained with the use of spin-labeled ESR-probe incorporated into the isolated sarcolemmal vesicles provide direct evidence in favor of the ordering effect of PCr sarcolemmal phospholipid packing with essential involvement of Ca2+ ions. PCr transform membrane phospholipids into more structured gel-like state. The results of biomedical studies suggest that the mechanism of this protective action is complex and includes at least four components: 1) inhibition of lysophosphoglyceride accumulation in the ischemic myocardium and preservation of cardiac cell sarcolemma structure via zwitterionic interaction with PCr molecules; ii) extracellular action consisting in inhibition of platelet aggregation via ADP removal in the extracellular creatine kinase reaction and increasing plasticity of red blood cells; iii) PCr penetration into cells maintenance of high local ATP levels is possible; iiii) inhibition of adenine nucleotide degradation at the step of 5'-nucleotidase reaction in cardiac cell sarcolemma.

Topics: Animals; Calcium; Cardiovascular Agents; Cell Membrane; Heart; Myocardial Contraction; Myocardial Ischemia; Oxidation-Reduction; Phosphocreatine; Phospholipids; Sarcolemma

Conventional strategies to treat myocardial ischemia include interventions that reduce oxygen demand and/or increase myocardial blood flow. Animal experiments suggest that right-shifting the hemoglobin-oxygen dissociation curve may also attenuate the metabolic consequences of myocardial ischemia. We evaluated whether exercise-induced myocardial ischemia can be alleviated in subjects with coronary artery disease (CAD) by enhancing oxygen release with an allosteric modifier of hemoglobin's affinity for oxygen (RSR13).. Seven subjects with CAD underwent a randomized, double-blind, cross-over study of the metabolic consequences of RSR13 administration on myocardial ischemia. Myocardial high-energy phosphates were quantified with 31P nuclear magnetic resonance (NMR) spectroscopy before, during, and after isometric handgrip-exercise. Subjects underwent NMR studies at baseline and on two separate occasions following the infusion of RSR13 (100 mg/kg) or placebo. RSR13 infusion significantly increased mean p50 by 8.1 +/- 2.7 mmHg at the end of the infusion, and it was still elevated by 4.9 +/- 3.3 mmHg after the completion of the treadmill tests while placebo had no effect. The myocardial creatine-phosphate (PCr) to adenosine-triphosphate (ATP) ratio decreased during handgrip-exercise in the baseline studies (from 1.39 +/- 0.23 before exercise to 0.95 +/- 0.21 during handgrip-exercise, p = 0.0001) and in the placebo studies (from 1.29 +/- 0.16 to 0.98 +/- 0.37, p = 0.06) but not during administration of RSR13 (from 1.28 +/- 0.18 to 1.02 +/- 0.24, p = 0.12). However, the mean values of cardiac PCr/ATP during handgrip-exercise did not differ significantly among the three measurements (baseline, placebo, RSR13).. A single infusion of RSR13 to subjects with CAD increased mean p50 by 4.9-8.1 mmHg but did not significantly alter myocardial PCr/ATP during exercise. This is the largest right-shift in hemoglobin-oxygen binding affinity achieved in CAD subjects, and it did not provide clear evidence of protection from cardiac ischemia.

Topics: Adenosine Triphosphate; Aged; Analysis of Variance; Aniline Compounds; Antisickling Agents; Biomarkers; Blood Flow Velocity; Coronary Artery Disease; Coronary Circulation; Cross-Over Studies; Double-Blind Method; Exercise Test; Female; Humans; Magnetic Resonance Spectroscopy; Male; Middle Aged; Myocardial Ischemia; Oxygen Consumption; Oxyhemoglobins; Phosphocreatine; Phosphorus Isotopes; Propionates; Treatment Outcome

After hospitalization for chest pain, women are more likely than men to have normal coronary-artery angiograms. In such women, myocardial ischemia in the absence of clinically significant coronary-artery obstruction has long been suspected. Most methods for the detection of the metabolic effects of myocardial ischemia are highly invasive. Phosphorus-31 nuclear magnetic resonance (31P-NMR) spectroscopy is a noninvasive technique that can directly measure high-energy phosphates in the myocardium and identify metabolic evidence of ischemia.. We enrolled 35 women who were hospitalized for chest pain but who had no angiographically significant coronary-artery obstructions and 12 age- and weight-matched control women with no evidence of heart disease. Myocardial high-energy phosphates were measured with 31P-NMR spectroscopy at 1.5 tesla before, during, and after isometric handgrip exercise at a level that was 30 percent of the maximal voluntary grip strength. We measured the change in the ratio of phosphocreatine to ATP during exercise.. Seven (20 percent) of the 35 women with chest pain and no angiographically significant stenosis had decreases in the phosphocreatine:ATP ratio during exercise that were more than 2 SD below the mean value in the control subjects without chest pain. There were no significant differences between the two groups with respect to hemodynamic variables at rest and during exercise, risk factors for ischemic heart disease, findings on magnetic resonance imaging and radionuclide perfusion studies of the heart, or changes in brachial flow during the infusion of acetylcholine.. Our results provide direct evidence of an abnormal metabolic response to handgrip exercise in at least some women with chest pain consistent with the occurrence of myocardial ischemia but no angiographically significant coronary stenoses. The most likely cause is microvascular coronary artery disease.

Topics: Adenosine Triphosphate; Adult; Aged; Case-Control Studies; Chest Pain; Coronary Angiography; Coronary Disease; Exercise; Exercise Test; Female; Humans; Magnetic Resonance Spectroscopy; Middle Aged; Myocardial Ischemia; Phosphocreatine; Phosphorus

Myocardial protection with blood cardioplegia during cardiac surgery is increasingly preferred, but few studies have compared the protective effects of crystalloid cardioplegia to the same solution with blood as the only variable. This clinical study compared the protective effects of crystalloid or blood-based St. Thomas' Hospital cardioplegic solution No. 1.. Fifty higher risk patients undergoing elective coronary artery bypass surgery, with an ejection fraction less than 40%, were randomly allocated to receive cold (4 degrees C) intermittent crystalloid St. Thomas' No. 1 cardioplegia (n = 25), or a similar blood-based solution (n = 25) with a haematocrit of 10-12%. We determined (1) peri-operative and post-operative arrhythmias, (2) left and right ventricular function (24 h) using the thermodilution technique, (3) left ventricular high-energy phosphate content sampled before ischaemia, the end of ischaemia and the end of bypass.. Pre-operative haemodynamic data, aortic cross-clamp and bypass times were similar in both groups of patients; there was no mortality. At the end of ischaemia there were no differences in ATP content between groups but creatine phosphate was maintained at a significantly (P < 0.007) higher level in the blood-based St. Thomas' cardioplegia group than the crystalloid St. Thomas' cardioplegia group (20+/-2 (SE) vs. 13+/-1 micromol/g dry wt, respectively). Return to spontaneous sinus rhythm was significantly (P = 0.002) increased in the blood-based St. Thomas' cardioplegia group (96%) compared to the crystalloid St. Thomas' cardioplegia group (60%). Early post-operative ventricular dysfunction occurred in both groups, but normal LV function (stroke work index) recovered significantly (P = 0.043) more rapidly (by 2 h) in the blood-based St. Thomas' cardioplegia group of patients.. In a higher risk (EF < 40%) group of patients undergoing elective cardiac surgery, addition of blood to an established crystalloid cardioplegic solution significantly enhanced myocardial protection by reducing arrhythmias, improving rate of recovery of function and maintaining myocardial high-energy phosphate content during ischaemia.

Topics: Adenine Nucleotides; Aged; Bicarbonates; Calcium Chloride; Cardioplegic Solutions; Coronary Artery Bypass; Crystalloid Solutions; Electrocardiography; Female; Heart Arrest, Induced; Hemodynamics; Humans; Intraoperative Period; Isotonic Solutions; Magnesium; Male; Middle Aged; Myocardial Ischemia; Myocardium; Phosphocreatine; Plasma Substitutes; Postoperative Complications; Potassium Chloride; Rehydration Solutions; Sodium Chloride; Treatment Outcome

Ischaemic preconditioning, with brief periods of ischaemia separated by reperfusion, increases myocardial resistance to infarction. In addition, preconditioning leads to preservation of myocardial adenosine triphosphate (ATP) during ischaemia. We propose that ischaemic preconditioning may share fundamental similarities with intermittent aortic cross-clamping utilised during aorto-coronary bypass surgery. The aim of this study was to test the hypothesis that controlled aortic cross-clamping is a form of preconditioning using conservation of ATP as the end point. Patients randomised to the preconditioned group (preconditioned, n = 10 patients), received a preconditioning stimulus of two 3-min periods of cross-clamping separated by 2 min of reperfusion prior to an ischaemic insult of 10 min ischaemia and ventricular fibrillation. In the control group (control, n = 10 patients) hearts received 10 min cross-clamping with fibrillation without prior preconditioning. Myocardial ATP, creatine phosphate (CP), and lactate were determined from biopsy specimens taken at the onset of cardiopulmonary bypass (A), at the end of preconditioning (B), and at the end of 10 min of ischaemic insult (C).. expressed as mean +/- SE (mumol/g dry weight). Preconditioning resulted in a significant depletion of the myocardial ATP content (preconditioned, B: 11.7 +/- 0.9 vs A: 19.8 +/- 1.4; P < 0.01). Furthermore 10 min of ischaemia resulted in a significant depletion of ATP in the control patients (control, C: 7.2 +/- 0.3 vs B: 19.5 +/- 1.2; P < 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adenosine Triphosphate; Aged; Constriction; Coronary Artery Bypass; Humans; Lactates; Middle Aged; Myocardial Infarction; Myocardial Ischemia; Myocardial Reperfusion; Myocardial Reperfusion Injury; Phosphocreatine; Postoperative Complications; Time Factors; Treatment Outcome

Donation after circulatory death (DCD) could improve cardiac graft availability. However, strategies to optimize cardiac graft recovery remain to be established in DCD; these hearts would be expected to be exposed to high levels of circulatory fat immediately prior to the inevitable period of ischemia prior to procurement.. We investigated whether acute exposure to high fat prior to warm, global ischemia affects subsequent hemodynamic and metabolic recovery in an isolated rat heart model of DCD.. Hearts of male Wistar rats underwent 20min baseline perfusion with glucose (11mM) and either high fat (1.2mM palmitate; HF) or no fat (NF), 27min global ischemia (37°C), and 60min reperfusion with glucose only (n=7-8 per group). Hemodynamic recovery was 50% lower in HF vs. NF hearts (34±30% vs. 78±8% (60min reperfusion value of peak systolic pressure*heart rate as percentage of mean baseline); p<0.01). During early reperfusion, glycolysis (0.3±0.3 vs. 0.7±0.3μmol*min. Acute, pre-ischemic exposure to high fat significantly lowers post-ischemic cardiac recovery vs. no fat despite identical reperfusion conditions. These findings support the concept that oxidation of residual fatty acids is rapidly restored upon reperfusion and exacerbates ischemia-reperfusion (IR) injury. Strategies to optimize post-ischemic cardiac recovery should take pre-ischemic fat levels into consideration.

Topics: Adenosine Triphosphate; Animals; Cytochromes c; Fatty Acids; Glucose; Heart Transplantation; Hemodynamics; In Vitro Techniques; Male; Myocardial Ischemia; Oxygen Consumption; Phosphocreatine; Rats; Rats, Wistar; Recovery of Function; Shock

Calcitonin gene-related peptide (CGRP) is a potent vasodilator neuropeptide. We investigated the ameliorating effect of CGRP in myocardial ischemia induced by endothelin-1 (ET-1), with special emphasis on myocardial microvascular hemodynamics and levels of energy-related metabolites.. The Langendorff preparations of rat isolated heart were perfused at a constant flow rate. Microvascular blood flow was also visualized in the anterior epicardium of the left ventricle by means of an intravital fluorescence microscope system. Energy-related metabolite contents in the myocardium were measured by means of (31)P-magnetic resonance spectroscopy ((31)P-MRS).. Intracoronary bolus injections of CGRP caused dose-dependent decreases in coronary perfusion pressure (CPP) in the hearts exposed to ET-1 (30 pmol). The vasodilator potency of CGRP was about 10,000-fold greater than that of nitroglycerin and 1,000-fold greater than that of isobutylmethylxanthine. Vasodilation of the small-sized arterioles (10-40 μm in diameter) in response to CGRP (100 pmol) was confirmed by direct microscopic observation. After ET-1 (30 pmol) plus vehicle administration, high energy phosphates (phosphocreatine (PCr), ATP) were markedly reduced (p<0.05). CGRP administration significantly (p<0.05) attenuated the anaerobic changes in the myocardium (decrease in PCr) and macrohemodynamic alterations (increase in CPP, decrease in dP/dt etc.) induced by ET-1.. We conclude that CGRP effectively confers hemodynamic and metabolic protections to isolated beating hearts against ET-1-induced myocardial ischemia.

Topics: 1-Methyl-3-isobutylxanthine; Adenosine Triphosphate; Animals; Calcitonin Gene-Related Peptide; Cardiotonic Agents; Endothelin-1; Heart Rate; Humans; Hydrogen-Ion Concentration; In Vitro Techniques; Magnetic Resonance Spectroscopy; Microvessels; Myocardial Contraction; Myocardial Ischemia; Myocardium; Nitroglycerin; Perfusion; Phosphocreatine; Phosphorus Isotopes; Rats; Rats, Wistar; Time Factors; Vasodilation

The pharmacokinetic (PK) studies of phosphocreatine (PCr) and its active metabolite creatine (Cr) are considerably lacking. This study is to comparatively investigate the PK profiles of PCr and Cr in mice plasma and myocardium as well as the ATP level.. After iv administration of equimolar PCr and preformed Cr to healthy and Pit-induced myocardial ischemic mice, plasma and myocardium samples were analyzed for exogenous PCr, Cr and related ATP concentrations using a specific ion-pair reversed-phase HPLC-UV assay.. The plasma C-T data of iv PCr and Cr were well fitted to two-compartment model. Following iv PCr, Cr appeared in plasma as early as 1.0 min postdose with a longer t1/2 than PCr and had a fm of 72%. The mice dosed iv PCr preceded 5 min by ip Pit 30 U/kg showed longer t1/2β PCr and t1/2 Cr in plasma and elevated Cmax, Cr and Cmax, ATP in myocardium compared with mice dosed iv PCr alone, and it was estimated that about 40% ATP produced by iv PCr was from Cr.. The PCr in plasma is converted to Cr rapidly and mostly, and shows an elimination rate limited (ERL) metabolite disposition. Iv PCr caused a significantly elevated and long-lasing myocardial ATP and Cr levels. The Pit-induced myocardial ischemia brings slower elimination of PCr and Cr and higher peak concentrations of Cr and ATP in myocardium. The metabolite Cr at least partially mediates PCr-caused rise in myocardial ATP level and also possibly the cardio-protective effects of PCr.

Topics: Adenosine Triphosphate; Animals; Chromatography, High Pressure Liquid; Creatine; Disease Models, Animal; Half-Life; Male; Mice; Myocardial Ischemia; Myocardium; Phosphocreatine; Pituitary Hormones, Posterior; Spectrophotometry, Ultraviolet

Experiments on rats with acute myocardial ischemia accompanied by early postocclusive arrhythmias have shown normalizing, energy-stabilizing, and antiarrhythmic effects of uridine and uridine-5'-monophosphate. The drugs decreased lactate and restored reserves of glycogen and creatine phosphate depleted by ischemia. Uridine and uridine-5'-monophosphate significantly decreased the severity of ventricular arrhythmias. Both drugs reduced the incidence and duration of fibrillation. Uridine -5'-monophosphate demonstrated most pronounced antifibrillatory effectiveness. We hypothesize that the antiarrhythmic effect of the drugs is determined by their capacity to activate energy metabolism.

Topics: Animals; Arrhythmias, Cardiac; Coronary Vessels; Energy Metabolism; Glycogen; Lactic Acid; Ligation; Male; Myocardial Ischemia; Phosphocreatine; Rats; Rats, Wistar; Uridine; Uridine Monophosphate

Reduced myofibrillar ATP availability during prolonged myocardial ischemia may limit post-ischemic mechanical function. Because creatine kinase (CK) is the prime energy reserve reaction of the heart and because it has been difficult to augment ATP synthesis during and after ischemia, we used mice that overexpress the myofibrillar isoform of creatine kinase (CKM) in cardiac-specific, conditional fashion to test the hypothesis that CKM overexpression increases ATP delivery in ischemic-reperfused hearts and improves functional recovery. Isolated, retrograde-perfused hearts from control and CKM mice were subjected to 25 min of global, no-flow ischemia and 40 min of reperfusion while cardiac function [rate pressure product (RPP)] was monitored. A combination of (31)P-nuclear magnetic resonance experiments at 11.7T and biochemical assays was used to measure the myocardial rate of ATP synthesis via CK (CK flux) and intracellular pH (pH(i)). Baseline CK flux was severalfold higher in CKM hearts (8.1 ± 1.0 vs. 32.9 ± 3.8, mM/s, control vs. CKM; P < 0.001) with no differences in phosphocreatine concentration [PCr] and RPP. End-ischemic pH(i) was higher in CKM hearts than in control hearts (6.04 ± 0.12 vs. 6.37 ± 0.04, control vs. CKM; P < 0.05) with no differences in [PCr] and [ATP] between the two groups. Post-ischemic PCr (66.2 ± 1.3 vs. 99.1 ± 8.0, %preischemic levels; P < 0.01), CK flux (3.2 ± 0.4 vs. 14.0 ± 1.2 mM/s; P < 0.001) and functional recovery (13.7 ± 3.4 vs. 64.9 ± 13.2%preischemic RPP; P < 0.01) were significantly higher and lactate dehydrogenase release was lower in CKM than in control hearts. Thus augmenting cardiac CKM expression attenuates ischemic acidosis, reduces injury, and improves not only high-energy phosphate content and the rate of CK ATP synthesis in postischemic myocardium but also recovery of contractile function.

Topics: Acidosis; Adenosine Triphosphate; Animals; Creatine Kinase, MM Form; Disease Models, Animal; Energy Metabolism; Hydrogen-Ion Concentration; Kinetics; L-Lactate Dehydrogenase; Magnetic Resonance Spectroscopy; Male; Mice; Mice, Inbred C57BL; Mice, Transgenic; Myocardial Contraction; Myocardial Ischemia; Myocardial Reperfusion Injury; Myocardium; Phosphocreatine; Up-Regulation

Alterations in myocardial glucose metabolism are a key determinant of ischemia-induced depression of left ventricular mechanical function. Since myocardial glycogen is an important source of endogenous glucose, we compared the effects of ischemia on glucose uptake and utilization in isolated working rat hearts in which glycogen content was either replete (G replete, 114 micromol/g dry wt) or partially depleted (G depleted, 71 mumol/g dry wt). The effects of low-flow ischemia (LFI, 0.5 ml/min) on glucose uptake, glycogen turnover (glycogenolysis and glycogen synthesis), glycolysis, adenosine 5'-monophosphate-activated protein kinase (AMPK) activity, and GLUT4 translocation were measured. Relative to preischemic values, LFI caused a time-dependent reduction in glycogen content in both G-replete and G-depleted groups due to an acceleration of glycogenolysis (by 12-fold and 6-fold, respectively). In G-replete hearts, LFI (15 min) decreased glucose uptake (by 59%) and did not affect GLUT4 translocation. In G-depleted hearts, LFI also decreased initially glucose uptake (by 90%) and glycogen synthesis, but after 15 min, when glycogenolysis slowed due to exhaustion of glycogen content, glucose uptake increased (by 31%) in association with an increase in GLUT4 translocation. After 60 min of LFI, glucose uptake, glycogenolysis, and glycolysis recovered to near-preischemic values in both groups. LFI increased AMPK activity in a time-dependent manner in both groups (by 6-fold and 4-fold, respectively). Thus, when glycogen stores are replete before ischemia, ischemia-induced AMPK activation is not sufficient to increase glucose uptake. Under these conditions, an acceleration of glycogen degradation provides sufficient endogenous substrate for glycolysis during ischemia.

Topics: Adenosine Monophosphate; Adenosine Triphosphate; Aerobiosis; Animals; Cell Membrane; Creatine; Cyclic AMP-Dependent Protein Kinases; Energy Metabolism; Enzyme Activation; Fatty Acids; Glucose; Glucose Transporter Type 4; Glycogen; Glycolysis; Hypoglycemic Agents; In Vitro Techniques; Insulin; Male; Myocardial Ischemia; Myocardium; Phosphocreatine; Rats; Rats, Sprague-Dawley; Sarcolemma; Ventricular Function, Left

The heterogeneity across the left ventricular wall is characterized by higher rates of oxygen consumption, systolic thickening fraction, myocardial perfusion, and lower energetic state in the subendocardial layers (ENDO). During dobutamine stimulation-induced demand ischemia, the transmural distribution of energy demand and metabolic markers of ischemia are not known. In this study, hemodynamics, transmural high-energy phosphate (HEP), 2-deoxyglucose-6-phosphate (2-DGP) levels, and myocardial blood flow (MBF) were determined under basal conditions, during dobutamine infusion (DOB: 20 microg x kg(-1) x min(-1) iv), and during coronary stenosis + DOB + 2-deoxyglucose (2-DG) infusion. DOB increased rate pressure products (RPP) and MBF significantly without affecting the subendocardial-to-subepicardial blood flow ratio (ENDO/EPI) or HEP levels. During coronary stenosis + DOB + 2-DG infusion, RPP, ischemic zone (IZ) MBF, and ENDO/EPI decreased significantly. The IZ ratio of creatine phosphate-to-ATP decreased significantly [2.30 +/- 0.14, 2.06 +/- 0.13, and 2.04 +/- 0.11 to 1.77 +/- 0.12, 1.70 +/- 0.11, and 1.72 +/- 0.12 for EPI, midmyocardial (MID), and ENDO, respectively], and 2-DGP accumulated in all layers, as evidenced by the 2-DGP/PCr (0.55 +/- 0.12, 0.52 +/- 0.10, and 0.37 +/- 0.08 for EPI, MID, and ENDO, respectively; P < 0.05, EPI > ENDO). In the IZ the wet weight-to-dry weight ratio was significantly increased compared with the normal zone (5.9 +/- 0.5 vs. 4.4 +/- 0.4; P < 0.05). Thus, in the stenotic perfused bed, during dobutamine-induced high cardiac work state, despite higher blood flow, the subepicardial layers showed the greater metabolic changes characterized by a shift toward higher carbohydrate metabolism, suggesting that a homeostatic response to high-cardiac work state is characterized by more glucose utilization in energy metabolism.

Topics: Adenosine Triphosphate; Animals; Coronary Circulation; Coronary Stenosis; Disease Models, Animal; Dobutamine; Dogs; Endocardium; Energy Metabolism; Glucose-6-Phosphate; Glycolysis; Hemodynamics; Lactic Acid; Magnetic Resonance Spectroscopy; Myocardial Ischemia; Myocardium; Oxygen Consumption; Pericardium; Phosphocreatine

To investigate the mechanisms regulating excitation-metabolic coupling in rabbit epicardial, midmyocardial, and endocardial ventricular myocytes we extended the LabHEART model (Puglisi JL and Bers DM. Am J Physiol Cell Physiol 281: C2049-C2060, 2001). We incorporated equations for Ca(2+) and Mg(2+) buffering by ATP and ADP, equations for nucleotide regulation of ATP-sensitive K(+) channel and L-type Ca(2+) channel, Na(+)-K(+)-ATPase, and sarcolemmal and sarcoplasmic Ca(2+)-ATPases, and equations describing the basic pathways (creatine and adenylate kinase reactions) known to communicate the flux changes generated by intracellular ATPases. Under normal conditions and during 20 min of ischemia, the three regions were characterized by different I(Na), I(to), I(Kr), I(Ks), and I(Kp) channel properties. The results indicate that the ATP-sensitive K(+) channel is activated by the smallest reduction in ATP in epicardial cells and largest in endocardial cells when cytosolic ADP, AMP, PCr, Cr, P(i), total Mg(2+), Na(+), K(+), Ca(2+), and pH diastolic levels are normal. The model predicts that only K(ATP) ionophore (Kir6.2 subunit) and not the regulatory subunit (SUR2A) might differ from endocardium to epicardium. The analysis suggests that during ischemia, the inhomogeneous accumulation of the metabolites in the tissue sublayers may alter in a very irregular manner the K(ATP) channel opening through metabolic interactions with the endogenous PI cascade (PIP(2), PIP) that in turn may cause differential action potential shortening among the ventricular myocyte subtypes. The model predictions are in qualitative agreement with experimental data measured under normal and ischemic conditions in rabbit ventricular myocytes.

Topics: Action Potentials; Adenosine Diphosphate; Adenosine Monophosphate; Adenosine Triphosphate; Animals; ATP-Binding Cassette Transporters; Calcium; Calcium Channels, L-Type; Computer Simulation; Creatine; Endocardium; Heart Ventricles; Hydrogen-Ion Concentration; Ion Channel Gating; Magnesium; Models, Cardiovascular; Myocardial Ischemia; Myocytes, Cardiac; Pericardium; Phosphocreatine; Potassium; Potassium Channels; Potassium Channels, Inwardly Rectifying; Rabbits; Receptors, Drug; Sarcoplasmic Reticulum Calcium-Transporting ATPases; Signal Transduction; Sodium-Potassium-Exchanging ATPase; Sulfonylurea Receptors

Because the question "is AMP-activated protein kinase (AMPK) alpha(2)-isoform a friend or a foe in the protection of the myocardium against ischemia-reperfusion injury?" is still in debate, we studied the functional consequence of its deletion on the contractility, the energetics, and the respiration of the isolated perfused heart and characterized the response to low-flow ischemia and reperfusion with glucose and pyruvate as substrates. alpha(2)-AMPK deletion did not affect basal contractility, respiration, and high-energy phosphate contents but induced a twofold reduction in glycogen content and a threefold reduction in glucose uptake. Low-flow ischemia increased AMPK phosphorylation and stimulated glucose uptake and phosphorylation in both alpha(2)-knockout (alpha(2)-KO) and wild-type (WT) groups. The high sensitivity of alpha(2)-KO to the development of ischemic contracture was attributed to the constitutive impairment in glucose transport and glycogen content and not to a perturbation of the energy transfer by creatine kinase (CK). The functional coupling of MM-CK to myofibrillar ATPase and the CK fluxes were indeed similar in alpha(2)-KO and WT. Low-flow ischemia impaired CK flux by 50% in both strains, showing that alpha(2)-AMPK does not control CK activity. Despite the higher sensitivity to contracture, the postischemic contractility recovered to similar levels in both alpha(2)-KO and WT in the absence of fatty acids. In their presence, alpha(2)-AMPK deletion also accelerated the contracture but delayed postischemic contractile recovery. In conclusion, alpha(2)-AMPK is required for a normal glucose uptake and glycogen content, which protects the heart from the development of the ischemic contracture, but not for contractile recovery in the absence of fatty acids.

Topics: Adenosine Triphosphate; AMP-Activated Protein Kinases; Animals; Cell Respiration; Creatine Kinase, MM Form; Energy Metabolism; Enzyme Activation; Fatty Acids; Glucose; Glycogen; In Vitro Techniques; Kinetics; Male; Mice; Mice, Knockout; Multienzyme Complexes; Myocardial Contraction; Myocardial Ischemia; Myocardial Reperfusion Injury; Myocardium; Oxygen Consumption; Perfusion; Phosphocreatine; Phosphorylation; Protein Serine-Threonine Kinases; Pyruvic Acid

The role of the creatine kinase (CK)/phosphocreatine (PCr) energy buffer and transport system in heart remains unclear. Guanidinoacetate-N-methyltransferase-knockout (GAMT-/-) mice represent a new model of profoundly altered cardiac energetics, showing undetectable levels of PCr and creatine and accumulation of the precursor (phospho-)guanidinoacetate (P-GA). To characterize the role of a substantially impaired CK/PCr system in heart, we studied the cardiac phenotype of wild-type (WT) and GAMT-/- mice.. GAMT-/- mice did not show cardiac hypertrophy (myocyte cross-sectional areas, hypertrophy markers atrial natriuretic factor and beta-myosin heavy chain). Systolic and diastolic function, measured invasively (left ventricular conductance catheter) and noninvasively (MRI), were similar for WT and GAMT-/- mice. However, during inotropic stimulation with dobutamine, preload-recruitable stroke work failed to reach maximal levels of performance in GAMT-/- hearts (101+/-8 mm Hg in WT versus 59+/-7 mm Hg in GAMT-/-; P<0.05). (31)P-MR spectroscopy experiments showed that during inotropic stimulation, isolated WT hearts utilized PCr, whereas isolated GAMT-/- hearts utilized P-GA. During ischemia/reperfusion, GAMT-/- hearts showed markedly impaired recovery of systolic (24% versus 53% rate pressure product recovery; P<0.05) and diastolic function (eg, left ventricular end-diastolic pressure 23+/-9 in WT and 51+/-5 mm Hg in GAMT-/- during reperfusion; P<0.05) and incomplete resynthesis of P-GA.. GAMT-/- mice do not develop hypertrophy and show normal cardiac function at low workload, suggesting that a fully functional CK/PCr system is not essential under resting conditions. However, when acutely stressed by inotropic stimulation or ischemia/reperfusion, GAMT-/- mice exhibit a markedly abnormal phenotype, demonstrating that an intact, high-capacity CK/PCr system is required for situations of increased cardiac work or acute stress.

Topics: Animals; Cardiomegaly; Creatine Kinase; Disease Susceptibility; Energy Metabolism; Guanidinoacetate N-Methyltransferase; Heart Function Tests; Hemodynamics; Mice; Mice, Knockout; Myocardial Contraction; Myocardial Ischemia; Myocardial Reperfusion Injury; Phosphocreatine; Stress, Physiological

Off pump coronary artery bypass grafting (OPCAB) involves, and is occasionally impaired by obligatory regional myocardial ischemia, particularly with the use of proximal coronary in-flow occlusion techniques. Intracoronary shunts do not guarantee absence of distal ischemia given their small inner diameter and the presence of proximal coronary stenosis. Additional adjunctive measures to provide short-term myocardial protection may facilitate OPCAB. High-energy phosphate supplementation with creatine phosphate prior to ischemia may attenuate ischemic dysfunction.. In a rodent model of a transient coronary occlusion and myocardial ischemia, 36 animals underwent preischemic intravenous infusion of either creatine phosphate or saline, 10 minutes of proximal left anterior descending (LAD) occlusion, and 10 minutes of reperfusion. Rats underwent continuous intracavitary pressure monitoring and cellular ATP levels were quantified using a luciferin/luciferase bioluminescence assay.. Within 2 minutes of ischemia onset, creatine phosphate animals exhibited statistically significant greater preservation of myocardial function compared to controls, an augmentation which persisted throughout the duration of ischemia and subsequent reperfusion. Furthermore, significantly greater cellular ATP levels were observed among creatine phosphate treated animals (344+/-55 nMol/g tissue, n=5) compared to control animals (160+/-9 nMol/g tissue, n=5)(p=0.014).. A strategy of intravenous high-energy phosphate administration successfully prevented ischemic ventricular dysfunction in a rodent model of OPCAB.

Topics: Adenosine Triphosphate; Animals; Cardiotonic Agents; Coronary Artery Bypass, Off-Pump; Disease Models, Animal; Infusions, Intravenous; Male; Myocardial Ischemia; Myocardium; Phosphocreatine; Rats; Rats, Wistar; Stroke Volume; Treatment Outcome; Troponin I

Data show that uptake of amino acids correlates with myocardial oxygen consumption after aortic cross-clamp in humans; this suggests a direct link between amino acids and myocardial energy metabolism. The aim of this preliminary study was to investigate the anti-ischemic effects of immediate and long-term supplementation of an amino acid mixture. We tested this hypothesis on isolated rats hearts subjected to global ischemia for 30 minutes. Long-term treatment with an amino acid mixture achieved the following: (1) reduced the increase of diastolic pressure (48 +/- 3 mm Hg vs 21 +/- 4 mm Hg; p <0.05); (2) maintained the tissue content of adenosine triphosphate during ischemia (2.5 +/- 0.6 micromol/g wet wt [gww] vs 7.0 +/- 1.2 micromol/gww; p <0.05); and (3) improved the recovery of developed pressure at the end of postischemic reperfusion (11 +/- 2 mm Hg vs 38 +/- 3 mm Hg; p <0.05), reducing the release of creatine kinase (375 +/- 30 microU/min/gww vs 196 +/- 15 microU/min/gww; p <0.05) and lactate (15 +/- 1.5 mg/min/gww vs 5 +/- 1 mg/min/gww; p <0.05). We conclude that long-term supplementation of an amino acid mixture reduced myocardial ischemic damage.

Topics: Adenosine Triphosphate; Administration, Oral; Amino Acids, Essential; Animals; Creatine Kinase; Dietary Proteins; Dietary Supplements; Disease Models, Animal; Lactic Acid; Male; Myocardial Ischemia; Myocardium; Phosphocreatine; Rats; Rats, Sprague-Dawley; Ventricular Function, Left

A computational model of myocardial energy metabolism was used to assess the metabolic responses to normal and reduced myocardial blood flow. The goal was to examine to what extent glycolysis and lactate formation are controlled by the supply of glycolytic substrate and/or the cellular redox (NADH/NAD+) and phosphorylation (ATP/ADP) states.. Flow was reduced over a wide range and for a sufficient duration in order to investigate the sequence of events that occur during the transition to a new metabolic steady state.. Simulation results indicated multiple time-dependent controls over both glycolysis and lactate formation.. Changes in phosphorylation state and glucose uptake only significantly affect the initial phase of the glycolytic response to ischemia, while glycogen breakdown exerts control over glycolysis during the entire duration of ischemia. Similarly, changes in the redox state affect the rates of lactate formation and release primarily during the initial transient phase of the response to the reductions in blood flow, while the rate of glycolysis controls the rate of lactate formation throughout the entire period of adaptation.

Topics: Adenosine Triphosphate; Glycogen; Glycolysis; Lactic Acid; Models, Cardiovascular; Myocardial Ischemia; Myocardium; NAD; Oxidation-Reduction; Oxygen Consumption; Phosphocreatine; Phosphorylation; Pyruvic Acid

We previously reported that 20% of women with chest pain but without obstructive coronary artery disease (CAD) had stress-induced reduction in myocardial phosphocreatine-adenosine triphosphate ratio by phosphorus-31 nuclear magnetic resonance spectroscopy (abnormal MRS), consistent with myocardial ischemia. The prognostic implications of these findings are unknown.. Women referred for coronary angiography for suspected myocardial ischemia underwent MRS handgrip stress testing and follow-up evaluation. These included (1) n=60 with no CAD/normal MRS, (2) n=14 with no CAD/abnormal MRS, and (3) n=352 a reference group with CAD. Cardiovascular events were death, myocardial infarction, heart failure, stroke, other vascular events, and hospitalization for unstable angina. Cumulative freedom from events at 3 years was 87%, 57%, and 52% for women with no CAD/normal MRS, no CAD/abnormal MRS, and CAD, respectively (P<0.01). After adjusting for CAD and cardiac risk factors, a phosphocreatine-adenosine triphosphate ratio decrease of 1% increased the risk of a cardiovascular event by 4% (P=0.02). The higher event rate in women with no CAD/abnormal MRS was primarily due to hospitalization for unstable angina, which is associated with repeat catheterization and higher healthcare costs.. Among women without CAD, abnormal MRS consistent with myocardial ischemia predicted cardiovascular outcome, notably higher rates of anginal hospitalization, repeat catheterization, and greater treatment costs. Further evaluation into the underlying pathophysiology and possible treatment options for women with evidence of myocardial ischemia but without CAD is indicated.

Topics: Adenosine Triphosphate; Aged; Angina, Unstable; Cardiac Catheterization; Cohort Studies; Coronary Angiography; Coronary Stenosis; Cost-Benefit Analysis; Disease-Free Survival; Female; Follow-Up Studies; Hand Strength; Health Care Costs; Heart Failure; Hospitalization; Humans; Life Tables; Magnetic Resonance Spectroscopy; Middle Aged; Myocardial Infarction; Myocardial Ischemia; Myocardium; Outcome Assessment, Health Care; Phosphocreatine; Prognosis; Risk Factors; Stroke; United States

Rat neonatal ventricular myocytes exposed to simulated ischaemia and reperfusion (SI/R) were used as an in vitro model to delineate the role(s) of extracellular signal-regulated kinase (ERK), p38 and c-Jun NH(2)-terminal protein kinase (JNK), as well as PKB in apoptosis. Exposure of the myocytes to SI (simulated ischaemia - energy depletion induced by KCN and 2-deoxy- D-glucose) reduced cell viability, as measured by the 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide (MTT) assay, and stimulated apoptosis as evidenced by caspase-3 activation and poly(ADP-ribose) polymerase (PARP) cleavage. However, morphological evidence of increased apoptosis, detected by staining with Hoechst 33342, was only seen in response to reperfusion. This suggests that although ischaemic conditions are sufficient to induce cellular markers of apoptosis (PARP cleavage and caspase-3 activation), reperfusion is required to complete the apoptotic pathway in these cells. Furthermore, SI resulted in a rapid, strong, biphasic activation of p38 concomitant with a weak and transient activation of the two ERK isoenzymes, p42/p44-MAPK. Reperfusion for 5 minutes resulted in a strong phosphorylation of p42/p44-MAPK, while no additional p38 activation was seen at this stage. On the other hand, p46/p54-MAPK (JNK) was phosphorylated in response to 5 minutes of reperfusion only and not during SI alone. A peak of PKB/Akt (Ser(473)) activity was seen within 5 minutes of exposure to SI, whereas PKB/Akt (Thr(308)) phosphorylation remained at the baseline level. Both PKB/Akt phosphorylation sites (Ser(473) and Thr(308)) were phosphorylated after 5 minutes of reperfusion. Inhibition of PI-3-kinase activity, using wortmannin, decreased phosphorylation on both sites during SI. However, only SI/R-induced PKB/Akt phosphorylation on Thr(308) was reduced by wortmannin. Myocytes pre-treated with SB203580, a p38-inhibitor, displayed a significant increase in cell viability [63.67 +/- 1.85 to 84.33 +/- 4.8% (p < 0.05)] and attenuation of the apoptotic index during SI/R [22.6 +/- 2.94% to 9 +/- 0.43% (p < 0.001)], while SP600125, a specific JNK inhibitor, caused a significant increase in caspase-3 activation [1.66 +/- 0.03 fold to 2.56 +/- 0.27 fold (p < 0.001)] and apoptotic index [22.6 +/- 2.94% to 32.75 +/- 6.13% (p < 0.05)]. However, PD98059, an ERK inhibitor, failed to affect apoptosis during SI/R. Inhibition of PI-3-kinase prevented the increase in mitochondrial viability usually observed dur

Topics: Adenosine Triphosphate; Animals; Animals, Newborn; Apoptosis; Caspase 3; Caspases; Cell Survival; Cells, Cultured; Enzyme Activation; Enzyme Inhibitors; Intracellular Membranes; JNK Mitogen-Activated Protein Kinases; Myocardial Ischemia; Myocardial Reperfusion Injury; Myocytes, Cardiac; p38 Mitogen-Activated Protein Kinases; Phosphocreatine; Phosphorylation; Poly (ADP-Ribose) Polymerase-1; Poly(ADP-ribose) Polymerases; Proteins; Rats; Rats, Wistar; Time Factors

The antiapoptotic protein Bcl-2 is targeted to the mitochondria, but it is uncertain whether Bcl-2 affects only myocyte survival after ischemia, or whether it also affects metabolic functions of mitochondria during ischemia. Hearts from mice overexpressing human Bcl-2 and from their wild-type littermates (WT) were subjected to 24 minutes of global ischemia followed by reperfusion. During ischemia, the decrease in pH(i) and the initial rate of decline in ATP were significantly reduced in Bcl-2 hearts compared with WT hearts (P<0.05). The reduced acidification during ischemia was dependent on the activity of mitochondrial F1F0-ATPase. In the presence of oligomycin (Oligo), an F1F0-ATPase inhibitor, the decrease in pH(i) was attenuated in WT hearts, but in Bcl-2 hearts, Oligo had no additional effect on pH(i) during ischemia. Likewise, addition of Oligo to WT hearts slowed the rate of decline in ATP during ischemia to a level similar to that observed in Bcl-2 hearts, but addition of Oligo had no significant effect on the rate of decline in ATP in Bcl-2 hearts during ischemia. These data are consistent with Bcl-2-mediated inhibition of consumption of glycolytic ATP. Furthermore, mitochondria from Bcl-2 hearts have a reduced rate of consumption of ATP on uncoupler addition. This could be accomplished by limiting ATP entry into the mitochondria through the voltage-dependent anion channel, and/or the adenine nucleotide transporter, or by direct inhibition of the F1F0-ATPase. Immunoprecipitation showed greater interaction between Bcl-2 and voltage-dependent anion channel during ischemia. These data indicate that Bcl-2 modulation of metabolism contributes to cardioprotection.

Topics: Adenosine Triphosphate; Anaerobiosis; Animals; Apoptosis; Blotting, Western; Cytosol; Energy Metabolism; Female; Gene Expression Regulation; Genes, bcl-2; Glycolysis; Humans; Hydrogen-Ion Concentration; Male; Mice; Mice, Transgenic; Mitochondria, Heart; Myocardial Contraction; Myocardial Infarction; Myocardial Ischemia; Myocardial Reperfusion Injury; Nuclear Magnetic Resonance, Biomolecular; Oligomycins; Phosphocreatine; Porins; Proto-Oncogene Proteins c-bcl-2; Proton-Translocating ATPases; Recombinant Fusion Proteins; Voltage-Dependent Anion Channels

Na/Ca-exchanger (NCX) and sarcoplasmic reticulum (SR) roles during the protection by a cardioplegic solution (25 mm K and 0.5 mm Ca, CPG) against ischaemia-reperfusion was studied.. Contractile performance (CP) and high energy phosphates contents (HEP) were evaluated in isolated ventricles from rats. They were pre-treated with Krebs (C) or CPG and submitted to no-flow ischaemia and reperfusion (I-R). KB-R7943 5 microm (inhibitor of NCX in reverse mode), 8 mm caffeine and ionic changes were used pre-ischaemically to evaluate each pathway role.. During R, CP recovered to 77 +/- 8% of basal in CPG-hearts vs. 55 +/- 8% (P < 0.05) in C-ones. CPG avoided the increases in end diastolic pressure (LVEDP) and in PCr/ATP ratio during I-R. Low [Na]o (78 mm) under both, CPG-2 mm Ca and C, increased further the LVEDP during I-R. LVEDP was also transiently increased by caffeine-CPG, but not modified by KB-R7943. The recovery of CP during reperfusion of CPG-hearts was decreased either, by caffeine (to approximately 75%), low [Na]o-2 mm Ca-CPG (to approximately 40%) and KB-R7943 (to approximately 16%).. CPG protected hearts from ischaemic contracture by attenuating the fall in ATP and removing diastolic Ca by means of NCX in forward mode. Moreover, CPG induces higher CP recovery during reperfusion by participation of SR and NCX in reverse mode. This work remarks the use of CPG based on the functional role of these Ca handling-mechanisms in a pathophysiological condition as ischaemia-reperfusion.

Topics: Adenosine Triphosphate; Animals; Anti-Arrhythmia Agents; Blood Pressure; Caffeine; Calcium; Cardioplegic Solutions; Central Nervous System Stimulants; Female; Male; Myocardial Contraction; Myocardial Ischemia; Myocardial Reperfusion Injury; Phosphocreatine; Rats; Rats, Wistar; Sarcoplasmic Reticulum; Sodium; Sodium-Calcium Exchanger; Thiourea; Ventricular Function, Left

Although ischemic preconditioning induces bioenergetic tolerance and thereby remodels energy metabolism that is crucial for postischemic recovery of the heart, the molecular components associated with preservation of cellular energy production, transfer, and utilization are not fully understood. Here myocardial bioenergetic dynamics were assessed by (18)O-assisted (31)P-NMR spectroscopy in control or preconditioned hearts from wild-type (WT) or Kir6.2-knockout (Kir6.2-KO) mice that lack metabolism-sensing sarcolemmal ATP-sensitive K(+) (K(ATP)) channels. In WT vs. Kir6.2-KO hearts, preconditioning induced a significantly higher total ATP turnover (232 +/- 20 vs. 155 +/- 15 nmol x mg protein(-1) x min(-1)), ATP synthesis rate (58 +/- 3 vs. 46 +/- 3% (18)O labeling of gamma-ATP), and ATP consumption rate (51 +/- 4 vs. 31 +/- 4% (18)O labeling of P(i)) after ischemia-reperfusion. Moreover, preconditioning preserved cardiac creatine kinase-catalyzed phosphotransfer in WT (234 +/- 26 nmol x mg protein(-1) x min(-1)) but not Kir6.2-KO (133 +/- 18 nmol x mg protein(-1) x min(-1)) hearts. In contrast with WT hearts, preconditioning failed to preserve contractile recovery in Kir6.2-KO hearts, as tight coupling between postischemic performance and high-energy phosphoryl transfer was compromised in the K(ATP)-channel-deficient myocardium. Thus intact K(ATP) channels are integral in ischemic preconditioning-induced protection of cellular energetic dynamics and associated cardiac performance.

Topics: Adenosine Triphosphate; Animals; Energy Metabolism; Heart; In Vitro Techniques; Ischemic Preconditioning, Myocardial; Magnetic Resonance Spectroscopy; Mice; Mice, Knockout; Myocardial Ischemia; Myocardium; Phosphocreatine; Potassium Channels, Inwardly Rectifying; Sarcolemma

Compared with normal hearts, those with pathology (hypertrophy) are less tolerant of metabolic stresses such as ischemia. Pharmacologic intervention administered prior to such stress could provide significant protection. This study determined, firstly, whether the pentose sugar ribose, previously shown to improve postischemic recovery of energy stores and function, protects against ischemia when administered as a pretreatment. Secondly, the efficacy of this same pretreatment protocol was determined in hearts with pathology (hypertrophy). For study 1, Sprague-Dawley rats received equal volumes of either vehicle (bolus i.v. saline) or ribose (100 mg/kg) before global myocardial ischemia. In study 2, spontaneously hypertensive rats (SHR; blood pressure approximately 200/130) with myocardial hypertrophy underwent the same treatment protocol and assessments. In vivo left ventricular function was measured and myocardial metabolites and tolerance to ischemia were assessed. In normal hearts, ribose pretreatment significantly elevated the heart's energy stores (glycogen), and delayed the onset of irreversible ischemic injury by 25%. However, in vivo ventricular relaxation was reduced by 41% in the ribose group. In SHR, ribose pretreatment did not produce significant elevations in the heart's energy or improvements in tolerance to global ischemia, but significantly improved ventricular function (maximal rate of pressure rise (+dP/dt(max)), 25%; normalized contractility ((+dP/dt)/P), 13%) despite no change in hemodynamics. Thus, administration of ribose in advance of global myocardial ischemia does provide metabolic benefit in normal hearts. However, in hypertrophied hearts, ribose did not affect ischemic tolerance but improved ventricular function.

Topics: Adenosine Triphosphate; Anaerobic Threshold; Animals; Cardiotonic Agents; Disease Models, Animal; Drug Administration Schedule; Glycogen; Hypertension; Hypertrophy, Left Ventricular; Injections, Intravenous; Male; Myocardial Ischemia; Myocardium; Phosphocreatine; Rats; Rats, Sprague-Dawley; Ribose; Structure-Activity Relationship; Ventricular Function, Left; Ventricular Function, Right

High-energy phosphate metabolism is altered in the ischemic myocardium. We investigated the effects of in vivo administration of phosphocreatine (PCr) in a transient ischemic rat model to emulate off-pump myocardial revascularization.. Rats received either PCr (100 mg/kg) or saline intravenously 1 hour before surgery. Regional ischemia was maintained for 12 minutes by ligation of the left anterior descending artery and compared with sham-operated animals. Cardiac tissue was studied for ATP, PCr, and inorganic phosphate (Pi) using (31)P-cryo-NMR. Results were compared by ANOVA.. Levels of ATP were significantly (p < 0.01) lower in the ischemic hearts compared with controls; Pi and PCr remained unchanged. The PCr/Pi ratio was altered in ischemic hearts, reflecting an increased energy demand. PCr administration significantly (p < 0.01) elevated the content of PCr and ATP in both normal and ischemic hearts.. PCr restores high-energy phosphates and attenuates metabolic stress during periods of myocardial ischemia in the rat. Preconditioning with PCr may serve as a useful adjunct to off-pump coronary revascularization.

Topics: Adenosine Triphosphate; Analysis of Variance; Animals; Coronary Vessels; Disease Models, Animal; Drug Evaluation, Preclinical; Energy Metabolism; Glycolysis; Injections, Intravenous; Ischemic Preconditioning, Myocardial; Ligation; Magnetic Resonance Imaging; Male; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Phosphates; Phosphocreatine; Phosphorus Isotopes; Phosphorylation; Rats; Rats, Sprague-Dawley; Time Factors

Current treatment for acute myocardial infarction (AMI) focuses on reestablishing blood flow (reperfusion). Paradoxically, reperfusion itself may cause additional injury to the heart. We previously found that delta-protein kinase C (deltaPKC) inhibition during simulated ischemia/reperfusion in isolated rat hearts is cardioprotective. We focus here on the role for deltaPKC during reperfusion only, using an in vivo porcine model of AMI.. An intracoronary application of a selective deltaPKC inhibitor to the heart at the time of reperfusion reduced infarct size, improved cardiac function, inhibited troponin T release, and reduced apoptosis. Using 31P NMR in isolated perfused mouse hearts, we found a faster recovery of ATP levels in hearts treated with the deltaPKC inhibitor during reperfusion only.. Reperfusion injury after cardiac ischemia is mediated, at least in part, by deltaPKC activation. This study suggests that including a deltaPKC inhibitor at reperfusion may improve the outcome for patients with AMI.

Topics: Animals; Apoptosis; Biomarkers; Cardiac Catheterization; Caspase 3; Caspases; Drug Evaluation, Preclinical; Enzyme Inhibitors; Female; Infusions, Intra-Arterial; Mice; Myocardial Infarction; Myocardial Ischemia; Myocardial Reperfusion Injury; Oligopeptides; Phosphocreatine; Phosphorus; Protein Kinase C; Protein Kinase C-delta; Swine; Troponin T

Excised rat hearts were perfused isovolumically and then made globally ischemic for times varying from 0 to 70 min followed by 50 min of reperfusion. In situ mitochondrial electrical potential gradients (Deltapsi(m)) were measured during reperfusion using the lipophilic cation, 3H-tetraphenylphosphonium. Therefore, it was possible to measure the relationships between mechanical performance, Deltapsi(m), and high energy phosphates as a function of time of ischemia. The absolute value of Deltapsi(m) remained constant and then dropped sharply in parallel with mechanical performance after 35 min of ischemia. Eliminating Ca2+ from the reperfusate medium did not preserve Deltapsi(m) nor increase high energy phosphates during the recovery period. An inhibitor of the mitochondrial permeability transition, cyclosporin A, delayed the fall in Deltapsi(m) but did not eliminate it. The data suggest that the mitochondrial permeability transition plays a role in ischemic cell death but is not triggered by influx of Ca2+ through the plasma membrane.

Topics: Animals; Blood Pressure; Calcium; Cell Membrane Permeability; Cyclosporine; Electrophysiology; Intracellular Membranes; Male; Membrane Potentials; Mitochondria, Heart; Myocardial Ischemia; Myocardial Reperfusion Injury; Onium Compounds; Organophosphorus Compounds; Phosphocreatine; Rats; Rats, Sprague-Dawley; Tritium

The hypothesis tested was that reoxygenation-induced contracture of myocardial cells, a form of reperfusion injury, can be due to a rigor-type mechanism. Isolated adult cardiomyocytes were exposed to 30- or 60-min anoxia (pH 6.4) and reoxygenation (pH 7.4). In cardiomyocytes, cytosolic Ca(2+) and cell length, and in isolated rat hearts left ventricular end-diastolic pressure (LVEDP) were measured. During reoxygenation, cardiomyocytes developed contracture. When energy recovery was slowed down, less Ca(2+) overload was required for contracture: (1) after 30-min anoxia Ca(20) (cytosolic Ca(2+) concentration in cells with 20% cell length reduction) was 1.42 +/- 0.11 micromol/l; (2) after 30-min anoxia with partial mitochondrial inhibition during reoxygenation (NaCN, 0.1 mmol/l) Ca(20) was reduced to 0.69 +/- 0.05 micromol/l; (3) after 60-min anoxia Ca(20) was reduced to 0.78 +/- 0.05 micromol/l and (4) when energy recovery was accelerated (succinate, 0.2 mmol/l), Ca(20) rose to 1.35 +/- 0.05 micromol/l. In isolated hearts, the reperfusion-induced rise in LVEDP was modulated by the same interventions. Slow recovery of energy production favors reoxygenation-induced contracture in cardiomyocytes and hearts. This shows that rigor contracture contributes to reoxygenation-induced cell injury.

Topics: Animals; Calcium; Cell Hypoxia; Cells, Cultured; Contracture; Cytosol; Heart Ventricles; Hydrogen-Ion Concentration; Male; Myocardial Ischemia; Myocardial Reperfusion Injury; Myocardium; Myocytes, Cardiac; Oxygen; Phosphocreatine; Rats; Rats, Wistar; Time Factors

We hypothesized that indices of myocyte contractility and metabolism could be preserved with ischemic preconditioning in a model of reversible ischemia similar to that occurring during routine cardiac surgery. Regional measures of metabolism and function have not been studied in conjunction with individual myocyte function during postischemic recovery of preconditioned myocardium.. In 16 dogs, myocardium supplied by the left anterior descending artery (LAD) was preconditioned with intermittent LAD ischemia and reperfusion. Following preconditioning, the heart was made globally ischemic for 20 min at normothermia by aortic cross-clamping while on cardiopulmonary bypass. In 10 animals, serial measurements of LAD and remote region adenosine triphosphate (ATP) levels, glucose uptake, and wall thickening were obtained with full-thickness drill biopsies, positron emission tomography (PET), and 2-D echocardiography, respectively. In the remaining 6 animals, cardiac myocytes were isolated after 1 h of reperfusion for measurement of myocyte contractility and intracellular calcium transients.. ATP levels were higher in the preconditioned LAD region than in the remote region at end of ischemia (3.17 +/- 0.33 nmol/mg vs 2.59 +/- 0.30 nmol/mg, P = 0.006). Similarly, preconditioned region glucose uptake was 40% higher than remote region glucose uptake at 2 days postischemia (0.35 +/- 0.06 micromol/min/g vs 0.25 +/- 0.05 micromol/min/g, P = 0.019). There were no differences in regional wall thickening as measured by 2-D echo either immediately following ischemia or at 2 days. Individual myocyte contractile response to increasing concentrations of extracellular calcium was preserved in cells from preconditioned myocardium, but it was severely depressed in remote region myocytes.. We conclude that regional ischemic preconditioning prior to prolonged ischemia protects myocardial glucose uptake and myocyte contractile function. The beneficial effects on glucose metabolism suggest that preconditioning may have sustained protective effects on cell metabolism.

Topics: Adenosine Triphosphate; Animals; Aorta; Constriction; Dogs; Female; Glucose; Ischemic Preconditioning, Myocardial; Male; Myocardial Contraction; Myocardial Ischemia; Myocardium; Phosphocreatine; Time Factors; Ultrasonography

To determine whether A(3) adenosine receptor (A(3)AR) signaling modulates myocardial function, energetics, and cardioprotection, hearts from wild-type and A(3)AR-overexpressor mice were subjected to 20-min ischemia and 40-min reperfusion while (31)P NMR spectra were acquired. Basal heart rate and left ventricular developed pressure (LVDP) were lower in A(3)AR-overexpressor hearts than wild-type hearts. Ischemic ATP depletion was delayed and postischemic recoveries of contractile function, ATP, and phosphocreatine were greater in A(3)AR-hearts. To determine the role of depressed heart rate and to confirm A(3)AR-specific signaling, hearts were paced at 480 beats/min with or without 60 nmol/l MRS-1220 (A(3)AR-specific inhibitor) and then subjected to ischemia-reperfusion. LVDP was similar in paced A(3)AR-overexpressor and paced wild-type hearts. Differences in ischemic ATP depletion and postischemic contractile and energetic dysfunction remained in paced A(3)AR-overexpressor hearts versus paced wild-type hearts but were abolished by MRS-1220. In summary, A(3)AR overexpression decreased basal heart rate and contractility, preserved ischemic ATP, and decreased postischemic dysfunction. Pacing abolished the decreased contractility but not the ATP preservation or cardioprotection. Therefore, A(3)AR overexpression results in cardioprotection via a specific A(3)AR effect, possibly involving preservation of ATP during ischemia.

Topics: Adenosine Triphosphate; Animals; Energy Metabolism; Gene Expression; Heart Rate; Hydrogen-Ion Concentration; Magnetic Resonance Spectroscopy; Mice; Mice, Transgenic; Myocardial Contraction; Myocardial Ischemia; Myocardium; Phosphocreatine; Receptor, Adenosine A3; Receptors, Purinergic P1; Recovery of Function

Effects of minoxidil on ischemia-induced myocardial mechanical and metabolic dysfunction were examined in anesthetized open-chest dogs. A regional portion of the left ventricle was made ischemic for 20 min by ligating the left anterior descending coronary artery, and then reperfused for 120 min. Dimethylsulfoxide or minoxidil (0.3, or 1.0 mg/kg) was injected intravenously 10 min before ligation. Ischemia decreased regional myocardial contraction, and reperfusion recovered it but incompletely. Myocardial metabolic derangement was observed during ischemia, such as decreases in the myocardial levels of ATP and creatine phosphate. These metabolic changes caused by ischemia were restored by reperfusion. Minoxidil injection at 0.3 and 1.0 mg/kg significantly decreased blood pressures but increased coronary flow. Pretreatment with minoxidil significantly enhanced the recovery of myocardial contraction during reperfusion after ischemia. The levels of ATP and creatine phosphate in the ischemic myocardium were significantly preserved by minoxidil at 0.3 mg/kg. No significant effect of minoxidil on the metabolism was observed in the 120 min reperfused myocardium. In conclusion, minoxidil improved the mechanical dysfunction in the reperfused heart and the drug at low dose preserved high-energy phosphates during ischemia.

Topics: Adenosine Triphosphate; Animals; Antihypertensive Agents; Dimethyl Sulfoxide; Dogs; Female; Injections, Intravenous; Male; Minoxidil; Myocardial Contraction; Myocardial Ischemia; Myocardial Reperfusion; Phosphocreatine; Potassium Channels

Experiments on dogs showed that energostim, a directly acting antihypoxant, injected 15 min after occlusion of the upper one-third of the left descending branch of the interventricular coronary artery produced a pronounced cardioprotective effect. The effect was confirmed by electron microscopy (evaluation the necrotic focus), biochemical tests of the heart and blood, and changes in intracardiac hemodynamics (recovery of systolic and diastolic functions). The cardioprotective effect of energostim greatly surpasses that of routine therapy applied during acute myocardium infarction.

Topics: Animals; Antioxidants; Coronary Disease; Coronary Vessels; Dogs; Heart Ventricles; Hemodynamics; Microscopy, Electron; Myocardial Infarction; Myocardial Ischemia; Myocardium; Necrosis; Phosphocreatine; Time Factors

Repetitive myocardial ischemia increases glucose uptake, but the effect on glycogen is unclear. Thirteen swine instrumented with a hydraulic occluder on the circumflex (Cx) artery underwent 10-min occlusions twice per day for 4 days. After 24 h postfinal ischemia and in the fasted state, echocardiogram and positron emission tomography imaging for blood flow ([(13)N]-ammonia) and 2-[(18)F]fluoro-2-deoxy-D-glucose (FDG) uptake were obtained. Tissue was then collected for ATP, creatine phosphate (CP), glycogen, and glucose transporter-4 content, and hexokinase activity. After reperfusion, regional function and CP-to-ATP ratios in the Cx and remote regions were similar. Despite the absence of stunning, the Cx region demonstrated higher glycogen levels (33 +/- 11 vs. 24 +/- 11 micromol/g; P < 0.05), and this increase correlated well with the increase in FDG uptake (r(2) = 0.78; P < 0.01). Hexokinase activity was also increased relative to remote regions (0.62 +/- 0.29 vs. 0.37 +/- 0.19 IU/g; P < 0.05), with no difference in GLUT-4 content. In summary, 24 h after repetitive ischemia, glucose uptake and glycogen levels are increased at a time that functional and bioenergetic markers of stunning have recovered. The significant correlation between glycogen content and FDG accumulation in the postischemic region suggests that increased rates of glucose transport and/or phosphorylation are linked to increased glycogen levels in hearts subjected to repetitive bouts of ischemia.

Topics: Adenosine Triphosphate; Ammonia; Animals; Biological Transport; Coronary Circulation; Echocardiography; Fluorodeoxyglucose F18; Glucose; Glucose Transporter Type 4; Glycogen; Heart; Hemodynamics; Hexokinase; Monosaccharide Transport Proteins; Muscle Proteins; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Nitrogen Isotopes; Phosphocreatine; Swine; Tomography, Emission-Computed

This study evaluates the effects of diltiazem administered during reperfusion on hemodynamic, metabolic, and ultrastructural postischemic outcome.. Hearts of 38 adult White New Zealand rabbits underwent 60 min of global cold ischemia followed by 40 min of reperfusion in an erythrocyte perfused isolated working heart model. Hearts were randomly assigned to four groups and received diltiazem (0.1, 0.25, and 0.5 micromol/l) during reperfusion only, or served as control.. The postischemic time courses of heart rate, aortic flow, and external stroke work clearly reflected the dose-dependent negative chronotropic and inotropic efficacy of diltiazem in the two higher concentrations. High energy phosphates (HEP) determined from myocardial biopsies taken after 40 min of reperfusion were significantly better preserved in all treatment groups compared to control hearts. Similarly ultrastructural grading of mitochondria and myofilaments revealed a significant reduction of reperfusion injury in hearts that received diltiazem compared to control.. Diltiazem protects mitochondrial integrity and function, thereby preserving myocardial HEP levels. Only low dose diltiazem (0.1 micromol/l) during reperfusion combines both, optimal mitochondrial preservation with minimal changes in hemodynamics.

Topics: Adenine Nucleotides; Analysis of Variance; Animals; Biopsy, Needle; Chromatography, High Pressure Liquid; Diltiazem; Disease Models, Animal; Female; Hemodynamics; Male; Mitochondria, Heart; Myocardial Ischemia; Myocardial Reperfusion; Phosphocreatine; Probability; Rabbits; Random Allocation; Reference Values; Reperfusion Injury; Sensitivity and Specificity

The phosphocreatine (PCr) overshoot is a well-documented phenomenon and is readily observable by 31P MRS. In addition, a second 31P MRS observation during ischemia with reperfusion is a diminution in ATP levels. Combining these two as the 'PCr Overshoot' the PCr/ATP ratio may provide an index of viability. However little information is available regarding the duration of this 'overshoot'. For this approach to be useful clinically, the duration of this phenomenon must be ascertained. An open chest canine model of 12 min of ischemia followed by reperfusion (6h) was used. A 2 cm surface coil was sutured to the myocardium and spectra were acquired at 4.7 T. Gated spectra were acquired in <2.5 min with an interpulse delay of 5 s. Integrals of the PCr and ATP (beta) resonances were analyzed using a line-fitting routine. Overall, the PCr signal increased from 22.0+/-0.8 to 25.5+/-0.9 and ATP decreased from 11.7+/-0.4 to 10.0+/-0.4 (arbitrary units). The PCr remained elevated for the entire 6h period and the percentage increase was 15.9%. The ATP remained depleted for the entire 6h period and the percentage decrease was 17.0%. Thus, the clinically relevant and readily observable PCr/ATP is a product of both an increase in PCr and a decrease in ATP for a calculated net increase in PCr/ATP of 39.6%. The PCr/ATP ratio of the ischemia group for baseline, ischemia, 6h reflow, were: 2.33+/-0.18, 1.04+/-0.29 and 3.22+/-0.21. We demonstrate that the 'PCr overshoot' is readily observable and can be monitored noninvasively and nondestructively for 6h. Therefore, the 'PCr overshoot' may be a viable marker of reversible injury in this model and may prove to be applicable for detecting myocardial viability in patients.

Topics: Adenosine Triphosphate; Animals; Dogs; Magnetic Resonance Spectroscopy; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Phosphates; Phosphocreatine; Time Factors

1. The present study was aimed to determine whether propranolol improves contractile function of the ischaemic/reperfused heart through protection of the mitochondrial function during ischaemia. 2. Isolated perfused rat hearts were subjected to 35-min ischaemia followed by 60-min reperfusion. Pre-treatment with propranolol at the concentrations of 10 to 100 microM for the final 3 min of pre-ischaemia resulted in the improvement of ischaemia/reperfusion-induced contractile dysfunction, release of creatine kinase (CK) into perfusate, and decrease in myocardial high-energy phosphates. Propranolol also attenuated ischaemia-induced accumulation in Na+, suggesting that cytosolic sodium overload during ischaemia was prevented by propranolol. 3. The mitochondrial oxygen consumption rate of skinned bundles from the perfused heart decreased at the end of ischaemia and it further decreased at the end of reperfusion. These decreases were cancelled by treatment with propranolol. A release of cytochrome c from the perfused heart was observed during ischaemia, and this release was suppressed by treatment with propranolol. 4. To elucidate the direct effect of propranolol on mitochondria, the mitochondria were isolated from normal hearts and their activities were determined in the presence of various concentrations of Na+ and propranolol. The addition of sodium lactate, which mimicked sodium overload in the ischaemic heart, reduced the state 3 respiration, whereas this reduction was not attenuated by the presence of propranolol. 5. These results suggest that cardioprotection of propranolol may be exerted via attenuating Na+ influx into cardiac cells followed by prevention of the mitochondrial dysfunction in the ischaemic heart, leading to improvement of energy production of the heart during reperfusion.

Topics: Adenosine Triphosphate; Animals; Calcium; Creatine Kinase; Cytochrome c Group; In Vitro Techniques; Male; Mitochondria, Heart; Myocardial Contraction; Myocardial Ischemia; Myocardial Reperfusion Injury; Myocardium; Oxygen Consumption; Phosphocreatine; Propranolol; Protective Agents; Rats; Sodium

The possible relationships between intracellular Na(+) (Na(i)(+)), bioenergetic status and intracellular pH (pH(i)) in the mechanism for ischemic preconditioning were studied using (23)Na and (31)P magnetic resonance spectroscopy in isolated Langendorff perfused rat heart. The ischemic preconditioning (three 5-min ischemic episodes followed by two 5-min and one 10-min period of reperfusion) prior to prolonged ischemia (20 min stop-flow) resulted in a decrease in ischemic acidosis and faster and complete recovery of cardiac function (ventricular developed pressure and heart rate) after 30 min of reperfusion. The response of Na(i) during ischemia in the preconditioned hearts was characterized by an increase in Na(i)(+) at the end of preconditioning and an accelerated decrease during the first few minutes of reperfusion. During post-ischemic reperfusion, bioenergetic parameters (PCr/P(i) and betaATP/P(i) ratios) were partly recovered without any significant difference between control and preconditioned hearts. The reduced acidosis during prolonged ischemia and the accelerated decrease in Na(i)(+) during reperfusion in the preconditioned hearts suggest activation of Na(+)/H(+) exchanger and other ion transport systems during preconditioning, which may protect the heart from intracellular acidosis during prolonged ischemia, and result in better recovery of mechanical function (LVDP and heart rate) during post-ischemic reperfusion.

Topics: Acidosis; Animals; Energy Metabolism; Hydrogen-Ion Concentration; Intracellular Membranes; Ischemic Preconditioning, Myocardial; Magnetic Resonance Spectroscopy; Male; Myocardial Ischemia; Myocardial Reperfusion Injury; Myocardium; Oxazoles; Perfusion; Phosphates; Phosphocreatine; Pyrimidinones; Rats; Rats, Sprague-Dawley; Sodium; Sodium-Hydrogen Exchangers

Heat shock factor (HSF), the transcription factor for the heat shock proteins, is activated by cardiac ischemia, but the mechanism of activation is unknown. Ischemia is accompanied by changes in the energy state and acid-base conditions. We hypothesized that decreased ATP and/or intracellular pH (pH(i)) might activate HSF. To test this hypothesis, we perfused rat hearts within an NMR spectrometer. NMR data showed that after 6.5, 13, and 20 min of ischemia, ATP dropped to 62.7, 23.1, and 6.9% of the control level, and pH(i) was 6.16, 5.94, and 5.79, respectively. Reperfusion after ischemia partially restored ATP levels, and this was associated with greater activation of HSF1. HSF1 was also activated after 6.5 min of ischemia. Activation of HSF1 was less after 13 min of ischemia and barely detectable after 20 min of ischemia. In conclusion, 1) a moderate decrease in intracellular ATP correlates with activation of HSF1 in the heart; and 2) a severe depletion in ATP correlates with an attenuation in HSF1 activation, and the restoration of ATP leads to greater activation of HSF1, suggesting that a critical ATP level is required for activation of HSF1.

Topics: Adenosine Triphosphate; Algorithms; Animals; DNA-Binding Proteins; Electrophoresis, Polyacrylamide Gel; Energy Metabolism; Heat Shock Transcription Factors; Heat-Shock Proteins; Heat-Shock Response; Hemodynamics; Hydrogen-Ion Concentration; Magnetic Resonance Spectroscopy; Male; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Phosphocreatine; Rats; Rats, Sprague-Dawley; Transcription Factors

In an article in a previous issue of the Journal of Magnetic Resonance, Ouwerkerk and Bottomley (J. Magn. Reson. 148, pp. 425--435, 2001) show that even in the presence of chemical exchange, the dependence of saturation factors on repetition time in the one-pulse experiment is approximately monoexponential. They conclude from this fact that the effect of chemical exchange on the use of saturation factors when correcting for partial saturation is negligible. We take issue with this conclusion and demonstrate that because saturation factors in the presence of chemical exchange are strongly dependent upon all of the chemical parameters of the system, that is, upon all T(1)'s and M(0)'s of resonances in the exchange network and upon the reaction rates themselves, it is problematic to apply saturation factor corrections in situations in which any of these parameters may change. The error criterion we establish reflects actual errors in quantitation, rather than departures from monoexponentiality.

Topics: Adenosine Triphosphate; Animals; Humans; Magnetic Resonance Spectroscopy; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Phosphates; Phosphocreatine; Phosphorus

This article replies to Spencer et al. (J. Magn. Reson. 149, 251--257, 2001) concerning the degree to which chemical exchange affects partial saturation corrections using saturation factors. Considering the important case of in vivo (31)P NMR, we employ differential analysis to demonstrate a broad range of experimental conditions over which chemical exchange minimally affects saturation factors, and near-optimum signal-to-noise ratio is preserved. The analysis contradicts Spencer et al.'s broad claim that chemical exchange results in a strong dependence of saturation factors upon M(0)'s and T(1) and exchange parameters. For Spencer et al.'s example of a dynamic (31)P NMR experiment in which phosphocreatine varies 20-fold, we show that our strategy of measuring saturation factors at the start and end of the study reduces errors in saturation corrections to 2% for the high-energy phosphates.

Topics: Adenosine Triphosphate; Animals; Humans; Magnetic Resonance Spectroscopy; Myocardial Ischemia; Myocardium; Phosphates; Phosphocreatine; Phosphorus

The ischemic heart is dependent on glycolysis for ATP generation, and therapies that increase glucose utilization during ischemia improve survival. Myocardial ischemia results in the translocation of the glucose transporter proteins GLUT1 and GLUT4 to the sarcolemma. The increased glucose entry via these transporters contributes to enhanced glycolysis during ischemia.. To determine the role of GLUT4 in mediating increased glycolytic flux during ischemia, hearts from mice with cardiac-selective GLUT4 deficiency (G4H-/-) were subjected to global low-flow ischemia. During normal perfusion, hearts from fed G4H-/- mice showed increased GLUT1-mediated glucose uptake, higher concentrations of glycogen and phosphocreatine, but delayed recovery after ischemia. When these compensatory changes were eliminated by a 20-hour fast, G4H-/- hearts exhibited depressed glucose utilization during ischemia and developed profound and irreversible systolic and diastolic dysfunction associated with accelerated ATP depletion during ischemia and diminished regeneration of high-energy phosphate compounds on reperfusion.. GLUT4 is an important mediator of enhanced glycolysis during ischemia and represents an important protective mechanism against ischemic injury.

Topics: Adenosine Triphosphate; Animals; Blood Pressure; Creatine; Fasting; Glucose; Glucose Transporter Type 1; Glucose Transporter Type 4; Glycogen; Glycolysis; Heart; Heart Rate; In Vitro Techniques; Insulin; Lactic Acid; Magnetic Resonance Spectroscopy; Mice; Monosaccharide Transport Proteins; Muscle Proteins; Myocardial Contraction; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Phosphates; Phosphocreatine

Metabolic interventions that promote glucose use during ischemia have been shown to protect the myocardium and improve functional recovery on reperfusion. In this study we evaluated if cardioprotection can be accomplished by inhibiting fatty acid uptake, which would be expected to increase glycolytic metabolism.. Diisothiocyanostilbene sulfonic acid (DIDS), commonly used to inhibit Band-3 mediated anion exchanger, and has also been demonstrated to inhibit fatty acid transport in adipocytes, was used to inhibit fatty acid uptake prior to ischemia. Isolated rat hearts were perfused with buffer containing 5 mM glucose, 70 mU/l insulin, 0.4 mM palmitate, and 0.4 mM albumin, paced at 300 beats/min, and subjected to 50 min of low-flow ischemia followed by 60 min of reperfusion.. Ischemic injury, as assessed by creatine kinase release, was diminished in hearts perfused with DIDS (334+/-72 in DIDS vs. 565+/-314 IU/g dry wt in controls, P<0.04). Increases in LVEDP during ischemia were attenuated (8+/-3 mmHg in DIDS vs. 15+/-18 mmHg in controls, P<0.03) and the % recovery of LV function with reperfusion was enhanced in DIDS-treated hearts (78+/-10% of baseline in DIDS vs. 62+/-19% of baseline in controls, P<0.04). These beneficial effects of DIDS were associated with increased glucose metabolism and ATP content during ischemia and reperfusion. Furthermore, treatment with DIDS lowered the accumulation of long chain acyl carnitines.. This study demonstrates that DIDS protects ischemic myocardium, and is associated with inhibition of fatty acid uptake, improved glucose metabolism, and enhanced functional recovery on reperfusion. The data presented here suggest a potential role for therapeutic agents that lower fatty acid uptake as a metabolic adjunct in the treatment of myocardial ischemia.

Topics: 4,4'-Diisothiocyanostilbene-2,2'-Disulfonic Acid; Adenosine Triphosphate; Animals; Anion Exchange Protein 1, Erythrocyte; Carnitine; Fatty Acids; Glucose; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Oxidation-Reduction; Perfusion; Phosphocreatine; Phospholipids; Rats; Triglycerides

Tumor necrosis factor (TNF)-alpha has been implicated in the pathogenesis of heart failure and ischemia-reperfusion injury. Effects of TNF-alpha are initiated by membrane receptors coupled to sphingomyelinase signaling and include altered metabolism and calcium cycling, contractile dysfunction, and cell death. We postulate that pressure-overload hypertrophy results in increased myocardial TNF-alpha expression and that it contributes to decreased contractility in hypertrophied infant hearts subjected to ischemia-reperfusion.. Neonatal rabbits underwent aortic banding to induce LV hypertrophy. Myocardial TNF-alpha protein expression increased progressively with LV hypertrophy. Serum TNF-alpha was detected only after the onset of heart failure. Before onset of ventricular dilatation and heart failure (determined by serial echocardiograms), hearts from aortic banded and age-matched control rabbits were perfused in the Langendorff mode and subjected to 45 minutes of ischemia and 30 minutes of reperfusion. Postischemic recovery was impaired in hypertrophied hearts, but addition of neutralizing anti-rabbit TNF-alpha antibody to cardioplegia and perfusate solutions restored postischemic function. This effect was mimicked by treatment with the ceramidase inhibitor N-oleoyl ethanolamine. TNF-alpha inhibition also was associated with faster postischemic recovery of phosphocreatine, ATP, and pH as assessed by (31)P nuclear magnetic resonance spectroscopy. Intracellular calcium handling, measured by Rhod 2 spectrofluorometry, demonstrated lower diastolic calcium levels and higher systolic calcium transients in anti-TNF-alpha treated hearts.. TNF-alpha is expressed in myocardium during compensated pressure-overload hypertrophy and contributes to postischemic myocardial dysfunction. Inhibition of TNF-alpha signaling significantly improves postischemic contractile function, myocardial energetics, and intracellular calcium handling.

Topics: Adenosine Triphosphate; Animals; Animals, Newborn; Antibodies; Calcium; Diastole; Disease Models, Animal; Enzyme Inhibitors; Fluorescent Dyes; Heart; Heterocyclic Compounds, 3-Ring; Hydrogen-Ion Concentration; Hypertrophy, Left Ventricular; In Vitro Techniques; Intracellular Fluid; Magnetic Resonance Spectroscopy; Myocardial Contraction; Myocardial Ischemia; Myocardium; Organ Size; Phosphocreatine; Rabbits; Systole; Tumor Necrosis Factor-alpha; Ventricular Function, Left

Experimental evidence indicates that ischemic glycolysis improves myocardial tolerance to low flow ischemia and anoxia, and cellular membrane disruption signals and/or causes transition to irreversible ischemic injury. The objective of this study was to determine the impact of ischemic glycolysis on membrane integrity and myocardial viability during total ischemia. Phosphorus metabolites were measured by 31P NMR spectroscopy and cellular volumes were determined by 1H and 59Co NMR in conjunction with the extracellular marker cobalticyanide. Isolated rat hearts were submitted to 30 min of total ischemia, followed by 30 min of reperfusion. Glycogen contents were modulated by pre-ischemic perfusion with various substrates. Increased glycolytic activities, as determined from lactate production, delayed onset of ischemic contracture (p < 0.05), induced cytosolic acidification (p < 0.005) and cellular swelling during ischemia (p < 0.05), reduced post-ischemic diastolic tone (p < 0.05), improved recovery of high energy phosphates and contraction force (p < 0.005). Inhibition of glycolysis with iodoacetate and glycogen depletion with 2-deoxyglycose resulted in early onset of ischemic contracture (p < 0.005), elevated post-ischemic diastolic pressures (p < 0.05), reduced coronary flow rates and mechanical activities (p < 0.05). Cellular viability was evaluated by creatine kinase efflux, and membrane integrity was determined from cellular swelling during perfusion with hypoosmotic medium. High activities of ischemic glycolysis correlated with improved cellular viability and preserved membrane integrity, while low glycolytic fluxes were associated with membrane permeabilization (p < 0.05). The protective effect of ischemic glycolysis over sarcolemmal integrity was attributed to continuous provision of energy, undetected by 31P NMR spectroscopy. There was no evidence that ischemic swelling caused by glycolytic end-metabolites accumulation had detrimental consequences, and of excessive swelling during reperfusion. It is concluded that one of the cardio-protective mechanisms of ischemic glycolysis is energy-dependent preservation of sarcolemmal integrity and cellular viability.

Topics: Adenosine Triphosphate; Anaerobic Threshold; Animals; Energy Metabolism; Glycolysis; Magnetic Resonance Spectroscopy; Male; Myocardial Ischemia; Myocardium; Phosphocreatine; Rats; Rats, Sprague-Dawley; Sarcolemma; Ventricular Pressure

Oxidative stress may cause apoptosis of cardiomyocytes in ischemic-reperfused myocardium. We investigated whether ischemia-reperfusion modifies the susceptibility of cardiomyocyte induction of apoptosis by oxidative stress. Ischemia was simulated by incubating isolated cardiomyocytes from adult rats in an anoxic, glucose-free medium, pH 6.4, for 3 h. Annexin V-fluorescein isothiocyanate/propidium iodide staining and the detection of DNA laddering were used as apoptotic markers. H(2)O(2) (7.5 micromol/l) induced apoptosis in 20.1 +/- 1.8% of cells under normoxic conditions but only 14.4 +/- 1.6% (n = 6, P < 0.05) after ischemia-reoxygenation. This partial protection of ischemic-reoxygenated cells was observed despite a reduction in their cellular glutathione content, from 11.4 +/- 1.9 in normoxic controls to 2.9 +/- 0.8 nmol/mg protein (n = 3, P < 0.05). Elevation of end-ischemic glutathione contents by pretreatment with 1 mmol/l N-acetylcysteine entirely protected ischemic-reoxygenated cells against induction of apoptosis by H(2)O(2). In conclusion, ischemia-reperfusion can protect cardiomyocytes against induction of apoptosis by exogenous oxidative stress. This endogenous protective effect is most clearly demonstrated when control and postischemic cardiomyocytes are compared at similar glutathione levels.

Topics: Acetylcysteine; Animals; Apoptosis; Cells, Cultured; Free Radical Scavengers; Hydrogen Peroxide; Male; Myocardial Ischemia; Myocardial Reperfusion Injury; Myocardium; Oxidants; Oxidative Stress; Phosphocreatine; Rats; Rats, Wistar

Topics: Adenosine Triphosphate; Chest Pain; Coronary Angiography; Exercise; Female; Humans; Magnetic Resonance Spectroscopy; Myocardial Ischemia; Phosphocreatine; Phosphorus

Our goals were to (1) simulate the degree of low-flow ischemia and mixed anaerobic and aerobic metabolism of an acutely infarcting region; (2) define changes in anaerobic glycolysis, oxidative phosphorylation, and the creatine kinase (CK) reaction velocity; and (3) determine whether and how increased glycolytic substrate alters the energetic profile, function, and recovery of the ischemic myocardium in the isolated blood-perfused rat heart.. Hearts had 60 minutes of low-flow ischemia (10% of baseline coronary flow) and 30 minutes of reperfusion with either control or high glucose and insulin (G+I) as substrate. In controls, during ischemia, rate-pressure product and oxygen consumption decreased by 84%. CK velocity decreased by 64%; ATP and phosphocreatine (PCr) concentrations decreased by 51% and 63%, respectively; inorganic phosphate (P(i)) concentration increased by 300%; and free [ADP] did not increase. During ischemia, relative to controls, the G+I group had similar CK velocity, oxygen consumption, and tissue acidosis but increased glycolysis, higher [ATP] and [PCr], and lower [P(i)] and therefore had a greater free energy yield from ATP hydrolysis. Ischemic systolic and diastolic function and postischemic recovery were better.. During low-flow ischemia simulating an acute myocardial infarction region, oxidative phosphorylation accounted for 90% of ATP synthesis. The CK velocity fell by 66%, and CK did not completely use available PCr to slow ATP depletion. G+I, by increasing glycolysis, slowed ATP depletion, maintained lower [P(i)], and maintained a higher free energy from ATP hydrolysis. This improved energetic profile resulted in better systolic and diastolic function during ischemia and reperfusion. These results support the clinical use of G+I in acute MI.

Topics: Adenosine Triphosphate; Animals; Creatine Kinase; Disease Models, Animal; Glucose; Hemodynamics; Insulin; Magnetic Resonance Spectroscopy; Male; Myocardial Infarction; Myocardial Ischemia; Myocardium; Oxidative Phosphorylation; Oxygen Consumption; Phosphocreatine; Rats; Rats, Wistar

Topics: Adenosine Triphosphate; Animals; In Vitro Techniques; Magnetic Resonance Spectroscopy; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Perfusion; Phosphates; Phosphocreatine; Phosphorus; Rats; Time Factors

Topics: Adenosine Triphosphate; Angina Pectoris; Chest Pain; Electrocardiography; Exercise Test; Female; Humans; Magnetic Resonance Spectroscopy; Myocardial Ischemia; Phosphocreatine; Sensitivity and Specificity

We determined the effect of 1-cis diltiazem, the enantiomer of diltiazem (d-cis isoform), on the energy metabolism of isolated guinea pig hearts during ischemia-reperfusion. We used 31P-NMR to measure the high-energy phosphate content and intracellular pH (pHi) during global ischemia for 30 min followed by reperfusion for 30 min. Before ischemia, the left ventricular developed pressure (LVDP) was reduced less by 10 microM l-cis diltiazem than by 3 microM diltiazem or 500 nM nifedipine. However, 10 microM l-cis diltiazem preserved the intracellular ATP content during ischemia and reperfusion, reduced the end-diastolic pressure increase during ischemia and reperfusion, and restored LVDP after reperfusion. Nifedipine at 50 nM, which reduced the LVDP more than 10 microM l-cis diltiazem, showed no cardioprotective effect. Ten micromolar l-cis diltiazem and 3 microM diltiazem, but neither 50 nor 500 nM nifedipine, reduced the pHi decrease that occurred 25 or 30 min after the onset of ischemia. Therefore, l-cis diltiazem has a cardioprotective effect on ischemic and reperfused myocardium and is less cardiodepressive than diltiazem and nifedipine. The effect of l-cis diltiazem during ischemia and reperfusion involves energy preservation, which is probably independent of its Ca2+-channel blocking action.

Topics: Adenosine Triphosphate; Animals; Calcium Channel Blockers; Diltiazem; Guinea Pigs; Heart; Hydrogen-Ion Concentration; Magnetic Resonance Spectroscopy; Myocardial Contraction; Myocardial Ischemia; Myocardial Reperfusion; Nifedipine; Phosphocreatine; Phosphorus Isotopes

The action of pharmacological openers of K(ATP) channels depends on the availability and levels of various intracellular nucleotides. Since these are subject to change during myocardial ischaemia, K(ATP) channel openers may affect ischaemic and non-ischaemic tissue differentially. Using a recently developed dual coronary perfusion method, we investigated the effects on arrhythmias of the prototypical K(ATP) channel opener levcromakalim when applied selectively to ischaemic and/or non-ischaemic tissue. A novel perfusion cannula was used to independently perfuse the left and right coronary beds of hearts isolated from rats. Selective infusion of levcromakalim (3, 10 or 30 microM) into the left coronary bed in the absence of ischaemia did not induce ventricular arrhythmias. Regional zero-flow ischaemia was induced by cessation of flow to the left coronary bed and hearts received levcromakalim selectively into either the left, right, or both coronary beds. When applied selectively to the ischaemic left coronary bed, levcromakalim (3, 10 or 30 microM; n=10/group) delayed the onset of ventricular tachycardia in a dose-dependent manner (by 21*, 43* and 112%* at 3, 10 and 30 microM; *P<0.05 vs. control). When applied only to the non-ischaemic right coronary bed, levcromakalim reduced the incidence of ventricular tachycardia during later phases of ischaemia (from 100% in controls to 30%*). When present in both coronary beds, levcromakalim had a striking anti-arrhythmic effect--the overall incidence of ventricular tachycardia being reduced from 100% in controls to 20%*. We conclude that levcromakalim may have an anti-arrhythmic effect when applied either to ischaemic or non-ischaemic tissue but that the mechanisms may differ depending on the metabolic state of the heart.

Topics: Adenosine Triphosphate; Animals; Anti-Arrhythmia Agents; ATP-Binding Cassette Transporters; Coronary Circulation; Cromakalim; Heart Rate; In Vitro Techniques; KATP Channels; Male; Myocardial Ischemia; NADP; Phosphocreatine; Potassium Channels; Potassium Channels, Inwardly Rectifying; Rats; Rats, Wistar

Hypoxia and reoxygenation were studied in rat hearts and ischemia and reperfusion in rat hindlimbs. Free radicals are known to be generated through these events and to propagate complications. In order to reduce hypoxic/ischemic and especially reoxygenation/reperfusion injury the (re)perfusion conditions were ameliorated including the treatment with antioxidants (lipoate or dihydrolipoate). In isolated working rat hearts cardiac and mitochondrial parameters are impaired during hypoxia and partially recover in reoxygenation. Dihydrolipoate, if added into the perfusion buffer at 0.3 microM concentration, keeps the pH higher (7. 15) during hypoxia as compared to controls (6.98). The compound accelerates the recovery of the aortic flow and stabilizes it during reoxygenation. With dihydrolipoate, ATPase activity is reduced, ATP synthesis is increased and phosphocreatine contents are higher than in controls. Creatine kinase activity is maintained during reoxygenation in the dihydrolipoate series. Isolated rat hindlimbs were stored for 4 h in a moist chamber at 18 degrees C. Controls were perfused for 30 min with a modified Krebs-Henseleit buffer at 60 mmHg followed by 30 min Krebs-Henseleit perfusion at 100 mmHg. The dihydrolipoate group contained 8.3 microM in the modified reperfusate (controlled reperfusion). With dihydrolipoate, recovery of the contractile function was 49% (vs. 34% in controls) and muscle flexibility was maintained whereas it decreased by 15% in the controls. Release of creatine kinase was significantly lower with dihydrolipoate treatment. Dihydrolipoate effectively reduces reoxygenation injury in isolated working rat hearts. Controlled reperfusion, including lipoate, prevents reperfusion syndrome after extended ischemia in exarticulated rat hindlimbs and in an in vivo pig hindlimbs model.

Topics: Adenosine Triphosphatases; Animals; Creatine Kinase; Disease Models, Animal; Heart; Hindlimb; In Vitro Techniques; Male; Muscle Contraction; Myocardial Ischemia; Myocardial Reperfusion Injury; Myocardium; Phosphocreatine; Rats; Rats, Sprague-Dawley; Thioctic Acid

We assessed the role of A(1) adenosine receptor (A(1)AR) activation by endogenous adenosine in the modulation of ischemic contracture and postischemic recovery in Langendorff-perfused mouse hearts subjected to 20 min of total ischemia and 30 min of reperfusion. In control hearts, the rate-pressure product (RPP) and first derivative of pressure development over time (+dP/dt) recovered to 57 +/- 3 and 58 +/- 3% of preischemia, respectively. Diastolic pressure remained elevated at 20 +/- 2 mmHg (compared with 3 +/- 1 mmHg preischemia). Interstitial adenosine, assessed by microdialysis, rose from approximately 0.3 to 1.9 microM during ischemia compared with approximately 15 microM in rat heart. Nonetheless, these levels will near maximally activate A(1)ARs on the basis of effects of exogenous adenosine and 2-chloroadenosine. Neither A(1)AR blockade with 200 nM 8-cyclopentyl-1,3-dipropylxanthine (DPCPX) during the ischemic period alone nor A(1)AR activation with 50 nM N(6)-cyclopentyladenosine altered rapidity or extent of ischemic contracture. However, ischemic DPCPX treatment significantly depressed postischemic recovery of RPP and +dP/dt (44 +/- 3 and 40 +/- 4% of preischemia, respectively). DPCPX treatment during the reperfusion period alone also reduced recovery of RPP and +dP/dt (to 44 +/- 2 and 47 +/- 2% of preischemia, respectively). These data indicate that 1) interstitial adenosine is lower in mouse versus rat myocardium during ischemia, 2) A(1)AR activation by endogenous adenosine or exogenous agonists does not modify ischemic contracture in murine myocardium, 3) A(1)AR activation by endogenous adenosine during ischemia attenuates postischemic stunning, and 4) A(1)AR activation by endogenous adenosine during the reperfusion period also improves postischemic contractile recovery.

Topics: Adenosine; Adenosine Diphosphate; Adenosine Triphosphate; Animals; Creatine; Extracellular Space; Heart Function Tests; Heart Rate; Hypoxanthine; In Vitro Techniques; Inosine; Male; Mice; Mice, Inbred C57BL; Microdialysis; Myocardial Ischemia; Myocardium; Phosphocreatine; Purinergic P1 Receptor Antagonists; Receptors, Purinergic P1; Recovery of Function; Reperfusion; Reperfusion Injury; Xanthines

Topics: Adenosine Triphosphate; Creatine Kinase; Humans; Hydrogen; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Myocardial Ischemia; Myocardium; Phosphocreatine; Phosphorus; Sodium

Ischemia and reperfusion were studied in isolated working rat hearts and in exarticulated rat hind limbs. Free radicals are known to be generated in ischemia/reperfusion and to propagate complications. To reduce reperfusion injury, conditions were ameliorated including the treatment with antioxidants, lipoate or dihydrolipoate. In isolated working rat hearts, cardiac and mitochondrial parameters are impaired during hypoxia and partially recover in reperfusion. Dihydrolipoate, if added into the perfusion buffer at 0.3 microM concentration, keeps the pH higher (7.15) during hypoxia, as compared to controls (6.98). This compound accelerates and stabilizes the recovery of the aortic flow. With dihydrolipoate, ATP synthesis is increased, ATPase activity (ATP hydrolysis) reduced, intracellular creatine kinase activity maintained and thus phosphocreatine contents are higher than in controls. For exarticulated rat hind limbs, the dihydrolipoate group contained 8.3 microM in the modified reperfusate. Recovery of the contractile function was 49% vs. 34% in controls and muscle flexibility was maintained whereas it decreased by 15% in the controls. Release of creatine kinase from cells was significantly lower with dihydrolipoate. Lipoate/dihydrolipoate effectively reduced reperfusion injury in isolated working rat hearts and in exarticulated rat hind limbs after extended ischemia. Finally, the compound was successfully applied in an in vivo pig hind limb model.

Topics: Adenosine Triphosphate; Animals; Antioxidants; Aorta, Thoracic; Cell Hypoxia; Constriction; Creatine Kinase; Drug Evaluation, Preclinical; Free Radical Scavengers; Hindlimb; Iliac Artery; Ischemia; Isoenzymes; Magnetic Resonance Spectroscopy; Male; Mitochondria, Heart; Muscle Contraction; Muscle Proteins; Myocardial Ischemia; Myocardial Reperfusion Injury; Oxidative Stress; Phosphocreatine; Rats; Rats, Wistar; Reperfusion Injury; Swine; Thioctic Acid

Topics: Adenosine Triphosphate; Age Factors; Animals; Creatine; Heart; Heat-Shock Response; Heating; HSP70 Heat-Shock Proteins; Myocardial Ischemia; Myocardium; NAD; NADP; Phosphocreatine; Rats; Stress, Physiological

This study examined the changes in myocardial energy metabolism during myocardial ischemia after "remote preconditioning" and investigated the involvement of adenosine receptors in the mechanisms of this effect.. Recent studies have indicated that a brief period of ischemia and reperfusion (ischemic preconditioning, PC) in a remote organ reduces myocardial infarct size (IS) protecting against subsequent sustained myocardial ischemia. However, the mechanisms of "remote PC" remain unclear. We assessed myocardial energy metabolism during sustained myocardial ischemia and reperfusion after renal PC (RPC), in comparison with that after myocardial PC (MPC) in open-chest rabbits. It has been established that adenosine receptors are involved in the mechanisms of MPC.. Rabbits that had been anesthetized with halothane were divided into six groups. The control (CNT) group underwent 40-min coronary occlusion followed by 120 min reperfusion. Before the procedure, the MPC group underwent an additional protocol of 5 min coronary artery occlusion and 20 min reperfusion, and the RPC group received a 10 min episode of renal artery occlusion and 20 min reperfusion. In additional experimental groups, 8 sulfophenyl-theophylline (SPT, 10 mg/kg), an adenosine receptor inhibitor, was intravenously injected before the 40 min myocardial ischemia (SPT, MPC + SPT and RPC + SPT groups, respectively). Myocardial levels of phosphocreatine (PCr), ATP and intracellular pH (pHi) were measured by 31P-NMR spectroscopy.. RPC and MPC delayed the decreases in ATP levels, preserved pHi during 40-min myocardial ischemia and resulted in better recovery of ATP and PCr during 120 min reperfusion compared with the controls. SPT abolished the improvement in myocardial energy metabolism and the reduction in myocardial IS caused by MPC or RPC. Myocardial IS in the CNT (n = 8), MPC (n = 9), RPC (n = 9), SPT (n = 6), MPC + SPT (n = 8) and RPC + SPT (n = 8) groups averaged 42.8+/-3.5%, 18.2+/-1.8%*, 19.6+/-1.3%*, 44.9+/-5.0%, 35.6+/-2.7% and 34.8+/-3.6% of the area at risk (*p < 0.05 vs. CNT), respectively.. PC in a remote organ, similar to MPC, improved myocardial energy metabolism during ischemia and reperfusion and reduced IS in vivo by an adenosine-dependent mechanism in rabbits.

Topics: Adenosine Triphosphate; Animals; Energy Metabolism; Hydrogen-Ion Concentration; Infusions, Intravenous; Intracellular Fluid; Ischemia; Ischemic Preconditioning, Myocardial; Kidney; Magnetic Resonance Spectroscopy; Male; Myocardial Ischemia; Myocardium; Phosphocreatine; Pilot Projects; Purinergic P1 Receptor Antagonists; Rabbits; Receptors, Purinergic P1; Theophylline

Conventional approaches for the treatment of myocardial ischemia increase coronary blood flow or reduce myocardial demand. To determine whether a rightward shift in the hemoglobin-oxygen saturation curve would reduce the metabolic and contractile effects of a myocardial oxygen-supply imbalance, we studied the impact of a potent synthetic allosteric modifier of hemoglobin-oxygen affinity, a 2-[4-[[(3,5-disubstituted anilino)carbonyl]methyl] phenoxy] -2-methylproprionic acid derivative (RSR13), during low-flow ischemia. Changes in myocardial high-energy phosphate levels and pH were studied by 31P nuclear magnetic resonance (NMR) spectroscopy in 12 open-chest dogs randomized to receive RSR13 or vehicle control during a reversible reduction of left anterior descending (LAD) coronary artery blood flow. Changes in cardiac metabolites and regional ventricular function studied by pressure segment-length relations were also investigated in additional animals before and after RSR13 administration during low-flow LAD ischemia. The intravenous administration of RSR13 before ischemia resulted in a substantial increase in the mean hemoglobin p50 and attenuated the decline in cardiac creatine phosphate/adenosine triphosphate (PCr/ATP), percent PCr, and pH during ischemia without a change in regional myocardial blood flow, heart rate, or systolic blood pressure. RSR13 given after the onset of low-flow ischemia also improved cardiac PCr/ATP ratios and regional function as measured by fractional shortening and regional work. Thus, synthetic allosteric reduction in hemoglobin-oxygen affinity may be a new and important therapeutic strategy to ameliorate the metabolic and functional consequences of cardiac ischemia.

Topics: Aniline Compounds; Animals; Antisickling Agents; Dogs; Hemoglobins; Myocardial Ischemia; Oxygen; Oxygen Consumption; Phosphocreatine; Propionates

We investigated temporal differences in the protective action of three types of Ca2+ channel blockers in myocardial ischemia, focusing particularly on the blocking ability under depolarizing conditions. The effects of diltiazem, verapamil, and nifedipine on extracellular potassium concentration ([K+]e), acidosis, and level of metabolic markers were examined during 30-min global ischemia and postischemic left ventricular (LV) function in isolated guinea pig hearts. Diltiazem and verapamil, but not nifedipine, inhibited the late phase (15-30 min) of [K+]e elevation, whereas all three blockers delayed the onset of the early phase (0-8 min) of [K+]e elevation. Diltiazem and verapamil inhibited ischemic contracture and improved postischemic LV function to a greater extent. These differences appeared to be linked to preservation of ATP and creatine phosphate and delay of cessation of anaerobic glycolytic activity. Maneuvers to preserve energy sources during ischemia (decrease in external Ca2+ concentration or pacing at a lower frequency) attenuated the late phase of [K+]e elevation. Inhibition of LV pressure was potentiated 12- and 8.2-fold by diltiazem and verapamil, respectively, at 8.9 mM K+ as compared with 2.9 mM K+, whereas that by nifedipine was unchanged. These results indicate that the differential cardioprotection of Ca2+ channel blockers in the late period of ischemia correlates with preservation of high-energy phosphates as a result of different Ca2+ channel blocking abilities under high [K+]e conditions.

Topics: Acidosis; Adenosine Triphosphate; Animals; Calcium Channel Blockers; Depression, Chemical; Diltiazem; Extracellular Space; Guinea Pigs; Heart; Heart Rate; Hydrogen-Ion Concentration; In Vitro Techniques; Lactic Acid; Male; Myocardial Contraction; Myocardial Ischemia; Myocardium; Nifedipine; Phosphocreatine; Potassium; Time Factors; Verapamil

The purpose of this study was to determine whether retrograde continuous normothermic blood cardioplegic perfusion provides better protection to ischemic areas of the left and right ventricles than does antegrade continuous normothermic blood cardioplegic perfusion. Localized phosphorus 31 magnetic resonance spectroscopy was used to monitor the changes in energy metabolism and intracellular pH in the ventricles of pig hearts.. Ten isolated pig hearts received 20 minutes of antegrade continuous normothermic blood cardioplegic perfusion for collection of control (baseline) data, followed by 60 minutes of either antegrade continuous normothermic blood cardioplegic perfusion (n = 5) or retrograde continuous normothermic blood cardioplegic perfusion (n = 5) with occlusion of the left anterior descending and the right coronary arteries. The hearts were then subjected to antegrade continuous normothermic blood cardioplegic perfusion for 20 minutes. The perfusion pressures were maintained between 80 and 100 mm Hg and between 38 and 43 mm Hg during antegrade and retrograde continuous normothermic blood cardioplegic perfusions, respectively. Intracellular pH and creatine phosphate, inorganic phosphate, and adenosine triphosphate levels were measured continuously in each ventricle by means of localized phosphorus 31 magnetic resonance spectroscopy with 2 surface coils.. Both antegrade and retrograde continuous normothermic blood cardioplegic perfusion resulted in a significant increase in inorganic phosphate level and decreases in creatine phosphate level, adenosine triphosphate level, and intracellular pH. No significant differences in these changes were observed between the two groups. The creatine phosphate and adenosine triphosphate levels were significantly lower in the right ventricle than in the left ventricle during retrograde continuous normothermic blood cardioplegic perfusion. On reperfusion, the inorganic phosphate level, creatine phosphate level, and intracellular pH recovered completely; however, no recovery in the adenosine triphosphate level was seen in the ventricles of either group.. Retrograde continuous normothermic blood cardioplegic perfusion does not provide better protection to ischemic areas of the ventricles than does antegrade continuous normothermic blood cardioplegic perfusion under our experimental conditions.

Topics: Adenosine Triphosphate; Animals; Blood; Cardioplegic Solutions; Chromatography, High Pressure Liquid; Creatine Kinase; Disease Models, Animal; Energy Metabolism; Female; Heart Arrest, Induced; Heart Ventricles; Hydrogen-Ion Concentration; Intracellular Fluid; Magnetic Resonance Spectroscopy; Male; Myocardial Ischemia; Phosphates; Phosphocreatine; Swine; Temperature

This study investigated whether Na+/K+ ATPase is inhibited and KATP channels activated during low flow ischemia (LFI) by monitoring Rb+ uptake and efflux from rat hearts using 87Rb NMR. In the uptake experiments, isolated Langendorff perfused hearts were exposed to Rb+-containing Krebs-Henseleit buffer (2.14 m m+3.76 m m K+) for 60 min. When Rb+ uptake started the flow of perfusate was decreased from 10 to 1 ml/min/g wet weight for 44 min and then returned to normal. The rate of Rb+ uptake and its equilibrium level decreased to 40 and 65% of the control (no ischemia) levels, respectively. Phosphocreatine and cytoplasmic [ATP]/[ADP] measured by 31P NMR decreased by half, intracellular pH (pHi) decreased to 6.8+/-0.1, and Pi increased two-fold. In wash-out experiments the hearts were pre-loaded with Rb+ for 30 min following which Rb+ wash-out was initiated. Four minutes later, flow was either decreased in the absence or presence of 10 microm 2,4-dinitrophenol (DNP), or 0.1 m m DNP was infused at normal flow for 20 min. LFI resulted in biphasic Rb+ efflux; during the initial phase, which lasted 8 min, the rate constant (kx10(3)/min) did not differ from control (43+/-3). The efflux was slightly inhibited by 5 microm glibenclamide (36+/-6) or 100 microm 5-hydroxydecanoic acid (32+/-4). In the second phase k decreased to half its initial value (18+/-2). More significant changes in energy state caused by LFI+10 microm DNP had no effect on the efflux kinetics. Similar changes in energy state induced by 0.1 m m DNP at normal flow were associated with activation of Rb+ efflux (71+/-5). DNP-stimulated Rb+ efflux was inhibited by acidosis (pHi approximately pHe = 6.7) produced with 5 m m morpholinoethane sulphonic acid (53+/-5) and by 100 microm adenosine (58+/-7). We suggest that accumulation of ischemic products such as H+and adenosine decreases activation of KATP channels in rat hearts.

Topics: 2,4-Dinitrophenol; Adenosine Triphosphate; Animals; Coronary Circulation; Energy Metabolism; Hemodynamics; In Vitro Techniques; Ion Transport; Magnetic Resonance Spectroscopy; Male; Myocardial Ischemia; Perfusion; Phosphocreatine; Potassium; Potassium Channels; Rats; Rats, Sprague-Dawley; Rubidium Radioisotopes; Sodium-Potassium-Exchanging ATPase

Decreasing coronary perfusion causes an immediate decrease in contractile function via unknown mechanisms. It has long been suspected that this contractile dysfunction is caused by ischemia-induced changes in cardiac energetics. Our goal was to determine whether changes in cardiac energetics necessarily precede the contractile dysfunction as one would expect if a causal relationship exists. In 14 isolated rat hearts, we gradually decreased coronary perfusion using a coronary perfusate with a normal hematocrit and normal concentrations of the major metabolic substrates. Using 31P NMR spectroscopy to measure ATP, phosphocreatine (PCr), Pi, and ADP concentrations ([ATP], [PCr], [Pi], [ADP]), pH, and amount of free energy released from ATP hydrolysis (|DeltaGATP|), we found that none of these variables changed significantly until several minutes after systolic pressure had significantly decreased. Even when developed pressure had decreased by over one-third, only very slight changes in [Pi], pH, and |DeltaGATP| had occurred, with no significant changes in [ATP], [PCr], or [ADP]. Additionally, the rate of high-energy phosphate transfer between ATP and PCr did not decrease enough during hypoperfusion to explain the contractile dysfunction. We conclude that nonenergetic factors are the dominant cause of the initial decrease in systolic function when myocardial perfusion is decreased.

Topics: Adenosine Diphosphate; Adenosine Triphosphate; Animals; Blood Pressure; Creatine Kinase; Energy Metabolism; Hibernation; Hydrogen-Ion Concentration; Magnetic Resonance Spectroscopy; Magnetics; Male; Myocardial Contraction; Myocardial Ischemia; Myocardium; Organ Culture Techniques; Phosphates; Phosphocreatine; Phosphorus Isotopes; Rats; Rats, Sprague-Dawley

The protease inhibitor aprotinin has been reported to have an anti-ischemic effect on left-ventricular myocardium in patients undergoing cardiopulmonary bypass operation. To examine the anti-ischemic properties beside its antifibrinolytic and inhibitory action on the kallikrein-bradykinin system, we investigated this substance in buffer-perfused rat hearts.. 24 isolated isovolumically contracting rat hearts received a 10-minute infusion of either 10000 units aprotinin or pure saline followed by 30 minutes of no-flow global ischemia and 45 minutes of reperfusion. Hemodynamics, high-energy phosphates, and troponin T as molecular marker of cardiac injury were studied.. During 15 minutes of reperfusion steady state function was identical in both groups, with a recovery of the developed left-ventricular pressure to 81.9+/-1.5% after protease inhibition and 83.0+/-2.6% in the controls. Coronary flow, myocardial oxygen consumption, and contractile reserve after maximum Ca++ stimulation were also identical. High-energy phosphates were comparably reduced in both groups (adenine nucleotides: 3.1+/-0.3 micromol/g ww after aprotinin vs. controls 2.7+/-0.4 micromol/g ww and creatine phosphate: 6.5+/-0.9 micromol/g ww vs. controls 4.7+/-1.1 micromol/g ww). However, release of the cardiac specific marker troponin T was lower after ischemia at several measurements (p<0.05). The total release of troponin T was 44+/-10 ng in the aprotinin treated hearts vs. 90+/-17 ng in the postischemic control hearts (p<0.05).. The findings demonstrate that aprotinin in a moderate dose is effective in reducing postischemic troponin release in a non-blood perfused system. Measurement of myocardial high-energy phosphates after aprotinin use was performed for the first time and indicates that not a reduction in severity of direct myocardial ischemic intensity but a beneficial action on processes causing release of troponin is the mode of action of this effect.

Topics: Adenosine Triphosphate; Animals; Aprotinin; Disease Models, Animal; Male; Myocardial Contraction; Myocardial Ischemia; Myocardium; Oxygen Consumption; Perfusion; Phosphocreatine; Plasma; Rats; Rats, Wistar; Serine Proteinase Inhibitors; Troponin T; Ventricular Pressure

Adenosine protects myocardium from ischemia and reperfusion damage; however, the mechanism of action is still under discussion. We investigated whether (a) adenosine protects isolated crystalloid-perfused rabbit heart from ischemia/ reperfusion injury; (b) this action is receptor mediated and what receptor subtypes are involved, and (c) this action is dependent on an enhanced nitric oxide production. Our results showed a cardioprotective effect of adenosine (10(-4) M), of nonselective adenosine-receptor agonist 5'-N-ethyl-carboxamidoadenosine (NECA; 5 x 10(-6) M), and of A2A agonists CGS 21680 (10(-8) and 10(-6) M), 2-hexynylNECA (10(-7) M). On the contrary, A1 agonist CCPA (10(-8) and 10(-6) M) does not provide any protection. The effect has been achieved in terms of significant reduction in contracture development during reperfusion [diastolic pressure was 46.8 +/- 7.1 mm Hg (p < 0.01); 46.1 +/- 7.8 mm Hg (p < 0.01); 46.9 +/- 5.5 mm Hg (p < 0.01); and 59.3 +/- 6.7 mm Hg (p < 0.05) with 10(-4) M adenosine, 5 x 10(-6) M NECA, 10(-6) M CGS 21680, and 10(-7) M 2-hexynylNECA, respectively, versus 77.6 +/- 5.0 mm Hg in control]; reduced creatine phosphokinase release (13.5 +/- 1.6, 22.2 +/- 7.9, 14.2 +/- 3.3, and 14.1 +/- 4.5 U/gww in treated hearts vs. 34.6 +/- 7.2 U/gww in controls; p < 0.05); improved energy metabolism [adenosine triphosphate (ATP) content is 9.9 +/- 0.5, 10.4 +/- 0.6, 9.8 +/- 0.5, and 10.5 +/- 0.5 micromol/gdw in treated hearts vs. 7.6 +/- 0.2 micromol/gdw; p < 0.05]. Moreover, our data indirectly show a functional presence of A2A receptors on cardiomyocytes as the protection is A2A mediated and exerted only during reperfusion, although in the absence of blood and coronary flow changes. These activities appear independent of nitric oxide pathways, as adenosine and 2-hexynylNECA effects are not affected by the presence of a nitric oxide-synthase inhibitor (10(-4) M L-NNA).

Topics: Adenosine; Animals; Creatine Kinase; Heart; In Vitro Techniques; Male; Myocardial Ischemia; Myocardium; Nitric Oxide; Nucleotides; Perfusion; Phosphocreatine; Rabbits; Receptors, Purinergic P1; Reperfusion Injury

Metabolic events during ischaemia are probably important in determining post-ischaemic myocardial recovery. The aim of this study was to assess the effects of the beta-blocker atenolol and the high energy demand in an ischaemia-reperfusion model free of neurohormonal and vascular factors. We exposed Langendorff-perfused isolated rat hearts to low-flow ischaemia (30 min) and reflow (20 min). Three groups of hearts were used: control hearts (n =11), hearts that were perfused with 2.5 micrograms l-1atenolol (n =9), and hearts electrically paced during ischaemia to distinguish the effect of heart rate from that of the drug (n =9). The hearts were freeze-clamped at the end of reflow to determine high-energy phosphates and their metabolites. During ischaemia, the pressure-rate product was 2.3+/-0.2, 5.2+/-1.1, and 3.3+/-0.3 mmHg 10(3)min in the control, atenolol and paced hearts, respectively. In addition, the ATP turnover rate, calculated from venous (lactate), oxygen uptake and flow, was higher in atenolol (11.2+/-1.7 micromol min-1) and paced (8.1+/-0.8 micromol min-1) hearts than in control (6.2+/-0.8 micromol min-1). At the end of reflow, the pressurexrate product recovered 75.1+/-6.4% of baseline in control vs 54.1+/-9.1 and 48.8+/-4.4% in atenolol and paced hearts (P<0.05). In addition, the tissue content of ATP was higher in the control hearts (15.8+/-1. 0 micromol g(dw)(-1)) than in atenolol (10.5+/-2.6 micromol g(dw)(-1)) and paced (10.9+/-1.3 micromol g(dw)(-1)) hearts. Thus, by suppressing the protective effects of down-regulation, both atenolol and pacing apparently depress myocardial recovery in this model.

Topics: Adenine Nucleotides; Adenosine Triphosphate; Adrenergic beta-Antagonists; Analysis of Variance; Animals; Atenolol; Blood Pressure; Cardiac Pacing, Artificial; Coronary Circulation; Creatine; Heart; Heart Rate; In Vitro Techniques; Lactic Acid; Myocardial Contraction; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Oxygen Consumption; Phosphocreatine; Purines; Rats

The majority of clinically used inotropes act by increasing cytosolic calcium levels, which may hypothetically worsen reperfusion stunning and provoke arrhythmias. We tested the hypothesis that the calcium sensitizer levosimendan (levo) given during ischemia alone or ischemia and reperfusion would improve reperfusion function without promoting arrhythmias. The Langendorff-perfused guinea pig heart, subjected to 40-min low-flow ischemia (0.4 ml/min) with or without levo (10-300 nM) given during ischemia or ischemia/reperfusion was used. Left ventricular developed pressure (LVDP) was used as an index of mechanical function. The effect of levo (300 nM) or dobutamine (0.1 microM) on the incidence of ischemia/reperfusion arrhythmias was also investigated. Control hearts (vehicle-perfused) had LVDPs of 69.4 +/- 2.1 mm Hg whereas hearts treated with levo during ischemia and reperfusion (300 nM) had LVDPs of 104.5 +/- 2.7 mm Hg (p <.05). Hearts treated with levo during ischemia alone (10 nM) had reperfusion LVDPs of 95.8 +/- 4.2 mm Hg (p <.05) after 30-min reperfusion. Hearts treated with both levo and 10 microM glibenclamide (K(ATP) channel blocker) during ischemia had reperfusion LVDPs of 73.4 +/- 4.3 mm Hg after 30-min reperfusion. Of control hearts, 25% developed reperfusion ventricular tachycardia but not ventricular fibrillation. Levo-treated hearts had no ischemia/reperfusion arrhythmias whereas 83% (p <.05 versus control) of dobutamine-treated hearts developed ventricular tachycardia and 33% (p <.05 versus levo) developed reperfusion ventricular fibrillation. Levo improved reperfusion function without promoting arrhythmias in this model. This was possibly achieved by opening the K(ATP) channels during ischemia and sensitizing myocardial contractile apparatus instead of elevating cytosolic calcium levels in reperfused hearts.

Topics: Adenosine Triphosphate; Animals; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Calcium Channel Agonists; Calcium Channel Blockers; Cyclic AMP; Cyclic GMP; Dobutamine; Glyburide; Guinea Pigs; Heart; Hydrazones; In Vitro Techniques; L-Lactate Dehydrogenase; Lactic Acid; Myocardial Contraction; Myocardial Ischemia; Myocardial Reperfusion Injury; Myocardium; Nucleotides, Cyclic; Phosphocreatine; Pyridazines; Simendan; Stereoisomerism

The cardioprotective properties of inhibition of poly (ADP-ribose) synthetase (PARS) were investigated in the isolated perfused heart of the rat. Hearts were perfused in the Langendorff mode and subjected to 23 min total global ischaemia and reperfused for 60 min. Left ventricular function was assessed by means of an intra-ventricular balloon. High energy phosphates were measured by 31P-NMR spectroscopy. Intracellular levels of NAD were measured by capillary electrophoresis of perchloric acid extracts of hearts at the end of reperfusion. Reperfusion in the presence of the PARS inhibitor 1,5 didroxyisoquinoline (ISO, 100 microM) attenuated the mechanical dysfunction observed following 1 h of reperfusion; 27+/-13 and 65+/-8% recovery of preischaemic rate pressure product for control and 100 microM ISO, respectively. This cardioprotection was accompanied by a preservation of intracellular high-energy phosphates during reperfusion; 38+/-2 vs 58+/-4% (P<0.05) of preischaemic levels of phosphocreatine (PCr) for control and 100 microM ISO respectively and 23+/-1 vs 31+/-3% (P < 0.05) of preischaemic levels of ATP for control and 100 microM ISO respectively. Cellular levels of NAD were higher in ISO treated hearts at the end of reperfusion; 2.56+/-0.45 vs 4.76+/-1.12 micromoles g(-1) dry weight (P<0.05) for control and ISO treated. These results demonstrate that the cardioprotection afforded by inhibition of PARS activity with ISO is accompanied by a preservation of high-energy phosphates and cellular NAD levels and suggest that the mechanism responsible for this cardioprotection may involve prevention of intracellular ATP depletion.

Topics: Adenosine Triphosphate; Animals; Blood Pressure; Cardiotonic Agents; Diastole; Enzyme Inhibitors; Heart; In Vitro Techniques; Isoproterenol; Isoquinolines; Magnetic Resonance Spectroscopy; Male; Myocardial Contraction; Myocardial Ischemia; Myocardial Reperfusion; Phosphocreatine; Poly(ADP-ribose) Polymerase Inhibitors; Rats; Rats, Sprague-Dawley; Systole; Ventricular Dysfunction, Left

A quantitative 31P-MR-spectroscopic technique was used to assess the energy metabolism in healthy and diseased myocardium.. 31P spectra were acquired on a 1.5 T scanner using a 3D-chemical shift imaging technique. Based on the anatomical information provided by 1H images, SLOOP (Spatial Localization with Optimal Pointspread Function) allows to obtain spectra from defined compartments. With SLOOP a free voxel shape with adaption to anatomic structures, e.g. the myocardium, is possible. Absolute values for phosphocreatine (PCr) and adenosine triphosphate (ATP) were determined using an external standard.. 31P-spectra showed only minimal contamination by surrounding tissue. The standard deviation for the determined values of healthy volunteers was low. Compared to healthy volunteers, reduced PCr and ATP concentrations were seen for dilative cardiomyopathies and coronary artery disease and unchanged concentrations were observed for hypertensive heart disease.. 31P-MR spectroscopy with SLOOP allows a non-invasive, quantitative analysis of cardiac energy metabolism.

Topics: Adenosine Triphosphate; Cardiomyopathy, Dilated; Electrocardiography; Energy Metabolism; Humans; Hypertension; Hypertrophy, Left Ventricular; Magnetic Resonance Spectroscopy; Myocardial Ischemia; Myocardium; Phosphates; Phosphocreatine

Alterations in metabolic pathways may contribute to the cardioprotective effects of heat stress (HS). We investigated the effects of HS on ATP and phosphocreatine (PCr) levels in the ischemic rat myocardium, after both normothermic and hypothermic ischemia.. Two protocols were used: (1) normothermic ischemia (20 min at 37 degrees C) with no myocardial protection (n=6 HS; n=6 control); (2) hypothermic ischemia (4 hrs at 4 degrees C) after cardioplegic arrest (n=6 HS; n=6 control). ATP and PCr levels in the heart were measured using 31P nuclear magnetic resonance spectroscopy.. At the end of normothermic ischemia, ATP levels were better maintained in HS hearts (C vs HS: 4.51+/-0.66 vs 7.81+/-1.06 micromol/g dry wt+/-SEM, p=0.04). A trend for higher ATP content in HS hearts was observed after 40 min of reperfusion (C vs HS: 11.7+/-1.5 vs 16.9+/-2.0 micromol/g dry wt+/-SEM, p=0.09). PCr content was also higher at the end of 40 minutes of reperfusion in HS hearts (C vs HS: 46.4+/-2.9 vs 56.9+/-3.0 micromol/g dry wt+/-SEM, p=0.03). After prolonged hypothermic ischemia under cardioplegic arrest, heat stress again led to better preservation of ATP levels at the end of ischemia (C vs HS: 5.71+/-0.88 vs 9.23+/-1.38 micromol/g dry wt+/-SEM, p=0.05) and after 40 minutes of reperfusion (C vs HS: 16.8+/-1.4 vs 24.6+/-2.8 micromol/g dry wt+/-SEM, p=0.03). PCr levels were also better maintained at the end of ischemia (C vs HS: 4.87+/-0.77 vs 12.4+/-3.0 micromol/g dry wt+/-SEM, p=0.03) and after 40 minutes of reperfusion in HS hearts (C vs HS: 55.1+/-7.0.vs 79.8+/-7.3 micromol/g dry wt+/-SEM, p=0.03).. Heat stress induces changes in the energy profile of the heart which results in better preservation of ATP and phosphocreatine levels. These changes could be observed after brief normothermic ischemia and also after prolonged hypothermic ischemia under cardioplegic arrest, mimicking conditions of preservation for cardiac transplantation.

Topics: Adenosine Triphosphate; Animals; Body Temperature; Energy Metabolism; Heart Arrest, Induced; Heart Transplantation; Hypothermia, Induced; Magnetic Resonance Spectroscopy; Male; Myocardial Ischemia; Myocardial Reperfusion Injury; Phosphocreatine; Rats; Rats, Sprague-Dawley

The effect of an endothelin (ET) A/ETB receptor antagonist, TAK-044, and/or an angiotensin converting enzyme (ACE) inhibitor, temocaprilat, on myocardial metabolism and contraction during ischemia and reperfusion was examined by phosphorus 31-nuclear magnetic resonance (31P-NMR) in Langendorff rabbit hearts. After normothermic 15 min global ischemia, 60min of postischemic reperfusion was carried out. TAK-044 and/or temocaprilat was administered from 40 min prior to the global ischemia. Adenosine triphosphate (ATP), creatine phosphate, inorganic phosphate, pH, left ventricular systolic developed pressure (LVDev.P), left ventricular end-diastolic pressure (LVEDP) and coronary flow were measured. Twenty-eight hearts were divided into 4 experimental groups consisted of seven hearts each: Group I consisted of controls, Group II was perfused with TAK-044 (10(-6) mol/L), Group III was perfused with temocaprilat (10(-6) mol/L), and Group IV was perfused with TAK-044 (10(-6) mol/L) in combination with temocaprilat (10(-6) mol/L). Group II showed a more early recovery of ATP during postischemic reperfusion (82+/-3%) compared with Group I (71+/-3%). Group III showed a significant inhibition of the decrease in ATP during global ischemia (54+/-3%) compared with Group I (45+/-3%). Group IV also showed a significant marked inhibition of the decrease in ATP during global ischemia (59+/-5%) and a more significant improvement on recovery of ATP during postischemic reperfusion (86+/-3%) compared with the other 3 groups. There were no differences in LVDev.P, LVEDP and coronary flow among these groups. In conclusion, TAK-044 in combination with temocaprilat had a significant potentiation on myocardial metabolism during both ischemia and reperfusion.

Topics: Adenosine Triphosphate; Angiotensin-Converting Enzyme Inhibitors; Animals; Coronary Circulation; Endothelin Receptor Antagonists; Energy Metabolism; Hydrogen-Ion Concentration; In Vitro Techniques; Magnetic Resonance Spectroscopy; Male; Myocardial Contraction; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Peptides, Cyclic; Phosphates; Phosphocreatine; Phosphorus Isotopes; Rabbits; Thiazepines; Ventricular Pressure

Activation of protein kinase C (PKC) protects the heart from ischemic injury; however, its mechanism of action is unknown, in part because no model for chronic activation of PKC has been available. To test whether chronic, mild elevation of PKC activity in adult mouse hearts results in myocardial protection during ischemia or reperfusion, hearts isolated from transgenic mice expressing a low level of activated PKCbeta throughout adulthood (beta-Tx) were compared with control hearts before ischemia, during 12 or 28 min of no-flow ischemia, and during reperfusion. Left-ventricular-developed pressure in isolated isovolumic hearts, normalized to heart weight, was similar in the two groups at baseline. However, recovery of contractile function was markedly improved in beta-Tx hearts after either 12 (97 +/- 3% vs. 69 +/- 4%) or 28 min of ischemia (76 +/- 8% vs. 48 +/- 3%). Chelerythrine, a PKC inhibitor, abolished the difference between the two groups, indicating that the beneficial effect was PKC-mediated. (31)P NMR spectroscopy was used to test whether modification of intracellular pH and/or preservation of high-energy phosphate levels during ischemia contributed to the cardioprotection in beta-Tx hearts. No difference in intracellular pH or high-energy phosphate levels was found between the beta-Tx and control hearts at baseline or during ischemia. Thus, long-term modest increase in PKC activity in adult mouse hearts did not alter baseline function but did lead to improved postischemic recovery. Furthermore, our results suggest that mechanisms other than reduced acidification and preservation of high-energy phosphate levels during ischemia contribute to the improved recovery.

Topics: Adenosine Triphosphate; Animals; Hydrogen-Ion Concentration; Magnetic Resonance Spectroscopy; Mice; Mice, Transgenic; Myocardial Ischemia; Myocardium; Phosphocreatine; Protein Kinase C

31P-NMR in vivo spectroscopy is a non-invasive and non-hazardous technique which investigates chemical composition and metabolism of living objects, for example by determining phosphocreatine (PCr) and ATP concentrations. In the present study we investigated the influence of L-carnitine, acetyl-L-carnitine and propionyl-L-carnitine on the energetic state of the Langendorff rat heart subjected to an ischemic period of 20 min followed by a reperfusion period of 60 min. To avoid an overlapping of the effects of fatty acids and glucose, the hearts were perfused with a Tyrode solution containing no fatty acids. Ischemia causes a rapid decrease in the PCr signal, followed by a decrease in the ATP signal after a prolonged period of ischemia. At the same time, a drastic increase in the Pi signal was observed. A partial recovery of the ATP and PCr signals was observed in the reperfusion period. With L-carnitine a markedly improved recovery of the high energy phosphates (e.g. increased PCr/P ratios) was found. With acetyl-L-carnitine this effect was enhanced in the first postischemic phase. It was followed, however, by a more rapid decrease in the PCr/Pi ratio in the late reperfusion period. The effect of propionyl-L-carnitine was not significantly improved in the first minutes of the reperfusion period, but during the whole reperfusion phase a stabilization of the PCr/Pi ratio was observed. Intracellular pH can be calculated from determination of the Pi-chemical shift. This shows that L-carnitine and its derivatives have a protective effect against intracellular pH decrease during ischemia. L-carnitine improves the energetic state of the heart, which leads to increased ischemia tolerance. Hearts under L-carnitine were able to tolerate up to four ischemia-reperfusion periods in succession, whereas the controls were not able to do so. These NMR results confirm the hypothesis that L-carnitine and its esters have a protective effect in the reperfusion period of the ischemic rat heart. This could be of importance for the treatment of ischemic cardiac diseases.

Topics: Acetylcarnitine; Adenosine Triphosphate; Animals; Carnitine; Energy Metabolism; Female; Heart; In Vitro Techniques; Magnetic Resonance Spectroscopy; Myocardial Ischemia; Myocardial Reperfusion Injury; Myocardium; Perfusion; Phosphates; Phosphocreatine; Rats; Rats, Wistar

Cardiac beta(2)-adrenergic receptor (beta(2)AR) overexpression is a potential contractile therapy for heart failure. Cardiac contractility was elevated in mice overexpressing beta(2)ARs (TG4s) with no adverse effects under normal conditions. To assess the consequences of beta(2)AR overexpression during ischemia, perfused hearts from TG4 and wild-type mice were subjected to 20-minute ischemia and 40-minute reperfusion. During ischemia, ATP and pH fell lower in TG4 hearts than wild type. Ischemic injury was greater in TG4 hearts, as indicated by lower postischemic recoveries of contractile function, ATP, and phosphocreatine. Because beta(2)ARs, unlike beta(1)ARs, couple to G(i) as well as G(s), we pretreated mice with the G(i) inhibitor pertussis toxin (PTX). PTX treatment increased basal contractility in TG4 hearts and abolished the contractile resistance to isoproterenol. During ischemia, ATP fell lower in TG4+PTX than in TG4 hearts. Recoveries of contractile function and ATP were lower in TG4+PTX than in TG4 hearts. We also studied mice that overexpressed either betaARK1 (TGbetaARK1) or a betaARK1 inhibitor (TGbetaARKct). Recoveries of function, ATP, and phosphocreatine were higher in TGbetaARK1 hearts than in wild-type hearts. Despite basal contractility being elevated in TGbetaARKct hearts to the same level as that of TG4s, ischemic injury was not increased. In summary, beta(2)AR overexpression increased ischemic injury, whereas betaARK1 overexpression was protective. Ischemic injury in the beta(2)AR overexpressors was exacerbated by PTX treatment, implying that it was G(s) not G(i) activity that enhanced injury. Unlike beta(2)AR overexpression, basal contractility was increased by betaARK1 inhibitor expression without increasing ischemic injury, thus implicating a safer potential therapy for heart failure.

Topics: Adenosine Triphosphate; Animals; beta-Adrenergic Receptor Kinases; Cyclic AMP-Dependent Protein Kinases; Enzyme Inhibitors; G-Protein-Coupled Receptor Kinase 2; Genetic Predisposition to Disease; Genetic Therapy; Genotype; GTP-Binding Protein alpha Subunits, Gi-Go; Heart Failure; Hydrogen-Ion Concentration; Magnetic Resonance Spectroscopy; Male; Mice; Muscle Proteins; Myocardial Contraction; Myocardial Ischemia; Myocardium; Pertussis Toxin; Phosphocreatine; Receptors, Adrenergic, beta-2; Signal Transduction; Virulence Factors, Bordetella

23Na and 31P NMR spectroscopy were used to follow intracellular [Na+] ([Na+]i) and energy metabolism in isolated, perfused rat hearts. During 30 min of Ca(2+)-free perfusion no significant change in [Na+]i could be detected, but during a subsequent 45 min period of ischemia [Na+]i rose significantly as expected, from 8.6 +/- 2.4 to 36.8 +/- 9.4 mM. In contrast, already during 30 min of Ca(2+)- and Mg(2+)-free perfusion [Na+]i rose significantly from 7.3 +/- 3.7 to 71.3 +/- 15.6 mM. During this period, the Na(+)-K+ ATPase was not limited by depletion of high energy phosphates, decrease of intracellular free Mg2+ or accumulation of inorganic phosphate. During the first 8 min of a subsequent period of ischemia, the rate of rise in [Na+]i even increased, suggesting that during the preceding period of Ca(2+)- and Mg(2+)-free perfusion, the Na(+)-K+ ATPase was indeed operative but apparently not coping with the large Na(+)-influx. Using verapamil, we could demonstrate that this large Na(+)-influx occurs through the L-type Ca2+ channels, and that both Mg2+ and verapamil can block this Na(+)-influx. Previously, we have demonstrated that [Na+]i does not play a role in the origin of the calcium paradox. The notion that an increased [Na+]i is a prerequisite for the calcium paradox to occur apparently results from experimental evidence obtained under conditions of low or absent Mg2+.

Topics: Adenosine Triphosphate; Animals; Calcium; Calcium Channel Blockers; Calcium Chloride; Cations, Divalent; In Vitro Techniques; Magnesium; Magnesium Chloride; Magnetic Resonance Spectroscopy; Male; Myocardial Ischemia; Myocardium; Perfusion; Phosphocreatine; Rats; Rats, Wistar; Sodium; Sodium-Potassium-Exchanging ATPase; Verapamil

A solution for prolonged cold storage of the heart has been developed. The Jerusalem-Cape Town Solution (JCT) is an "intracellular" type cardioplegic solution and is formulated to (1) minimize hypothermic-induced cell swelling, (2) diminish intracellular acidosis, (3) prevent the expansion of the interstitial space during the reperfusion, (4) protect against oxygen free radical injury during early reperfusion, and (5) provide substrates for regenerating high-energy phosphates.. With a Langendorff model, rat hearts were subjected to 15 minutes of perfusion with Krebs-Henseleit, 10 minutes of cardioplegic infusion and 20 hours of cold storage (5 degrees to 6 degrees C). Hearts were reperfused for 60 minutes and hemodynamic recovery was assessed. The hearts were assigned to three groups (eight hearts in each), according to the cardioplegic solution used: group 1, JCT; group 2, Bretschneider's HTK cardioplegic solution; and group 3 University of Wisconsin cold storage solution.. After 60 minutes of reperfusion, the recovery of the coronary artery flow in group 1 (JCT) was significantly better than in group 2, and slightly better than in group 3 (64% +/- 8.9%, 47.2% +/- 11.6%, 52.5% +/- 19.9%, mean +/- SD, respectively; group 1 versus group 2, p < 0.01). The recovery of the left ventricular developed pressure (LVDP) was significantly better in group 1 compared with group 2 and group 3 (60.2% +/- 14.5%, 41.1% +/- 12.6% and 36.5% +/- 10.1%, respectively; p < 0.01). The recovery of the heart contractility expressed by the product of LVDP and the heart rate (LVDP x heart rate) was significantly higher in group 1 than in group 2 and group 3 (47.5% +/- 3.4%, 23.6% +/- 9.6%, and 28.7% +/- 8.3%, respectively, p < 0.001). In hearts stored for 12 hours in JCT or HTK, the recovery of the heart contractility did not differ significantly (73.4% +/- 12.7% or 70.8% +/- 30.8%, respectively). Modified reperfusion aimed to improve postischemic heart recovery did not bring significant changes in cardiac mechanical function but resulted in an increase in postischemic coronary artery flow recovery in hearts reperfused with amino acid-enriched buffer.. The JCT solution is effective (as well as HTK) in preserving the ischemic hearts for up to 12 hours. It is superior to HTK or University of Wisconsin solution at 20 hours of isolated ischemic storage.

Topics: Adenosine Triphosphate; Animals; Cardioplegic Solutions; Cold Temperature; Heart; Heart Transplantation; Hemodynamics; Male; Myocardial Ischemia; Myocardial Reperfusion; Organ Preservation; Oxygen Consumption; Phosphocreatine; Rats; Rats, Sprague-Dawley

To elucidate the contribution of reduced activity of Na+/H+ exchange in streptozotocin-induced diabetic hearts against stunning, intracellular Na+ concentration ([Na+]i) was measured in isolated rat hearts using 23Na-MRS. The recovery of left ventricular developed pressure in hearts reperfused after 15 min global ischaemia at 37 degreesC was significantly better in diabetic ones (102.9+/-2.0% of pre-ischemic level, mean+/-s.e., n=6; P<0.05), and non-diabetic ones pre-treated with potent Na+/H+ exchange inhibitor, EIPA (1 mu mol/l; 93.8+/-2.3%, n=5; *P<0.05) than non-treated, non-diabetic hearts (75.1+/-2.5%, n=8). When diabetic hearts were pre-treated with EIPA, the recovery (101.2+/-2.6%, n=5) was identical to that of non-treated, diabetic hearts. [Na+]i in non-diabetic hearts increased to 329.1+/-8.1% of pre-ischemic level during 15 min ischemia, whereas the increase in [Na+]i in diabetic hearts significantly suppressed to 199.8+/-10.3% (P<0.001). EIPA attenuated the increase of [Na+]i during ischemia to 189.1+/-9.0% in non-diabetic hearts ( P<0.001) and to 155.3+/-4.6% in diabetic hearts (P<0.05). Thus, the EIPA-dependent Na+ accumulation during ischemia, i.e. Na+ influx probably mostly via Na+/H+ exchange was smaller in diabetic hearts by 69.7% compared with that in non-diabetic hearts. These results indicate that the cardiac protection against stunning in streptozotocin-induced diabetic hearts is mediated by the attenuation of Na+ accumulation during ischemia, which is caused by the reduced activity in Na+/H+ exchanger.

Topics: Adenosine Triphosphate; Animals; Diabetes Mellitus, Experimental; Hydrogen-Ion Concentration; Intracellular Fluid; Ion Transport; Myocardial Contraction; Myocardial Ischemia; Myocardial Reperfusion Injury; Myocardial Stunning; Phosphocreatine; Rats; Sodium; Sodium-Hydrogen Exchangers

The purpose of this study was to measure the spatially varying 31P MR signals in global and regional ischemic injury in the isolated, perfused rat heart. Chronic myocardial infarcts were induced by occluding the left anterior descending coronary artery eight weeks before the MR examination. The effects of acute global low-flow ischemia were observed by reducing the perfusate flow. Chemical shift imaging (CSI) with three spatial dimensions was used to obtain 31P spectra in 54-microl voxels. Multislice 1H imaging with magnetization transfer contrast enhancement provided anatomical information. In normal hearts (n = 8), a homogeneous distribution of high-energy phosphate metabolites (HEP) was found. In chronic myocardial infarction (n = 6), scar tissue contained negligible amounts of HEP, but their distribution in residual myocardium was uniform. The size of the infarcted area could be measured from the metabolic images; the correlation of infarct sizes determined by histology and 31P MR CSI was excellent (P < 0.006). In global low-flow ischemia (n = 8), changes of HEP showed substantial regional heterogeneity. Three-dimensional 31P MR CSI should yield new insights into the regionally distinct metabolic consequences of various forms of myocardial injury.

Topics: Adenosine Triphosphate; Animals; Magnetic Resonance Spectroscopy; Male; Myocardial Infarction; Myocardial Ischemia; Myocardium; Phosphates; Phosphocreatine; Rats; Rats, Wistar

Topics: Adenosine Triphosphate; Animals; Aorta, Abdominal; Energy Metabolism; Heart Arrest, Induced; In Vitro Techniques; Kinetics; Magnetic Resonance Spectroscopy; Male; Myocardial Ischemia; Myocardium; Phosphocreatine; Rats; Rats, Wistar; Time Factors

Topics: Adenine Nucleotides; Animals; Creatine; Cytidine Triphosphate; Guanine Nucleotides; Guanosine Triphosphate; Hot Temperature; Male; Myocardial Ischemia; Myocardium; NAD; NADP; Phosphocreatine; Rats; Rats, Wistar; Ribonucleotides; Stress, Physiological; Uridine Triphosphate

We investigated the effects of L-glutamine (0-20 mM) on cardiac function. The isolated perfused working rat heart (left atrial and aortic pressures of 5 and 70 cm H2O, respectively) was subjected to 20 min of normothermic low-flow ischaemia followed by reperfusion for 35 min. In the absence of glutamine, ischaemia-reperfusion caused an immediate significant (P < 0.01) fall in cardiac output from 46 to 20 ml/min, with a further deterioration to 17 ml/min at 35 min reperfusion. Ischaemia also caused a significant (P < 0.05) fall in myocardial glutamate from 2.6 to 1.8 mumol/g wet weight; and ischaemia-reperfusion caused significant (each P < 0.05) diminutions of myocardial ATP from 3.5 to 1.0 mumol/g wet weight and phosphocreatine from 4.8 to 1.5 mumol/g wet weight and resulted in significant (P < 0.05) accumulation of myocardial lactate from 0.9 to 4.3 mumol/g wet weight. Glutamine, present throughout the perfusion protocol (i.e. prior to ischaemia), at or above 1.25 mM, prevented the post-ischaemic diminution of cardiac output and the deleterious changes in myocardial metabolites. Post-ischaemic treatment with glutamine at 2.5 mM completely prevented the post-ischaemic diminution of cardiac output and restored the myocardial metabolites to normal.. Glutamine may be suitable as a cardioprotective and rescue agent. These effects may be mediated by maintenance of myocardial glutamate, ATP and phosphocreatine: and prevention of lactate accumulation.

Topics: Adenosine Triphosphate; Alanine; Animals; Cardiac Output; Glutamates; Glutaminase; Glutamine; Lactates; Male; Myocardial Ischemia; Myocardial Reperfusion Injury; Myocardium; Phosphocreatine; Rats; Rats, Sprague-Dawley; Water

Fructose-1,6-diphosphate is a glycolytic intermediate that has been shown experimentally to cross the cell membrane and lead to increased glycolytic flux. Because glycolysis is an important energy source for myocardium during early reperfusion, we sought to determine the effects of fructose-1,6-diphosphate on recovery of postischemic contractile function.. Langendorff-perfused rabbit hearts were infused with fructose-1,6-diphosphate (5 and 10 mmol/L, n = 5 per group) in a nonischemic model. In a second group of hearts subjected to 35 minutes of ischemia at 37 degrees C followed by reperfusion (n = 6 per group), a 5 mmol/L concentration of fructose-1,6-diphosphate was infused during the first 30 minutes of reperfusion. We measured contractile function, glucose uptake, lactate production, and adenosine triphosphate and phosphocreatine levels by phosphorus 31-nuclear magnetic resonance spectroscopy.. In the nonischemic hearts, fructose-1,6-diphosphate resulted in a dose-dependent increase in glucose uptake, adenosine triphosphate, phosphocreatine, and inorganic phosphate levels. During the infusion of fructose-1,6-diphosphate, developed pressure and extracellular calcium levels decreased. Developed pressure was restored to near control values by normalizing extracellular calcium. In the ischemia/reperfusion model, after 60 minutes of reperfusion the hearts that received fructose-1,6-diphosphate during the first 30 minutes of reperfusion had higher developed pressures (83 +/- 2 vs 70 +/- 4 mm Hg, p < 0.05), lower diastolic pressures (7 +/- 1 vs 12 +/- 2 mm Hg, p < 0.05), and higher phosphocreatine levels than control untreated hearts. Glucose uptake was also greater after ischemia in the hearts treated with fructose-1,6-diphosphate.. We conclude that fructose-1,6-diphosphate, when given during early reperfusion, significantly improves recovery of both diastolic and systolic function in association with increased glucose uptake and higher phosphocreatine levels during reperfusion.

Topics: Adenosine Triphosphate; Animals; Calcium; Fructosediphosphates; Glucose; Immunologic Factors; Lactic Acid; Magnetic Resonance Spectroscopy; Myocardial Contraction; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Phosphocreatine; Phosphorus Isotopes; Rabbits

Metabolic and functional responses to extracellular Mg2+ concentration ([Mg2+]o) were studied in perfused rat heart. Elevations of [Mg2+]o from 1.2 to 2.4, 5.0, and 8.0 mM dose dependently reduced contractile function and myocardial oxygen consumption (MVO2) up to 80%. Intracellular Mg2+ concentration ([Mg2+]i) remained stable (0.45-0.50 mM) during perfusion with 1.2-5. 0 mM [Mg2+]o but increased to 0.81 +/- 0.14 mM with 8.0 mM [Mg2+]o. Myocardial ATP was unaffected by [Mg2+]o, phosphocreatine (PCr) increased up to 25%, and Pi declined by up to 50%. Free energy of ATP hydrolysis (DeltaGATP) increased from -60 to -64 kJ/mol. Adenosine efflux declined in parallel with changes in MVO2 and [AMP]. At comparable workload and MVO2, the effects of [Mg2+]o on cytosolic free energy were mimicked by reduced extracellular Ca2+ concentration ([Ca2+]o) or Ca2+ antagonism with verapamil. Moreover, functional and energetic effects of [Mg2+]o were reversed by elevated [Ca2+]o. Despite similar reductions in preischemic function and MVO2, metabolic and functional recovery from 30 min of global ischemia was enhanced in hearts treated with 8.0 mM [Mg2+]o vs. 2.0 microM verapamil. It is concluded that 1) 1.2-8.0 mM [Mg2+]o improves myocardial cytosolic free energy indirectly by reducing metabolic rate and Ca2+ entry; 2) [Mg2+]i does not respond rapidly to elevations in [Mg2+]o from 1.2 to 5.0 mM and is uninvolved in acute functional and metabolic responses to [Mg2+]o; 3) adenosine formation in rat heart is indirectly reduced during elevated [Mg2+]o; and 4) 8.0 mM [Mg2+]o provides superior protection during ischemia-reperfusion compared with functionally equipotent Ca2+ channel blockade.

Topics: Adenosine Triphosphate; Animals; Calcium; Cytosol; Depression, Chemical; Extracellular Space; Magnesium; Male; Myocardial Contraction; Myocardial Ischemia; Myocardium; Oxygen Consumption; Phosphates; Phosphocreatine; Potassium Chloride; Rats; Rats, Wistar; Thermodynamics; Verapamil

Adenosine has been shown to modulate myocardial intermediary metabolism. The purpose of this study was to determine whether adenosine-mediated attenuation of in vivo myocardial stunning is associated with improved myocardial phosphorylation potential. Adult, open chest pigs were subjected to 10 minutes of regional myocardial ischemia and 90 minutes reperfusion. Regional ventricular function was assessed by measuring systolic wall thickening. Myocardial phosphorylation potential was estimated from the tissue (CrP/CrxPi) ratio determined in rapid-frozen tissue biopsy samples from normal and stunned myocardium. Control pigs were compared to animals treated prior to ischemia with intracoronary adenosine (50 micrograms/kg/min). Postischemic regional systolic wall thickening in adenosine treated pigs was significantly improved (40 +/- 3% of preischemic values) compared to control untreated pigs (26 +/- 3%). Myocardial stunning was associated with decreased ATP levels, but neither the total creatine pool (CrP + Cr) nor the (CrP/CrxPi) ratio was reduced. Adenosine pretreatment was associated with decreased Pi and Cr contents resulting in improved postischemic (CrP/CrxPi) ratio in the stunned bed compared to controls, but this effect occurred only after postischemic function had attained maximal improvement. These results suggest that adenosine attenuation of in vivo myocardial stunning is independent of elevated myocardial phosphorylation potential.

Topics: Adenosine; Animals; Cardiovascular Agents; Female; Heart; Hemodynamics; Male; Myocardial Ischemia; Myocardial Reperfusion; Myocardial Stunning; Myocardium; Phosphates; Phosphocreatine; Phosphorylation; Swine

Insulin improves myocardial contractile function during moderate ischemia, but the mechanism is unknown. To determine effects of insulin on myocardial oxygen utilization efficiency (O2UE) and energetics, regional left coronary perfusion pressure (CPP) was lowered sequentially from 100 to 60, 50, and 40 mmHg in 24 anesthetized, open-chest dogs. Regional power index (PI), myocardial oxygen consumption (MVO2), and O2UE index (PI/MVO2) were determined in untreated and insulin treated (4 U/min, i.v.) hearts. Biopsies were obtained from six untreated and six insulin-treated hearts at CPP=40 mmHg for determining high energy phosphates and the cytosolic phosphorylation potential. Measurements were compared with data from normal, untreated myocardium (n=11). MVO2 fell (P<0.05) in all hearts as CPP was lowered to 40 mmHg, and was unaffected by insulin treatment. PI decreased 32 and 75% in untreated hearts at CPP=50 and 40 mmHg, respectively (P<0.05). In insulin treated hearts, PI was not significantly depressed at CPP>40 mmHg, and fell only 26% at CPP=40 mmHg. O2UE increased (P<0.05) in all hearts at CPP=60 mmHg. In insulin treated hearts, O2UE was greater (P<0.05) at CPP=50 and 40 mmHg than at CPP=100 mmHg, and greater (P<0.05) than in untreated hearts at CPP=40 mmHg. Reducing CPP to 40 mmHg produced similar metabolic changes in all hearts. Compared to normal myocardium, ATP content of untreated and treated hearts was unchanged, creatine phosphate content decreased 21 and 14%, creatine content increased 24 and 30%, inorganic phosphate concentration increased 108 and 140%, and phosphorylation potential decreased 80 and 77%. We conclude that insulin markedly improves PI and O2UE without altering cytosolic energetics during moderate myocardial ischemia.

Topics: Adenosine Triphosphate; Animals; Blood Glucose; Coronary Circulation; Coronary Vessels; Creatine; Dogs; Energy Metabolism; Female; Heart; Insulin; Male; Myocardial Contraction; Myocardial Ischemia; Myocardium; Oxygen Consumption; Phosphocreatine; Reference Values

The novel blocker of voltage-gated Na+ channels KC 12291 (1-(5-phenyl-1,2,4-thiadiazol-3-yl-oxypropyl)-3-[N-methyl-N- [2-(3,4-dimethoxyphenyl)ethyl] amino] propane hydrochloride) delays myocardial Na+ overload in ischemia. To test whether KC 12291 displays cardioprotective properties in the intact heart, cardiac function, energy status and intracellular pH (31P NMR) as well as ion homeostasis (23Na NMR) were investigated during low-flow ischemia (100 microl/min for 36 min) followed by reperfusion. In the well-oxygenated, isolated perfused guinea pig heart, KC 12291 (1 microM) had no effect on left ventricular developed pressure (LVDP; 54+/-19 mmHg). KC 12291 delayed the onset and decreased the extent of ischemic contracture and markedly improved the recovery of LVDP in reperfusion [39+/-14 mmHg (n=4) vs 2+/-2 mmHg in controls (n=5)]. KC 12291 did not influence the rapid drop in phosphocreatine (PCr) following onset of ischemia but attenuated the decline in ATP. It also diminished the ischemia-induced fall in intracellular pH [6.39+/-0.2 (n=6) vs 6.18+/-0.20 in controls (n=6)]. In reperfusion, KC 12291 remarkably enhanced the recovery of PCr (84.8+/-9.6% vs 51.1+/-8.8% of baseline) and ATP (38.2+/-12.9% vs 23.7+/-9.3% of baseline). It also accelerated the recovery of intracellular pH. KC 12291 not only reduced the extent of ischemia-induced Na+ overload, but also enhanced Na+ recovery. It is concluded that KC 12291 delays contracture and reduces ATP depletion and acidosis in ischemia, and markedly improves the functional, energetic and ionic recovery in reperfusion. Blocking voltage-gated Na+ channels in ischemia to delay Na+ overload may thus constitute a promising therapeutic approach for cardioprotection.

Topics: Adenosine Triphosphate; Animals; Blood Pressure; Cardiovascular Agents; Energy Metabolism; Guinea Pigs; Heart; Hydrogen-Ion Concentration; In Vitro Techniques; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Phosphocreatine; Sodium; Thiadiazoles; Ventricular Dysfunction, Left; Ventricular Function, Left

The purpose of this study was to determine the effects of chronic moderate and heavy ethanol consumption on myocardial ischemia/ reperfusion injury. Three groups (n = 18) of 6-month-old female Sprague-Dawley rats were fed a nutritionally balanced liquid diet. Control, moderate alcohol, and heavy alcohol groups consumed 0%, 20%, and 35% of their calories from ethanol, respectively. After 10 weeks of feeding, hearts were isolated and subjected to 21.5 min of ischemia alone, or 21.5 min of ischemia followed by 30 min reperfusion. Hearts were evaluated for hemodynamic characteristics and high-energy phosphate content. Hearts from animals exposed to moderate and heavy amounts of ethanol recovered significantly less (30.61% and 29.45%, respectively) of their preischemic cardiac external work than control hearts (65.52%). Postischemic diastolic stiffness was increased approximately 7-fold, and high-energy phosphate content, both creatine phosphate and adenosine triphosphate, decreased >25% by both chronic moderate and heavy ethanol consumption. In conclusion, both chronic moderate and heavy ethanol consumption exacerbate myocardial ischemia/reperfusion injury. The ethanol-induced reduction in postischemic energy status may be the mechanism of increased diastolic stiffness and subsequent reduced cardiac external work.

Topics: Adenosine Triphosphate; Alcoholism; Animals; Cardiomyopathy, Alcoholic; Diastole; Energy Metabolism; Female; Hemodynamics; Myocardial Contraction; Myocardial Ischemia; Myocardial Reperfusion Injury; Phosphocreatine; Rats; Rats, Sprague-Dawley

The aim of this study was to assess how coronary flow, oxygen supply and energy demand affect myocardial ATP, phosphocreatine and their metabolites during oxygen shortage and recovery.. Isolated rat hearts were exposed for 20 min to either low-flow ischaemia or hypoxaemia at the same oxygen supply, followed by return to baseline conditions (20 min). Seventy-three hearts were divided into four groups: ischaemic or hypoxaemic, spontaneously beating or paced to increase energy demand.. During O2 shortage, myocardial performance was less in ischaemic, spontaneously beating hearts (SpIs), than in the other groups (14 +/- 1% of baseline vs. 25-48%). Consequently, the tissue levels of ATP, total adenylates and phosphocreatine were maintained in SpIs, in contrast to marked decreases in the other groups. Upon reflow, the recovery of performance and of myocardial ATP was 94 +/- 5% in SpIs (P = NS vs. baseline) compared with 64-85% (P < 0.05 vs. baseline) in the other groups. The degree of recovery was positively related to the ischaemic contents of ATP (P = 0.03) and adenylates (P = 0.001), but not to that of phosphocreatine (P = NS).. The maintenance of the ATP pool under low oxygen supply conditions is essential for good recovery. The most important factors that determine the ATP pool size are the energy demand, which increases the formation of diffusible ATP catabolites, and the coronary flow, which removes these catabolites, rather than the oxygen supply per se.

Topics: Adenosine Triphosphate; Animals; Cardiac Pacing, Artificial; Chromatography, High Pressure Liquid; Coronary Circulation; Hypoxia; Male; Myocardial Contraction; Myocardial Ischemia; Myocardium; Phosphates; Phosphocreatine; Rats; Rats, Sprague-Dawley

We investigated if blockade of ATP-sensitive K+ channels (KATP) abolishes the protective effect of ischemic preconditioning (IP) on myocardial metabolism and ischemia-induced reactive hyperemia (RH) in pigs.. IP was elicited by a single cycle of 5 min occlusion and 5 min reperfusion of coronary artery, followed by 15 min of test ischemia and 120 min of reperfusion. Vehicle or the ATP-sensitive K+ channels (KATP) blocker, glibenclamide (3 or 6 mg/kg; G3 or G6) was administered before IP (groups; IP, G3+IP, G6+IP). As respective controls, the same treatment was performed in groups without IP (groups; C, G3, G6). Tissue levels of ATP, creatine phosphate (CP) and intracellular pH (pHi) in the area at risk were measured by 31P-nuclear magnetic resonance spectroscopy. RH after 5 min of preconditioning ischemia was assessed by regional myocardial blood flow.. ATP and pHi were preserved after 15 min of ischemia in the IP group [C/IP; ATP=57+/-4/76+/-10% of baseline, pHi=6.18+/-0.08/6.66+/-0.03, P<0.05, C vs. IP]. Both doses of glibenclamide completely abolished the ATP sparing effect of IP. The high dose completely abolished pHi preservation (G6+IP=6.33+/-0.06), while the low dose showed only a partial effect (G3+IP=6.48+/-0.03). Glibenclamide did not adversely affect myocardial metabolism in groups without IP. Glibenclamide attenuated RH after 5 min of ischemia by 30% in both subendocardium and subepicardium.. Blockade of KATP abolished the preconditioning effect on myocardial metabolism, and partially attenuated post-ischemic reactive hyperemia in pigs. These results indicate that KATP activation might be involved in the mechanisms of these phenomena, reactive hyperemia is not sufficient to induce IP protection.

Topics: Adenosine Triphosphate; Animals; Blood Glucose; Coronary Vessels; Glyburide; Hemodynamics; Hydrogen-Ion Concentration; Hypoglycemic Agents; Ischemic Preconditioning, Myocardial; Magnetic Resonance Spectroscopy; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Phosphates; Phosphocreatine; Phosphorus Radioisotopes; Potassium Channel Blockers; Regional Blood Flow; Swine; Time Factors

The metabolic effects during myocardial ischemia and sustained reperfusion of the antianginal agents diltiazem (n = 10) and propranolol (n = 10) were monitored with noninvasive phosphorus nuclear magnetic resonance spectroscopy to establish any correlation between metabolic changes and infarct size. Spectroscopy followed changes in high-energy phosphate concentrations and myocardial intracellular pH during 2 h of left anterior descending coronary artery occlusion and 3 subsequent weeks of reperfusion, in a closed chest canine infarct model. Gadolinium-DTPA enhanced magnetic resonance imaging was used to assess the extent of myocardial injury (infarct size). Microspheres were used to document the zone at risk and the success of reperfusion. Whereas diltiazem appeared to reduce the derangement in high-energy phosphates during coronary occlusion, there was no significant change in infarct size when compared with a previously studied control group. Propranolol, which produced a lesser decline in pH during occlusion and smaller pH changes during early reperfusion, was associated with a significant reduction in the degree of tissue necrosis (compared with controls). There was an inverse correlation (r = -0.51) between the change in myocardial pH (occlusion end to immediate reperfusion) and the recovery index (an index of myocardial salvage). By 1 h into reperfusion, there was a stronger inverse correlation between pH and infarct size (r = -0.75), implying a protective effect of delaying pH recovery during early reperfusion and indicating the potential use of this parameter as a predictor of tissue viability.

Topics: Adenosine Triphosphate; Animals; Anti-Arrhythmia Agents; Calcium Channel Blockers; Coronary Circulation; Diltiazem; Dogs; Drug Evaluation; Energy Metabolism; Female; Gadolinium DTPA; Heart; Hydrogen-Ion Concentration; Magnetic Resonance Spectroscopy; Myocardial Ischemia; Myocardium; Phosphocreatine; Phosphorus Isotopes; Propranolol

The hypothesis was tested that infusion of a solution containing creatine phosphate (CP) into rats with acutely failing hearts would enhance recovery of cardiac function. The acutely failing heart was produced by constricting the ascending aorta. This overload produced failure in approximately 25 min. At the point of failure the constriction was removed and solutions containing sterile physiological saline (PSS), PSS and CP, PSS and creatine, or PSS and creatine plus phosphate were infused. Cardiac function was assessed from systolic and diastolic blood pressure, +/- dp/dt, heart rate, and cardiac work. Ca2+ uptake by isolated sarcoplasmic reticulum and the concentrations of selected blood and tissue metabolites were measured. Normal cardiac function was restored in the PSS-CP infused rats whereas all other treatments did not restore cardiac function. Adenosine triphosphate and CP had declined in the myocardium of the failing hearts while lactate was elevated. The concentrations of these metabolites were normal in the PSS-CP infused animals. The glycogen concentration in the myocardium was reduced following the constriction. Ca2+ uptake by isolated sarcoplasmic reticulum was depressed in the failed hearts but normal in the hearts of CP-infused animals. These results demonstrate that the infusion of CP into animals with failing hearts can be effective in restoring cardiac function.

Topics: Animals; Cardiotonic Agents; Evaluation Studies as Topic; Heart Failure; Male; Myocardial Contraction; Myocardial Ischemia; Phosphocreatine; Rats; Rats, Sprague-Dawley

Adenosine triphosphate (ATP)-sensitive potassium channel openers as a class exert cardioprotective effects, and we can separate vasodilator from glyburide-reversible cardioprotective activity in cromakalim analogs (e.g., BMS-180448). The purpose of this study was to determine the relation between cardiac function, energy status, and cardioprotective effects for BMS-180448 in isolated rat hearts compared with diltiazem. BMS-180448 (1-30 microM) or 0.1-1 microM diltiazem were given 10 min before 25-min global ischemia in rat hearts followed by 30 min of reperfusion. Both compounds significantly increased time to the onset of contracture during ischemia and improved postischemic recovery of contractile function in a concentration-dependent manner. At equivalent cardioprotective concentrations, BMS-180448 depressed preischemic cardiac function significantly less than did diltiazem. During ischemia, diltiazem significantly accelerated the functional decline observed in vehicle-treated hearts, whereas BMS-180448 attenuated the net rate of decline of function. Despite these different effects on preischemic and ischemic cardiac function, diltiazem and BMS-180448 conserved cardiac ATP during ischemia to a similar degree. BMS-180448 enhanced the recovery of ATP (also seen for diltiazem, but not to the same magnitude) and creatine phosphate during reperfusion compared with vehicle-treated hearts. For BMS-180448, this enhanced ATP recovery was accompanied by a significant improvement in the efficiency of oxygen use, which was profoundly reduced in reperfused vehicle-treated hearts. BMS-180448 also significantly enhanced the functional reserve after the 25-min period of global ischemia. Thus BMS-180448 protects ischemic myocardium and conserves ATP with less reduction in cardiac function compared with diltiazem.

Topics: Adenosine Triphosphate; Animals; Benzopyrans; Calcium Channel Blockers; Cardiotonic Agents; Depression, Chemical; Diltiazem; Dose-Response Relationship, Drug; Glyburide; Guanidines; Heart; In Vitro Techniques; Magnetic Resonance Spectroscopy; Male; Myocardial Contraction; Myocardial Ischemia; Oxygen Consumption; Phosphocreatine; Potassium Channels; Rats; Rats, Sprague-Dawley

Substantial release of bradykinin has been demonstrated to occur during short periods of myocardial ischaemia in various species. The aim of the present study was to investigate the protective effect of bradykinin in ischaemia and whether bradykinin could be involved in ischaemic preconditioning in the rat heart.. Isolated, buffer-perfused hearts were subjected to 30 min of global ischaemia, followed by 30 min of reperfusion. Postischaemic functional recovery was recorded in the following groups: (1) control; (2) treatment with 0.1 microM bradykinin for 10 min before ischaemia (BK); (3) bradykinin treatment combined with pretreatment with the specific bradykinin B2-receptor antagonist, HOE 140; (4) ischaemic preconditioning by 5 min ischaemia +5 min reperfusion prior to sustained ischaemia (i.p.); and (5) ischaemic preconditioning combined with HOE 140 administration.. Postischaemic myocardial function was significantly improved in both BK and i.p. groups (developed pressure 66.9 +/- 6.8 and 67.6 +/- 7.1 mmHg, respectively, vs. 43.1 +/- 5.9 mmHg in controls, P < 0.05). Pretreatment with 1 microM HOE 140 completely abolished the effect of bradykinin, while protection achieved by i.p. was unaltered by this drug. None of the protective interventions was associated with any significant improvement in myocardial adenosine triphosphate, creatine phosphate, glycogen, lactate or glucose tissue levels, detected either at the end of ischaemia or after 30 min of reperfusion.. Bradykinin, acting via B2-receptors, can protect against postischaemic contractile dysfunction to a similar extent as i.p.. An involvement of B2-receptors in the ischaemic preconditioning phenomenon could, however, not be demonstrated.

Topics: Adenosine Triphosphate; Animals; Bradykinin; Bradykinin Receptor Antagonists; Glucose; Glycogen; Ischemic Preconditioning, Myocardial; Lactic Acid; Male; Myocardial Contraction; Myocardial Ischemia; Myocardium; Phosphocreatine; Rats; Rats, Wistar

To test the role of inorganic phosphate (Pi) in downregulation of myocardial contractile force at the onset of ischemia, Pi of rat hearts was determined with 31P nuclear magnetic resonance spectroscopy. Forty cycles of brief hypoperfusion (30% of baseline flow for 33 s) were used to achieve a time resolution of 0.512 s for comparing dynamic changes in Pi and contractile force. Initial control values of left ventricular developed pressure (LVP), heart rate, and oxygen consumption were 136 +/- 11 mmHg, 236 +/- 4 beats/min, and 95 +/- 3 microl O2 x min(-1) x g(-1); these values were unchanged at the end of the experiment. During the first 10 s of hypoperfusion, Pi increased at a rate (percentage of the total observed change) faster than the decrease in LVP; Pi and LVP then changed at the same rate during the remainder of the hypoperfusion. ADP did not change in advance of LVP. Intracellular pH did not change. The results indicate that Pi plays an important role in initiating the downregulation of myocardial contractile force at the onset of ischemia. Perfusion pressure also declined faster than LVP at the onset of ischemia, indicating potential importance of vascular collapse in contractile downregulation during early ischemia.

Topics: Adenosine Diphosphate; Adenosine Triphosphate; Animals; Cytosol; Heart Rate; Hemodynamics; In Vitro Techniques; Magnetic Resonance Spectroscopy; Myocardial Contraction; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Oxygen Consumption; Phosphates; Phosphocreatine; Phosphorus; Rats; Time Factors; Ventricular Function, Left

Vanadium compounds have been shown to cause a variety of biological and metabolic effects including inhibition of certain enzymes, alteration of contractile function, and as an insulin like regulator of glucose metabolism. However, the influence of vanadium on metabolic and ionic changes in hearts remains to be understood. In this study we have examined the influence of vanadate on glucose metabolism and sodium transport in isolated perfused rat hearts. Hearts were perfused with 10 mM glucose and varying vanadate concentrations (0.7-100 microM) while changes in high energy phosphates (ATP and phosphocreatine (PCr)), intracellular pH, and intracellular sodium were monitored using 31P and 23Na NMR spectroscopy. Tissue lactate, glycogen, and (Na+, K+)-ATPase activity were also measured using biochemical assays. Under baseline conditions, vanadate increased tissue glycogen levels two fold and reduced (Na+, K+)-ATPase activity. Significant decreases in ATP and PCr were observed in the presence of vanadate, with little change in intracellular pH. These changes under baseline conditions were less severe when the hearts were perfused with glucose, palmitate and beta-hydroxybutyrate. During ischemia vanadate did not limit the rise in intracellular sodium, but slowed sodium recovery on reperfusion. The presence of vanadate during ischemia resulted in attenuation of acidosis, and reduced lactate accumulation. Reperfusion in the presence of vanadate resulted in a slower ATP recovery, while intracellular pH and PCr recovery was not affected. These results indicate that vanadate alters glucose utilization and (Na+, K+)-ATPase activity and thereby influences the response of the myocardium to an ischemic insult.

Topics: 3-Hydroxybutyric Acid; Adenosine Triphosphate; Animals; Energy Metabolism; Glucose; Glycogen; Glycolysis; Heart; Hydrogen-Ion Concentration; Hydroxybutyrates; In Vitro Techniques; Kinetics; Lactates; Magnetic Resonance Spectroscopy; Male; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Palmitic Acid; Perfusion; Phosphocreatine; Rats; Rats, Sprague-Dawley; Sodium; Sodium-Potassium-Exchanging ATPase; Vanadates

Our objective was to test the effects of exogenous L-aspartate and L-glutamate on myocardial energy metabolism during ischemia-reperfusion.. Phosphorus 31-magnetic resonance spectroscopy was used to observe cellular energetics and intracellular pH in isolated pig hearts perfused with blood (group A, n = 8) or blood enriched with 13 mmol/L each of L-aspartate and L-glutamate (group B, n = 6). The hearts were subjected to 30 minutes of total normothermic ischemia and then reperfused for 40 minutes. Two hearts from each group were inotropically stimulated by titration with calcium after normokalemic reperfusion. Left ventricular function was measured with the use of a compliant balloon and oxygen consumption was calculated.. Magnetic resonance spectroscopy showed no decrease in the rate of energy decline during ischemia for group B versus group A. No significant differences were observed between the two groups in terms of myocardial function, oxygen consumption, or the rate or extent of high-energy phosphate recovery after normokalemic reperfusion or inotropic stimulation. Inotropic stimulation of postischemic hearts, however, led to dramatic improvement in myocardial function in both groups (p < 0.05 for all parameters) and significant improvement in oxygen consumption (p = 0.01).. In a normal, isolated, blood-perfused pig heart subjected to 30 minutes of total normothermic ischemia, (1) enrichment of the perfusate with aspartate/glutamate before and after ischemia affects neither myocardial energy metabolism during ischemia-reperfusion nor postischemic recovery of myocardial function or oxygen consumption and (2) inotropic stimulation can recruit significant postischemic function and sufficient aerobic respiration to support it, irrespective of aspartate/glutamate enrichment.

Topics: Adenosine Triphosphate; Animals; Aspartic Acid; Cardioplegic Solutions; Chromatography, High Pressure Liquid; Energy Metabolism; Glutamates; In Vitro Techniques; Magnetic Resonance Spectroscopy; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Oxygen Consumption; Phosphocreatine; Phosphorus Radioisotopes; Stimulation, Chemical; Swine

Pharmacologic inhibition of the Na-H exchanger prior to and during ischemia has been shown to protect the ischemic heart by reducing Na-H exchange. However, pH regulation in the ischemic heart is primarily mediated by other pH regulatory mechanisms, such as metabolite efflux and sodium-coupled HCO3-influx, which may compensate for a reduction in Na-H exchange by increasing proton efflux. We hypothesized that short-term pharmacologic inhibition of the Na-H exchanger would result in increases in other compensatory pH regulatory mechanisms and thereby limit acidosis during ischemia and reduce ischemic injury.. In order to test this hypothesis, we exposed isolated perfused rat hearts to ethylisopropylamiloride (EIPA, 3 micro M) for 40 min, followed by 10 min of EIPA-free perfusate and 30 min of global ischemia (termed CTL/EIPA hearts). The effects of this intervention were compared to hearts perfused with either glucose alone (CTL) or EIPA 3 micro M for 10 min before ischemia (EIPA). Ischemic injury was measured using creatine kinase (CK) release on reperfusion, while pH and metabolic effects were measured using 31P nuclear magnetic resonance spectroscopy. The effect of this intervention on recovery from an acid load was assessed using an NH4Cl pre-pulse in bicarbonate-containing Krebs-Henseleit as well as a HEPES buffer.. Both CTL/EIPA and EIPA hearts had marked reduction in ischemic injury (CK control 1191 +/- IU/g dry weight: CTL/EIPA 406 +/- 42 IU/gdw; EIPA 333 +/- 78 IU/gdw), as well as significantly reduced end-diastolic pressure on reperfusion. Intracellular pH was higher in the CTL/EIPA hearts (end-ischemic pH = 6.34 +/- 0.05) compared to either control (5.86 +/- 0.02) or EIPA hearts (6.01 +/- 0.02), while pH recovery on reperfusion was markedly slowed in the CTL/EIPA hearts. CTL/EIPA hearts had rapid ATP depletion during ischemia, but PCr recovery comparable to EIPA hearts. Acidification on exposure to NH4Cl was increased in the presence of HEPES, but ph recovery was not altered by short-term exposure to EIPA.. These data show that short-term inhibition of the Na-H altered pH regulation in the ischemic heart, resulting in reduced acidosis and slow pH recovery on reperfusion, coupled with reduction in ischemic injury and end-diastolic pressure on a reperfusion. These findings are consistent with short-term exposure to EIPA accelerating ATP depletion during ischemia, as well as limiting proton efflux during reperfusion.

Topics: Acidosis; Adenosine Triphosphate; Amiloride; Ammonium Chloride; Animals; Anti-Arrhythmia Agents; Hydrogen-Ion Concentration; Magnetic Resonance Spectroscopy; Male; Myocardial Ischemia; Myocardium; Perfusion; Phosphocreatine; Rats; Rats, Sprague-Dawley; Sodium-Hydrogen Exchangers; Time Factors

Previously, we have shown that potassium and magnesium (K-Mg, 20 mM each) cardioplegia ameliorated cytosolic calcium ([Ca2+]i) accumulation and was associated with enhanced functional recovery after surgically induced global ischemia in the aged heart. K-Mg cardioplegia was also shown to enhance cytosolic cytochrome oxidase I activity and mRNA levels, suggesting that enhanced functional recovery may involve the preservation of high-energy phosphates. To investigate this hypothesis, 31P nuclear magnetic resonance was used to measure serial alterations in phosphocreatine (PCr), inorganic phosphate, nucleoside triphosphate (NTP), intracellular free magnesium (Mgf), and intracellular pH (pHi) in Langendorff-perfused, aged (135 wk) rabbit hearts during preischemia, global ischemia (30 min), and reperfusion (30 min). K-Mg cardioplegia retarded PCr depletion (P < 0.05) and significantly enhanced NTP preservation (P < 0.05) during ischemia and reperfusion. K-Mg cardioplegia also attenuated the increase in Mgf during ischemia (P < 0.05). These results were correlated with amelioration of [Ca2+]i accumulation during ischemia and preservation of left ventricular function after reperfusion and suggest that optimal functional recovery from surgically induced ischemia is provided by K-Mg cardioplegia in the aged myocardium.

Topics: Aging; Animals; Calcium; Cardioplegic Solutions; Cytosol; Energy Metabolism; Heart; Heart Arrest, Induced; Hydrogen-Ion Concentration; Magnesium; Magnetic Resonance Spectroscopy; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Phosphates; Phosphocreatine; Potassium; Rabbits; Ribonucleotides

During moderate reductions of blood flow, the myocardium downregulates contractile function and ATP utilization to result in reduced but stable ATP levels, recovery or stability of (reduced) creatine phosphate (CP), and preservation of myocyte viability. The intent of this study was to determine the influence of the level of ischemic blood flow and the major determinants of myocardial O2 consumption (MVO2) (heart rate and systolic blood pressure) on recovery of CP during prolonged moderate myocardial hypoperfusion. 31P-nuclear magnetic resonance spectroscopy was used to measure CP, ATP, and Pi in the subepicardium (Epi) and subendocardium (Endo) of 13 open-chest dogs. Wall thickening was measured with sonomicrometry. A coronary stenosis reduced mean myocardial blood flow (microspheres) from 1.10 +/- 0.07 to 0.71 +/- 0.06 ml.g-1.min-1 (P < 0.01) and the Endo-to-Epi blood flow ratio from 1.12 +/- 0.07 to 0.59 +/- 0.06 (P < 0.01), and dyskinesis developed. Coronary blood flow and systolic wall thickening did not change significantly during 4 h of hypoperfusion. Epi CP and ATP fell to 80 +/- 4% (P < 0.05) and 93 +/- 3% of control, respectively, at 30 min. Epi CP then recovered to 87 +/- 5% while ATP decreased further to 83 +/- 5% of baseline by the end of the 240-min ischemic period. Endo CP and ATP fell to 53 +/- 4 and 77 +/- 5% of control, respectively, at 30 min; then Endo CP recovered to 85 +/- 6% while ATP decreased further to 68 +/- 6% of baseline at 240 min of hypoperfusion. ADP levels were significantly increased at 30 min but recovered to baseline by 240 min of hypoperfusion. delta Pi/CP increased significantly (Endo > Epi) at the onset of ischemia and then progressively decreased. At 30 min, mild myocardial acidosis was observed in some hearts with variable pH recovery during continuing hypoperfusion. The data demonstrate that variations in blood flow cannot account for the magnitude of the initial fall in CP or for the final extent of recovery. However, the rate at which CP recovered was significantly correlated with the level of blood flow. Variations in the determinants of MVO2 did not account for differences in CP recovery.

Topics: Adenosine Diphosphate; Adenosine Triphosphate; Animals; Coronary Circulation; Coronary Disease; Cytosol; Dogs; Endocardium; Energy Metabolism; Heart; Heart Rate; Hemodynamics; Hibernation; Magnesium; Myocardial Ischemia; Myocardium; Oxygen Consumption; Phosphocreatine; Regional Blood Flow; Regression Analysis; Systole; Time Factors

31P NMR allows non-invasive measurement of intracellular pH, which drops during tissue hypoxia or ischemia. Determination is usually based on the chemical shift between the inorganic phosphate (P(i)) and phosphocreatine (PCr) peaks. During reperfusion, P(i) is taken up to form PCr and ATP, and in our model at least (an isolated, working rat heart perfused with an erythrocyte suspension), the level of P(i) reduces well below the pre-ischemic level, making pH determination difficult. The chemical shifts of the three ATP peaks also depend on pH, and the level of ATP remains high during reperfusion, so these might be used to determine pH. The results of one experiment are presented in detail, showing the time course of high energy phosphate levels before, during and after a 32 min ischemic insult, and close agreement between the pH determinations from the Pi and gamma-ATP peaks can be seen. The formula used to calculate pH from the ATP peak was: pH (ATP) = 0.59 delta 2-5.0 delta + 15.9 where delta is the shift in ppm between PCr and gamma-ATP. All pH readings by both methods from a series of seven experiments were compared and a 1:1 agreement demonstrated (correlation coefficient 0.63, p < 0.0001). Although the ATP shifts also depend on magnesium complexation which we have ignored, this appears to be justifiable within the errors of the method; the good agreement between the results of the two methods, and the ability to determine pH during reperfusion suggest that calculation of intracellular pH from the chemical shift of gamma-ATP is a useful technique.

Topics: Adenosine Triphosphate; Animals; Hydrogen-Ion Concentration; In Vitro Techniques; Magnetic Resonance Spectroscopy; Male; Myocardial Ischemia; Myocardium; Phosphates; Phosphocreatine; Phosphorus; Rats; Rats, Wistar

Although freshwater turtles as a group are highly anoxia tolerant, dramatic interspecific differences in the degree of anoxia tolerance have been demonstrated in vivo. Painted turtles (Chrysemys picta bellii) appear to be the most hypoxia-tolerant species thus far studied, while softshelled turtles (Trionyx spinifer) are the most hypoxia-sensitive. We have assumed that this dichotomy persists in vitro but have not, until now, directly tested this assumption. We therefore, directly compared the responses of isolated, perfused, working hearts from these two species to either 240 min of anoxia, 90 min of global ischemia, or 240 min of global ischemia followed by reoxygenation/reperfusion. Isolated hearts were perfused at 20 degrees C and monitored continuously for phosphocreatine (PCr), adenosine triphosphate (ATP), inorganic phosphate (Pi), and intracellular pH (pHi) by 31P-nuclear magnetic resonance spectroscopy as well as for ventricular developed pressure and heart rate. Contrary to our expectations, we observed few significant differences in any of these parameters between painted and softshelled turtle hearts. Hearts from both species tolerated 240 min of anoxia equally well and both restored PCr, pHi, and Pi contents to control levels during reoxygenation. We did observe some significant interspecific differences in the 90 min (pHi and Pi) and 240 min (PCr) ischemia protocols although these seemed to suggest that Trionyx hearts might be more tolerant to these stresses than Chrysemys hearts. We conclude that: (a) the observed in vivo differences in anoxia tolerance between painted and softshelled turtles must either be due to differences in organ metabolism in organs other than the heart (e.g., brain) or to some integrative physiologic differences between the species; and (b) isolated hearts from a species known to be relatively anoxia sensitive in vivo can exhibit an apparent high degree of anoxia and ischemia tolerance in vitro.

Topics: Adenosine Triphosphate; Animals; Cardiac Output; Female; Heart Rate; Hypoxia; In Vitro Techniques; Magnetic Resonance Spectroscopy; Male; Myocardial Ischemia; Myocardium; Phosphocreatine; Species Specificity; Turtles

To elucidate the role of bound creatine kinase in adenine nucleotide compartmentation in myofibrils, the effects of this enzyme's substrates and products on rigor tension were studied in using isolated skinned rat cardiomyocytes rather than fibers, to avoid restrictions due to concentration gradients within the multicellular preparations.. A new experimental set-up was built to allow continuous and stable measurements of force developed by cells. Triton X-100-treated cardiomyocytes were glued between a glass holder and the needle of a galvanometer. A feedback system allowed the precise measurement of force by recording the coil current necessary to prevent movement of the needle.. At very low [Ca2+] (pCa 7), as MgATP level decreased, rigor tension appeared. In the absence of phosphocreatine (PCr), this tension started to rise at MgATP concentrations several times higher than in the presence of 12 mM PCr. In the absence of PCr, the pMgATP/tension curves of single cells usually had a complicated relationship which could not be analyzed by a simple Hill equation. In the absence of PCr, 250 microM MgADP strongly potentiated rigor tension development in the 1 mM-3 microM range of [MgATP]; at 100 microM MgATP, in the presence of MgADP, the tension was 4.6 times higher than in the absence of MgADP. Addition of 12 mM PCr immediately eliminated rigor. Finally, in the presence of 100 microM MgATP and 250 microM MgADP, a decrease in PCr resulted in rigor; the half-maximal contracture being recorded at 1 mM PCr.. These results indicate a myofibrillar compartmentation of adenine nucleotides influenced by bound creatine kinase, since at equal MgATP concentrations in extramyofibrillar milieu the response of myofibrils strongly depends on the presence of PCr. Local accumulation of ADP in myofibrils due to a fall in cellular PCr and inability of myofibrillar creatine kinase to rephosphorylate ADP produced by myosin ATPase could be an important mechanism of diastolic tension rise in ischaemic conditions.

Topics: Adenosine Diphosphate; Adenosine Triphosphate; Analysis of Variance; Animals; Calcium; Creatine Kinase; In Vitro Techniques; Male; Myocardial Contraction; Myocardial Ischemia; Myocardium; Myofibrils; Phosphocreatine; Rats; Rats, Wistar

In postischemia hearts, cytoplasmic creatinine kinase (CK) inactivation resulting from toxic oxygen metabolite injury may lead to bioenergetic and mechanical dysfunction. This study determines the relationship between CK activity, mechanical function, and bioenergetics during reperfusion (RP) after a reversible ischemic injury. Rat hearts pretreated after 12 hr without (CTRL) or with myristic acid (MA) underwent 10 min global, 37 degrees C ischemia followed by 10 or 40 min RP while developed pressure (DP) was monitored. Catalase and CK were assayed at preischemia. CK was also assayed at end ischemia and 10 and 40 min RP. 31 P nuclear magnetic resonance spectra assessed changes in phosphocreatinine (PCr) and adenosine triphosphate (ATP) concentration. Preischemic DP was 95 +/- 5 mm Hg. CTRL DP returned to 84 +/- 3 by RP10 and 88 +/- 6 by RP40 while MA hearts recovered fully by RP10 (90 +/- 2). Preischemic catalase activity was significantly increased in MA hearts (1217 +/- 36 U/g left ventricular tissue (LV) vs 1007 +/- 40 U/g LV, P < 0.01, MA vs CTRL). CTRL CK activity fell from 1870 +/- 75 to 1103 +/- 11 U/g LV at RP10, but rose to 1272 +/- 13 by RP40 (P < 0.01, RP10 vs RP40). MA hearts lost no CK activity during RP. By RP10, CTRL PCr/ATP ratio was elevated to 2.2 +/- 0.2 (P < 0.001) from a preischemic level of 1.7 +/- 0.4 and normalized by RP40, while MA hearts had a normal PCr/ATP throughout RP. Reversible RP injury transiently depresses mechanical function. Cytoplasmic CK damage during RP impairs PCr utilization, leading to a PCr overshoot. Functional recovery and metabolic recovery follow return of CK activity. Increased endogenous catalase preserves CK during RP, resulting in normal function and bioenergetics.

Topics: Adenosine Triphosphate; Animals; Biomechanical Phenomena; Catalase; Creatine Kinase; Energy Metabolism; Magnetic Resonance Spectroscopy; Male; Myocardial Ischemia; Myocardial Reperfusion Injury; Myristic Acid; Myristic Acids; Phosphocreatine; Rats; Rats, Sprague-Dawley

Topics: Adenosine Triphosphate; Allopurinol; Animals; Cardioplegic Solutions; Creatine Kinase; Glutathione; Heart; Heart Arrest; Hydrogen-Ion Concentration; Magnetic Resonance Spectroscopy; Myocardial Ischemia; Myocardium; Organ Preservation; Phosphates; Phosphocreatine; Phosphorus; Purines; Raffinose; Rats; Time Factors

We hypothesized that following reversible myocardial ischemia recovery of glucose metabolism would be prolonged and would parallel recovery of high energy phosphate levels. Normothermic ischemia was achieved in dogs by aortic cross-clamping for 20 min on cardiopulmonary bypass. Glucose uptake was determined by [18F]fluorodeoxyglucose uptake and positron emission tomography (PET) 1 week pre-ischemia and at 2 and 7 days post-ischemia (n = 8). Oxygen consumption (MVO2) and glucose uptake were also measured by Fick. In a separate group of animals, adenosine triphosphate (ATP) and creatine phosphate (CP) levels were measured by left ventricular/septal biopsies at baseline, 2 days, and 7 days (n = 6). Glucose uptake, as measured by PET, was reduced to 15% of baseline at 2 days post-ischemia and returned to normal by 7 days post-ischemia (P < 0.05). These results were confirmed by Fick measures of glucose uptake. ATP levels were reduced to 49% of pre-ischemic levels at 2 days and returned to baseline by 7 days (P < 0.05). CP and MVO2 levels were normal at 2 and 7 days following ischemia. We conclude that reduced glucose uptake in the presence of intact oxidative metabolism suggests that glucose is not the favored substrate for ATP production following ischemia.

Topics: Adenosine Triphosphate; Analysis of Variance; Animals; Blood Glucose; Cardiopulmonary Bypass; Deoxyglucose; Dogs; Fatty Acids, Nonesterified; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Heart; Lactates; Myocardial Ischemia; Myocardium; Oxygen Consumption; Phosphocreatine; Time Factors; Tomography, Emission-Computed

The ability of ischemic preconditioning (IP) to protect the myocardium against prolonged ischemia may derive from improved energy balance. We therefore examined myocardial energy metabolism and mitochondrial oxidative phosphorylation in isolated perfused rat hearts which were either subjected (IP group), or not subjected (control group), to preconditioning prior to 30 min sustained ischemia and 30 min reperfusion. Preconditioning was achieved with two cycles of 5 min ischemia followed by 5 min reperfusion. Recovery of myocardial function was significantly greater, and creatine kinase release was significantly lower, in the IP group. Although ATP hydrolysis during the sustained ischemia remained unchanged in both groups, greater preservation of high energy phosphate (eg. ATP and CP) was observed in the IP group after reperfusion. CP content immediately after preconditioning greatly exceeded pre-ischemic values. Lactate production during the sustained ischemia was significantly lower in the IP group, suggesting a decrease in anaerobic glycolysis and a probable attenuation of intracellular acidosis. Oligomycin-sensitive mitochondrial ATPase activity in the control group was significantly decreased both after the sustained ischemia and the reperfusion, but in the IP group it did not change after the preconditioning, sustained ischemia, or reperfusion. Although atractyloside-inhibitable adenine nucleotide translocase activity was markedly decreased during sustained ischemia in both groups, its activity was significantly higher after reperfusion in the IP group. These data suggest that (1) mitochondrial ATPase contributes only slightly to ATP depletion during sustained ischemia, (2) both the CP overshoot phenomenon and the decrease in anaerobic glycolysis can be attributable to cardioprotection during the sustained ischemia, and (3) the preservation of ATPase and adenine nucleotide translocase activities may be a possible explanation for the restoration of high energy phosphates after sustained ischemia-reperfusion injury in the preconditioned hearts of rats.

Topics: Adenosine Triphosphatases; Adenosine Triphosphate; Anaerobiosis; Animals; Creatine; Creatine Kinase; Evaluation Studies as Topic; Glycolysis; Lactates; Lactic Acid; Male; Mitochondria, Heart; Mitochondrial ADP, ATP Translocases; Myocardial Ischemia; Myocardial Reperfusion Injury; Oxidative Phosphorylation; Phosphocreatine; Rats; Rats, Sprague-Dawley

The mitochondrial ATPase enzyme accounts for roughly 35-50% of the overall energy demand that leads to ATP depletion under conditions of severe myocardial ischemia. In larger mammalian hearts, this energy squandering action of the ATPase is modulated by an endogenous inhibitor protein. The present studies were undertaken to characterize the time course of inhibition of the mitochondrial ATPase in canine myocardium under conditions of severe regional ischemia in vivo. In addition, we determined if the energy sparing effects of ischemic preconditioning (PC) can be explained by persistent inhibition of the mitochondrial ATPase enzyme. The circumflex coronary artery was ligated for 1.5 min (n = 4), 5 min (n = 6), or 15 min (n = 5). In a separate group (n = 7), hearts were preconditioned by four 5-min periods of ischemia each followed by 5 min of reperfusion. Sub-mitochondrial particles were prepared from the sub-endocardial zone of the ischemic and non-ischemic regions and were assayed for oligomycin-sensitive ATPase activity. ATPase activity was reduced to about 79% at 1.5 min and to approximately 55% at 5 and 15 min of ischemia, relative to non-ischemic tissue from the same heart. The rate of HEP utilization slowed concurrently with the development of ATPase inhibition. In preconditioned myocardium, ATPase activity was not significantly different from control myocardium from the same heart. We conclude that the early inhibition of the mitochondrial ATPase activity slows the utilization of high energy phosphate and thereby serves as an important endogenous cardioprotective mechanism. Nevertheless, altered activity of the ATPase is not the explanation of the energy sparing effect of ischemic preconditioning.

Topics: Adenosine Diphosphate; Adenosine Triphosphatases; Adenosine Triphosphate; Animals; Cell Fractionation; Coronary Circulation; Coronary Vessels; Dogs; Energy Metabolism; Kinetics; Microscopy, Electron, Scanning; Mitochondria, Heart; Myocardial Ischemia; Myocardium; Oligomycins; Phosphocreatine; Reference Values; Regional Blood Flow; Submitochondrial Particles; Time Factors

The role of adenosine in ischemic preconditioning in different species remains controversial. Ischemic preconditioning was examined in perfused rat and rabbit hearts. In rat and rabbit hearts subjected to 30 min global normothermic ischemia followed by 30 min of reperfusion, left ventricular developed pressure (LVDP) recovered to 36 +/- 8% and 44 +/- 7% of preischemia, respectively. Pre-treatment with transient (6 min) global ischemia improved recovery of LVDP (75 +/- 7% and 82 +/- 9% pre-ischemia, respectively), and improved recovery of coronary flow and end-diastolic pressure. Effects of preconditioning were unrelated to cytosolic [ATP], but were associated with reduced ischemic acidosis, and improved post-ischemic recovery of [Mg2+], [P(i)] and delta GATP. In addition to ischemia, transient episodes of hypoxia (5% O2), norepinephrine stimulation (0.1 microM) or metabolic inhibition (5 mM cyanide minus glycolytic substrate) all improved recovery from prolonged ischemia. Microdialysis revealed that 6 min of ischemic preconditioning increased dialysate [adenosine] from 0.25 to 6.81 +/- 0.87 microM in rat hearts, and from 0.33 to 1.98 +/- 0.41 microM in rabbit hearts. Extracellular [adenosine] was also enhanced during the transient periods of hypoxia, norepinephrine stimulation and metabolic inhibition shown to be protective. Pre-treatment with 0.5 microM Nb-cyclohexyladenosine mimicked preconditioning, and 50 microM 8-(rho-sulfophenyl) theophylline attenuated ischemic preconditioning in rat and rabbit hearts. 8-(rho-sulfophenyl) theophylline also abolished effects of preconditioning on ischemic acidosis, and post-ischemic [Mg2+], [P(i)] and delta GATP. The data demonstrate that (i) preconditioning is triggered by transient periods of energy imbalance: (ii) endogenous adenosine is of primary importance in mediating the cardioprotection following a single transient ischemic stimulus in rat and rabbit hearts; and (iii) post-receptor mechanisms of this adenosine-mediated preconditioning appear to involve reduced ischemic acidosis and enhanced recovery of [P(i)], [Mg2+] and delta GATP.

Topics: Adenosine; Adenosine Diphosphate; Adenosine Triphosphate; Animals; Coronary Circulation; Energy Metabolism; Heart; Hydrogen-Ion Concentration; In Vitro Techniques; Ischemic Preconditioning, Myocardial; Magnesium; Magnetic Resonance Spectroscopy; Male; Microdialysis; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Oxygen Consumption; Phosphates; Phosphocreatine; Phosphorus; Rabbits; Rats; Rats, Sprague-Dawley; Species Specificity; Time Factors; Ventricular Function, Left

Exposure to a short ischemic period (ischemic preconditioning, IP) will protect the heart from damage following a subsequent longer ischemic episode. The aim of the study was to test whether IP is cardioprotective in the setting of repeated ischemia-reperfusion cycles. Thus, Langendorff-perfused hearts, exposed to IP, were subjected to three consecutive ischemia-reperfusion (10/15 min) cycles. Myocardial energetics, manifested by 31P NMR spectroscopy, was correlated with hemodynamics. ATP recovery was significantly higher for the IP group compared with control (P < 0.02) during reperfusions. However, there was no significant difference in ATP recovery during the three ischemic intervals. The supernormal recovery of phosphocreatine recorded during reperfusion was lower for the IP group (approximately 120%) compared with control (approximately 135%, P < 0.065). Better recovery of the left ventricular-developed pressure was noted during reperfusions for the IP group and became significant only during the last reperfusion (86% versus 68%, P < 0.025). In conclusion, the above results support prolonged IP cardioprotection.

Topics: Adenosine Triphosphate; Animals; Coronary Circulation; Energy Metabolism; Heart Rate; Hydrogen-Ion Concentration; Ischemic Preconditioning, Myocardial; Magnetic Resonance Spectroscopy; Male; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Phosphocreatine; Phosphorus Isotopes; Rats; Rats, Sprague-Dawley; Ventricular Function, Left; Ventricular Pressure

The purpose of this study was to evaluate the oxidative capacities and the rate of energy synthesis in isolated mitochondria extracted from normal and post-ischemic myocardium. Isolated rat hearts were perfused according to the working mode with a Krebs Heinseleit buffer containing glucose (11 mM), insulin (10 IU/l) and caprylic acid (25 microM). After a 15 min perfusion in normoxic conditions, the hearts were subjected to a 20 min local zero-flow ischemia followed by a 20 min reperfusion. During the perfusion, the aortic and coronary flows, the aortic pressure and the electrocardiogram were monitored. At the end of the reperfusion period, the non-ischemic and ischemic zones (NIZ and IZ, respectively) were separated and the mitochondria were harvested from each zone. The oxygen uptake and the rate of energy production of the NIZ and IZ mitochondria were then assessed with palmitoylcarnitine as substrate in 2 buffers differing in their free calcium concentration (0.041 and 0.150 microM). Ischemia provoked a 50% reduction of coronary and aortic flows. The reperfusion of the IZ allowed the partial recovery of coronary flow, but the aortic flow decreased beneath its ischemic value because of the occurrence of severe arrhythmias, stunning and probably hibernation. The IZ mitochondria displayed a lower rate of oxygen consumption, whatever the buffer free calcium concentration. Conversely, their rate of energy production was increased, indicating that their metabolic efficiency was improved as compared to NIZ mitochondria. This might be due to the mitochondrial calcium overload persisting during reperfusion, to the activation of the inner membrane Na+/Ca2+ exchange and to a significant mitochondrial swelling. On the other hand, the presence of an elevated free calcium concentration in the respiration buffer provoked some energy wasting characterized by a constant AMP production. This was attributed to some accumulation of acetate and the activation of the energy-consuming acetylCoA synthetase. In conclusion, ischemia and reperfusion did not alter the membrane integrity of the mitochondria but improved their metabolic efficiency. Nevertheless, these in vitro results can not reflect the mitochondrial function in the reperfused myocardium. The mitochondrial calcium overload reported to last during reperfusion in the cardiomyocytes might mimic the free calcium-induced reduction of metabolic efficiency observed in vitro in the present study. The resulting energy wast

Topics: Adenosine Triphosphate; Animals; Calcium; Magnesium; Male; Mitochondria, Heart; Myocardial Ischemia; Myocardial Reperfusion Injury; Osmolar Concentration; Oxidative Phosphorylation; Oxygen Consumption; Phosphocreatine; Rats; Rats, Wistar

Endothelin-1 (ET-1) has been suggested to be involved in the pathophysiology of ischemia/reperfusion injury, but direct proof for this is still sparse. We tested whether protection of high-energy phosphate metabolism contributes to the beneficial effects of ETA receptor antagonists during ischemia/reperfusion. In isolated, buffer-perfused rat hearts, isovolumic function was measured by a left ventricular (LV) balloon, and 31P nuclear magnetic resonance spectra were continuously recorded. Two protocols were performed: (a) 15-min control, 30-min total, global ischemia, and 15-min reperfusion; and (b) 15-min control, 15-min total, global ischemia, and 30-min reperfusion. Treatment with BQ610 (1.75 micrograms/min) or saline was started during control and continued throughout the protocol. BQ610 did not affect function or energy metabolism under control conditions. In BQ610-treated hearts subjected to 30-min ischemia, time to ischemic contracture was significantly delayed (treated 10.6 +/- 0.4 min; untreated 8.1 +/- 0.7 min), and end-diastolic pressure (EDP) remained lower (after 30-min ischemia 26 +/- 2 vs. 35 +/- 2 mm Hg). In addition, recovery of mechanical function in BQ610-treated hearts was accelerated during reperfusion. BQ610 did not affect ATP but significantly accelerated and increased creatine phosphate (51 +/- 7 vs. 37 +/- 3%) recovery on reperfusion after 30-min ischemia. BQ610-treated hearts subjected to 15-min ischemia also showed lower EDP during ischemia and accelerated recovery of mechanical function during reperfusion. However, in this case, there were no differences in high-energy phosphate concentrations between treated and untreated hearts. We conclude that the protective action of BQ610 on mechanical function during ischemia/reperfusion injury can be but is not consistently associated with beneficial effects on cardiac high-energy phosphate metabolism.

Topics: Adenosine Triphosphate; Animals; Blood Pressure; Coronary Circulation; Endothelins; Energy Metabolism; Heart; Heart Rate; In Vitro Techniques; Magnetic Resonance Spectroscopy; Male; Myocardial Ischemia; Myocardial Reperfusion Injury; Oligopeptides; Phosphocreatine; Rats; Rats, Wistar; Ventricular Pressure

In a randomized prospective experimental study on 48 adult white Elco rabbits biochemical and rhythmic changes after bolus administration of the phosphodiesterase inhibitor piroximone were investigated using a working heart model. The treatment group (n = 21) intravenously received 1 mg/kg of piroximone 15 min before thoracotomy. Twenty-three untreated hearts served as the control group. From 6 hearts of each group myocardial biopsies were taken before ischemia, 4 (2/2) hearts were excluded. Hemodynamic results of a previous study with an identical protocol were reanalyzed; a biochemical analysis of myocardial high-energy phosphates was investigated after 60 min of global ischemia and at the end of the experiments after 45 min of reperfusion. Already prior to ischemia, in the treatment group depletion of high-energy phosphates was detected. After 60 min of ischemia during early reperfusion in the treatment group ATP and creatine phosphate depletion became even more evident and increased until the end of the experiments. The incidence of reperfusion-induced arrhythmias was significantly lower in the treatment group. Consequently these results and the hemodynamic results of prior studies indicate a possible positive effect of piroximone during the early reperfusion period by optimizing hemodynamics and arrhythmias.

Topics: Adenosine Triphosphate; Animals; Arrhythmias, Cardiac; Heart; Imidazoles; In Vitro Techniques; Incidence; Myocardial Ischemia; Myocardial Reperfusion; Myocardial Reperfusion Injury; Myocardium; Phosphocreatine; Phosphodiesterase Inhibitors; Rabbits

To assess whether the administration of felodipine protects the myocardium in a dose-dependent manner against ischemia and reperfusion, isolated rabbit hearts were infused with three different concentrations of felodipine: 10(-10), 10(-9), and 10(-8) M. Diastolic and developed pressures were monitored; coronary effluent was collected and assayed for CPK activity and for noradrenaline concentration; mitochondria were harvested and assayed for respiratory activity; and ATP production and calcium content and tissue concentration of ATP, creatine phosphate (CP), and calcium were determined. The occurrence of oxidative stress during ischemia and reperfusion was also monitored in terms of tissue content and release of reduced (GSH) and oxidized (GSSG) glutathione. Treatment with felodipine at 10(-10) and 10(-9) M had no effect on the hearts when perfused under aerobic conditions, whilst the higher dose reduced developed pressure from 57.7 +/- 2.6 to 30.0 +/- 2.6 mmHg (p < 0.01). On reperfusion treated hearts recovered better than the untreated hearts with respect to left ventricular performance, replenishment of ATP and CP stores, and mitochondrial function. Recovery of developed pressure was 100% at 10(-8) M, 55% at 10(-9) M, and 46% at 10(-10) M. The reperfusion-induced tissue and mitochondrial calcium overload, release of CPK and noradrenaline, and oxidative stress were also significantly reduced. The effects of felodipine were dose dependent. Felodipine inhibited the initial rate of ATP-driven calcium uptake but failed to affect the initial rate of mitochondrial calcium transport. It is concluded that felodipine infusion provides dose-dependent protection of the heart against ischemia and reperfusion. Because this protection also occurred at 10(-9) M and 10(-10) M in the absence of a negative inotropic effect during normoxia and of a coronary dilatory effect during ischaemia, it cannot be attributed to an energy-sparing effect or to improvement in oxygen delivery. From our data we can envisage two other major mechanisms-(1) membrane protection and (2) reduction in oxygen toxicity. The ATP-sparing effect occurring at 10(-8) M is likely to be responsible for the further protection.

Topics: Adenosine Triphosphate; Analysis of Variance; Animals; Calcium; Calcium Channel Blockers; Dose-Response Relationship, Drug; Felodipine; Glutathione; Male; Mitochondria, Heart; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Phosphocreatine; Rabbits; Sarcolemma

The relationships between the metabolic, ionic, and electrical changes of acute ischemia have not been determined precisely because they have been studied under different experimental conditions. We used ion-selective electrodes, nuclear magnetic resonance spectroscopy, and the four-electrode method to perform four series of experiments in the isolated blood-perfused rabbit heart loaded with 5F-BAPTA during 30 to 35 minutes of no-flow ischemia. We sought to determine the relationship between changes in phosphocreatine (PCr), adenosine triphosphate (ATP), intracellular calcium ([CA2+]i), intracellular pH (pHi) extracellular potassium ([K+]e), extracellular pH (pHe), and whole-tissue resistance (rt).. In the first 8 minutes of ischemia, [K+]e rose from 4.9 to 10.8 mmol/L, PCr fell by 90%, ATP decreased by 25%, and pHi and pHe decreased by 0.5 U, while [Ca2+]i and rt changed only slightly. Between 8 and 23 minutes, [K+]e changed only slightly; pHi, pHe, and ATP continued to fall, and [Ca2+]i rose. rt did not increase until >20 minutes of ischemia, when pHi was <6.0 and [Ca2+]i had increased more than three-fold. The increase in rt, indicating electrical uncoupling, coincided with the third phase of the [K+]e change.. Our study suggests that cellular uncoupling occurs only after a significant rise in [Ca2+]i and fall in pHi and that these ionic and electrical changes can be identified by the change in [K+]e. Our study underscores the importance of using a common model while attempting to formulate an integrated picture of the ionic, metabolic, and electrical events that occur during acute ischemia.

Topics: Adenosine Triphosphate; Animals; Blood; Calcium; Cell Communication; Electric Conductivity; Electric Impedance; Extracellular Space; Hydrogen-Ion Concentration; In Vitro Techniques; Intracellular Membranes; Ions; Myocardial Ischemia; Myocardium; Perfusion; Phosphocreatine; Potassium; Rabbits

This study examines the effects of Mg depletion on myocardial bioenergetic, carbohydrate, lipid and phospholipid metabolism. Rats were studied after long-term (12 week) selective dietary restriction of Mg (20% normal dietary intake). Myocardial biopsy samples were examined for glucose 6-phosphate and glycogen to evaluate carbohydrate pathways and for glycerol phosphate and mitochondrial fatty acid oxidation and phospholipid contents to evaluate lipid and phospholipid turnover. Dietary Mg deficiency resulted in falls in myocardial glycogen, glucose-6-phosphate, glycerol phosphate, as well as the contents of phosphatidylcholine (PC), phosphatidylethanolamine (PE), diphosphatidyl glycerol (DPG), phosphatidyl inositol (PI) and total phospholipid phosphorus. These observations demonstrate impaired phospholipid metabolism, probably at the biosynthetic level. The mitochondrial oxidation of long-chain fatty acids was also impaired after Mg depletion. Mg depletion (serum Mg fell 60%) also resulted in significant falls in myocardial [ATP], phosphocreatine (PCr), and Mg with a concomitant rise in myocardial Ca content. These observations are consistent with the tenet that prolonged low [Mg2+]zero can result in marked reduction in oxygen and substrate delivery to the cardiac myocytes, with concomitant changes in membrane phospholipids (potentially resulting in a pro-oxidant state) probably as a result of coronary vasoconstriction.

Topics: Adenosine Triphosphate; Animals; Calcium; Diet; Energy Metabolism; Fatty Acids; Magnesium; Magnesium Deficiency; Mitochondria, Heart; Myocardial Ischemia; Myocardium; Oxidation-Reduction; Oxygen Consumption; Phosphocreatine; Phospholipids; Rats; Rats, Sprague-Dawley

Protection of the ischemic myocardium by pretreatment with a high dose of 2,3-butanedione monoxime (BDM) is attributed to the enhancement of glycolytic ATP production rather than to the inhibition of contracture during mild ischemia. Our objective was to investigate whether the inhibition of contracture would protect the arrested heart during prolonged ischemia. Isolated perfused rat hearts were subjected to 30 min of low-flow ischemia followed by reperfusion. Ischemic hearts were treated with BDM (5 mmol/l) after beating stopped. BDM ameliorated the increase in intraventricular pressure after ischemia without significant changes in ATP levels and with a decreased accumulation of lactate. BDM treatment accelerated the recovery of function and high-energy phosphates with reduced myocardial Ca2+ overload. The results of this study suggested that inhibition of contracture can protect the heart from ischemia-reperfusion injury.

Topics: Adenosine Triphosphate; Animals; Calcium; Contracture; Diacetyl; Energy Metabolism; Heart; In Vitro Techniques; Lactic Acid; Male; Myocardial Ischemia; Myocardium; Phosphocreatine; Rats; Rats, Sprague-Dawley; Ventricular Function, Left

The mechanism of ischemic preconditioning remains unknown. The role of glycogen depletion prior to prolonged ischemia was examined as a potential mechanism of ischemic preconditioning. The glycogen content of the rat heart varies in a 24-h rhythm. In a retrospective study, the relationships between the time of day the animals were sacrificed, pre-ischemic myocardial glycogen content, and post-ischemic functional recovery were assessed in non-conditioned and ischemically preconditioned hearts. The analyses were performed on previously published data (Asimakis et al.. 1992, 1993). After an equilibration perfusion, isolated rat hearts were given 40 min of global ischemia followed by 30 min of reperfusion. Preconditioned hearts received 5 min of ischemia followed by a 5-min recovery period prior to the 40-min ischemic period. Some of the hearts were freeze-clamped immediately prior to the 40-min ischemic period to determine pre-ischemic glycogen content. Pre-ischemic glycogen was higher in the morning than afternoon. The time of day correlated significantly with the pre-ischemic glycogen content of non-conditioned (r = 0.67; P < 0.005) and preconditioned (r = 0.79; P < 0.001) hearts. However, time of day did not correlate significantly with post-ischemic recovery of heart rate x developed pressure (HR x DP) on end-diastolic pressure (EDP) in either the non-conditioned or preconditioned hearts. The relationships were also assessed by subdividing the groups into either morning (a.m.) or afternoon (p.m.) hearts. The pre-ischemic glycogen content was lower in the non-conditioned-p.m. (n = 5) hearts compared to the non-conditioned-a.m. (n = 10) hearts (67.6 +/- 9.0 nu 128.1 +/- 13.3 nmol glucose/mg protein P < 0.005). However, there were no significant differences between p.m. (n = 13) and a.m. (n = 9) non-conditioned hearts with respect to post-ischemic recovery of HR x DP (20.6 +/- 4 nu 12.0 +/- 4% of baseline, respectively, P = N.S.). In contrast, preconditioned-p.m. (n = 6) and -a.m. (n = 7) had pre-ischemic glycogen contents of 49.6 +/- 6 and 76.6 +/- 5.0 nmol glucose/mg protein, respectively. These glycogen values were not significantly different from the non-conditioned-p.m. hearts (67.6 nmol/mg protein). However, post-ischemic recovery of HR x DP in the preconditioned-p.m. (n = 5) and -a.m. (n = 6) hearts were 54.6 +/- 5 and 51.4 +/- 8% of baseline, respectively (these values were significantly higher (P < 0.05) than the recovery for the non-conditioned-p.

Topics: Adenosine Triphosphate; Animals; Glucose-6-Phosphate; Glycogen; In Vitro Techniques; Ischemic Preconditioning, Myocardial; Lactic Acid; Male; Myocardial Ischemia; Myocardium; Phosphocreatine; Rats; Rats, Sprague-Dawley; Retrospective Studies

We tested the hypothesis that residual oxygen supply during acute low-flow ischaemia or hypoxemia is a major regulator of myocardial performance, metabolism and recovery. Rat hearts were exposed for 20 min to either ischemia (coronary flow reduced to 10% of baseline), hypoxemia (oxygen content reduced to 10% baseline) or a "mixed" condition (combined ischaemia and hypoxemia). The oxygen supply (coronary flow x oxygen content) was matched in all groups (n = 16 per group). Hypoxemic hearts had the highest performance (systolic and developed pressures, +/- dP/dtmax and oxygen uptake) and content of IMP and AMP. Ischaemic hearts had the highest content of ATP, phosphocreatine, adenine nucleotides and purines. As flow and/or oxygenation were restored, post-ischemic hearts showed better functional and metabolic recovery than post-hypoxemic ones. "Mixed" hearts were more similar to hypoxemic ones during oxygen shortage but to ischemic ones during recovery. We conclude that as oxygenation is critically limiting, coronary flow is relatively more important than oxygen supply in determining myocardial function, metabolism and recovery, most likely secondary to changes in the metabolism of diffusible substances.

Topics: Adenine Nucleotides; Adenosine Triphosphate; Animals; Coronary Circulation; Diastole; Hypoxia; In Vitro Techniques; Inosine Monophosphate; Male; Myocardial Contraction; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Oxygen Consumption; Phosphocreatine; Purines; Rats; Rats, Sprague-Dawley

Studies during 20% to 50% reductions in regional coronary blood flow have revealed a number of metabolic and functional adaptations that suggest the heart downregulates energy requirements and contractility in response to ischemia. In contrast to prior studies of sudden changes in coronary blood flow, we tested whether the heart could reduce ATP consumption commensurate with a gradual decrease in coronary blood flow or whether transient metabolic abnormalities are a necessary trigger in this process.. From 0 to 35 minutes, mean left anterior descending coronary artery blood flow was reduced by approximately 1% per minute in 10 acutely anesthetized and instrumented swine. Coronary blood flow then was held constant between 35 and 60 minutes at the resulting 35% net blood flow reduction. Although systemic hemodynamics remained stable, a significant decrease in regional left ventricular systolic wall thickening developed (from control value of 45 +/- 11% to 18 +/- 11% at 60 minutes, P < .001) without a sustained decrease in the phosphorylation potential (as assessed by a < 2% decrease in either the transmural or subendocardial phosphocreatine-to-ATP ratio) and with minimal myocardial lactate production (4 +/- 44 mumol.min-1 x 100 g-1).. Metabolic markers of ischemia such as ratio of phosphocreatine to ATP, ATP content, lactate content, and lactate production were blunted during this protocol of gradually worsening ischemia. Thus, contractile abnormalities of mild ischemia can develop with minimal metabolic evidence of ischemia. The downregulation of myocardial energy requirements can almost keep pace with the gradual decline in coronary blood flow.

Topics: Adaptation, Physiological; Adenosine Triphosphate; Animals; Coronary Circulation; Down-Regulation; Energy Metabolism; Hemodynamics; Lactates; Lactic Acid; Myocardial Contraction; Myocardial Ischemia; Myocardium; Phosphocreatine; Swine; Time Factors

The aim was to define: (1) whether bradykinin administration during reperfusion improves postischaemic myocardial recovery; (2) whether high energy phosphate compounds are involved in the protective effects of bradykinin; and (3) whether bradykinin-induced release of prostacyclin and nitric oxide mediate the protective effects of bradykinin.. In the Langendorff rat heart preparation, coronary flow, left ventricular developed pressure, and, using 31P magnetic resonance spectroscopy, the high energy phosphate compounds phosphocreatine and beta-ATP were assessed during 15 min of global ischaemia and 30 min of reperfusion. Administration of 10(-7) M bradykinin was started before ischaemia and maintained throughout the experiment (BK-pre). This was compared to 10(-7) M bradykinin given exclusively with reperfusion (BK-post). Then 10(-7) M bradykinin was given simultaneously with 10(-4) M N omega-nitro-L-arginine-methyl ester (BK-LNAME) or 10(-5) M indomethacin (BK-indo).. In comparison to control hearts, BK-pre exerted a significant protective effect on the postischaemic recovery of coronary flow [71(5)% v 43(4)%, P < 0.05], left ventricular pressure [81(8)% v 42(5)%, P < 0.05], phosphocreatine [105(4)% v 67(8)%, P < 0.05], and beta-ATP [78(9)% v 48(7)%, P < 0.05]. With BK-post, recovery of coronary flow [71(4)% v 43(4)%, P < 0.05] and left ventricular pressure [78(4)% v 42(5)%, P < 0.05] significantly improved; however the recovery of phosphocreatine [70(4)% v 67(8)%, NS] and beta-ATP [58(2)% v 48(7)%, NS] was not different from control. When bradykinin and L-NAME or indomethacin was given the beneficial effects of bradykinin on ischaemic hearts were abolished.. (1) Bradykinin improved postischaemic myocardial recovery when given before ischaemia or starting exclusively with reperfusion; (2) this was only partially related to a protective action on the high energy phosphate compounds during ischaemia; (3) the beneficial effects of bradykinin on ischaemic hearts are dependent from an unrestrained action of prostacyclin and nitric oxide.

Topics: Adenosine Triphosphate; Animals; Arginine; Bradykinin; Epoprostenol; Heart; Indomethacin; Magnetic Resonance Spectroscopy; Male; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; NG-Nitroarginine Methyl Ester; Nitric Oxide; Phosphocreatine; Rats; Rats, Sprague-Dawley

Carnitine palmitoyltransferase-I (CPT-I) inhibitors improve postischemic myocardial function either by decreasing muscle long-chain acylcarnitines (LCAC) during ischemia or by increasing oxidation of alternate substrates such as glucose during reperfusion. These possibilities were evaluated using oxfenicine, a CPT-I inhibitor, and alternate substrates that bypass carnitine-dependent metabolism. Isolated rat hearts subjected to 20 min of ischemia followed by 40 min of reperfusion with 1.8 mM palmitate as exogenous substrate recovered little function during reperfusion. Hearts made ischemic and reperfused with palmitate and 2.4 mM hexanoate as exogenous substrates had significantly improved reperfusion function compared to palmitate-perfused hearts. Addition of 2 mM oxfenicine to palmitate-hexanoate-perfused hearts gave an additional small improvement in reperfusion function. At the end of ischemia, the LCAC content of hearts perfused with palmitate or hexanoate and palmitate was identical. Palmitate-, hexanoate, and oxfenicine-perfused hearts had significantly decreased LCAC content at the end of ischemia compared with hexanoate-palmitate-perfused hearts. Therefore, depressed reperfusion function in long-chain fatty acid-perfused hearts can be ameliorated by alternate substrates, including medium-chain fatty acids. LCAC accumulation during ischemia apparently plays only a minor role in the postischemic dysfunction of long-chain fatty acid-perfused hearts.

Topics: Acylation; Adenosine Triphosphate; Animals; Blood Pressure; Caproates; Carnitine; Carnitine O-Palmitoyltransferase; Energy Metabolism; Glucose; Glycine; Heart; Heart Rate; Hemodynamics; Hydrogen-Ion Concentration; Male; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Palmitic Acid; Palmitic Acids; Phosphates; Phosphocreatine; Rats; Rats, Sprague-Dawley; Ventricular Function, Left

To clarify the role of Na+i, pHi, and high-energy phosphate (HEP) levels in the initiation and maintenance of ischemia-induced ventricular fibrillation (VF), interleaved 23Na and 31P nuclear magnetic resonance spectra were collected on perfused rat hearts during low-flow ischemia (51 minutes, 1.2 mL/g wet wt). When untreated, 50% of the hearts from normal (sham) rats and 89% of the hypertrophied hearts from aorticbanded (band) rats (P < .01 versus sham) exhibited VF. Phosphocreatine content was significantly higher in sham than band hearts during control perfusion (53.3 +/- 1.6 versus 39.8 +/- 2.0 mumol/g dry wt). Before VF at 20 minutes of ischemia, Na+i accumulation was greater in hearts that eventually developed VF than in hearts that did not develop VF for both band and sham groups (144% versus 128% of control in sham; P < .005) and was the strongest metabolic predictor of VF; ATP depletion was also greater for VF hearts in the sham group. Infusion of the Na(+)-H+ exchange inhibitor 5-(N,N-hexamethylene)-amiloride prevented VF in sham and band hearts; reduced Na+i accumulation but similar HEP depletion were observed compared with VF hearts before the onset of VF. Rapid changes in Na+i, pHi, and HEP began with VF, resulting in intracellular Na+i overload (approximately 300% of control) and increased HEP depletion. A delayed postischemic functional recovery occurred in VF hearts, which correlated temporally with the recovery of Na+i. In conclusion, alterations in Na+i were associated with spontaneous VF transitions, consistent with involvement of excess Na+i accumulation in VF initiation and maintenance and with previously reported alterations in Ca2+i with VF.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adenosine Triphosphate; Analysis of Variance; Animals; Cardiomegaly; Energy Metabolism; In Vitro Techniques; Lactates; Magnetic Resonance Spectroscopy; Male; Myocardial Ischemia; Perfusion; Phosphocreatine; Phosphorus Isotopes; Rats; Rats, Sprague-Dawley; Sodium; Sodium Isotopes; Time Factors; Ventricular Fibrillation

31P NMR spectroscopy was used to investigate whether improved functional recovery in ischaemic preconditioning was due to improved metabolic recovery in isolated rat hearts. The preconditioning stimulus was global ischaemia of 1 or 4 min followed by 12 min of reperfusion (Langendorff mode). The hearts were then subjected to a main ischaemic period of 16 min and 40 min of reperfusion. Functional and metabolic recoveries of hearts were compared to a control group subjected only to the main ischaemia. Preconditioning improved recovery of contractile function during the final reperfusion. Thus left ventricular developed pressure (LVDP) and heart rate (HR) product after 40 min of reperfusion recovered to 56, 67 and 68% in the control group, 1 min group and 4 min group, respectively. However, the metabolic recovery was comparable in all groups. CrP and ATP recovered to levels of 67-78% (CrP) and 35-41% (ATP), and pH to a level of 7.13-7.15 (not different from baseline values) at the end of the final reperfusion. We conclude that the improved functional recovery in preconditioning is not due to a higher level of high energy phosphates or less acidosis during the final reperfusion.

Topics: Adenosine Triphosphate; Animals; Blood Pressure; Heart; Heart Rate; Hydrogen-Ion Concentration; Magnetic Resonance Spectroscopy; Male; Myocardial Contraction; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Phosphates; Phosphocreatine; Rats; Rats, Wistar; Ventricular Function, Left

Topics: Adenosine Triphosphate; Animals; Biological Transport; Deoxyglucose; Glucose; Heart; In Vitro Techniques; Insulin; Magnetic Resonance Spectroscopy; Male; Myocardial Ischemia; Myocardium; Phosphates; Phosphocreatine; Phosphorus; Rats; Rats, Wistar

We studied the effect of sevoflurane on ischaemic myocardium in terms of myocardial energy and carbohydrate metabolism. Mongrel dogs were anaesthetized initially with sodium pentobarbitone, and then inhaled sevoflurane at 0% (0 MAC), 2.4% (1.0 MAC) or 4.7% (2.0 MAC) of inspired concentration for 60 min. Ischaemia was then induced for 3 min by ligating the left anterior descending coronary artery. The tissue levels of energy and carbohydrate metabolites were determined before and after sevoflurane inhalation, and after 3 min of ischaemia. Sevoflurane significantly decreased systolic and diastolic blood pressures, heart rate, and rate-pressure product in a dose dependent manner. When the animals did not inhale sevoflurane (0 MAC), ischaemia significantly decreased adenosine triphosphate and creatine phosphate levels, and produced alterations of carbohydrate metabolism. These metabolic changes induced by ischaemia were lessened by inhalation of sevoflurane. To exclude the influence of haemodynamic changes, blood pressure and heart rate were maintained during 1.0 MAC sevoflurane inhalation. Significant attenuation of ischaemia-induced metabolic changes caused by sevoflurane was still observed in some metabolites. These results indicate that the ischaemic influences on the myocardium may be reduced by sevoflurane, and this protective effect can be explained not only by its haemodynamic effect.

Topics: Adenosine Diphosphate; Adenosine Triphosphate; Anesthetics, Inhalation; Animals; Blood Pressure; Dogs; Dose-Response Relationship, Drug; Electrocardiography; Energy Metabolism; Ethers; Female; Fructosediphosphates; Fructosephosphates; Glucose-6-Phosphate; Glucosephosphates; Heart Rate; Hexosephosphates; Lactates; Male; Methyl Ethers; Myocardial Ischemia; Myocardium; Phosphocreatine; Pyruvates; Sevoflurane

Myocardial metabolic requirements during reperfusion of ventricular fibrillation are poorly understood. The objective of this study was to determine if controlled reperfusion after a clinically relevant global ischemia period of 10 mins was sufficient to prevent or reverse myocardial ischemia as indicated by changes in myocardial high energy phosphates, myocardial intracellular pH, and great cardiac vein lactate.. Prospective laboratory study with controlled reperfusion.. Research laboratory at a university medical center.. Five swine weighing 19 +/- 3 kg.. Ten minutes of nonperfused ventricular fibrillation followed by reperfusion with cardiopulmonary bypass (flow 30 mL/kg/min) for 50 mins.. Myocardial adenosine triphosphate (ATP), phosphocreatine, and intracellular pH were determined using in vivo 31P nuclear magnetic resonance. Myocardial blood flow, measured by 15-mu radiolabeled microspheres, was significantly increased above baseline during reperfusion. Phosphocreatine was depleted during the 10 mins of nonperfused ventricular fibrillation, but recovered to 122 +/- 18% of baseline with reperfusion and was 112 +/- 18% at 60 mins (p < .005). ATP concentrations decreased to 51 +/- 16% of baseline after 10 mins of nonperfused ventricular fibrillation, improved to 67 +/- 9% of baseline with early reperfusion, and were 65 +/- 9% of baseline at 60 mins (p < .02). Myocardial intracellular pH improved from 6.11 +/- 0.18 after 10 mins of nonperfused ventricular fibrillation, to 6.89 +/- 0.20 with early reperfusion, and then decreased to 6.85 +/- 0.35 at 60 mins ventricular fibrillation (p < .001). Despite myocardial blood flows higher than baseline during the reperfusion period, great cardiac vein/aortic lactate gradient increased over the reperfusion period.. Prolonged reperfusion with supranormal myocardial blood flow does not restore normal myocardial aerobic metabolism in the fibrillating myocardium after a 10-min nonperfused ventricular fibrillation period.

Topics: Adenosine Triphosphate; Animals; Cardiopulmonary Bypass; Coronary Circulation; Hydrogen-Ion Concentration; Lactates; Magnetic Resonance Spectroscopy; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Oxygen Consumption; Phosphocreatine; Prospective Studies; Swine; Ventricular Fibrillation

Heart rate (HR) is a major factor determining the severity of myocardial ischemia, and HR reduction is an effective therapy for myocardial ischemia. We tested the effects of HR reduction induced by either UL-FS 49 or atenolol on regional myocardial blood flow, function, and infarct size (IS) in a porcine model of 90-min low-flow ischemia and 2-h reperfusion. In 24 Göttinger miniswine, the left anterior descending coronary artery (LAD) was cannulated and hypoperfused at constant inflow to reduce anterior systolic wall thickening (AWT, sonomicrometry) by approximately 85%. Eight swine served as a placebo group, and 8 other swine received UL-FS 49 (0.60 mg/kg intravenously, i.v.) after 10-min ischemia. In the remaining 8 swine, atenolol was infused after 10-min ischemia at a dosage [mean 1.75 +/- 1.20 (SD) mg/kg i.v.] to mimic the HR reduction observed with UL-FS 49. Systemic hemodynamics, subendocardial blood flow (ENDO, microspheres) and AWT were measured under control conditions, at 10 and 90 min of ischemia. In the swine receiving UL-FS 49 or atenolol, additional measurements were made 5 min after administration of the respective drug. After 2-h reperfusion, IS (percentage of area at risk) was determined with TTC-staining. Five minutes after administration of UL-FS 49, HR was decreased from 113 +/- 9 to 83 +/- 13 beats/min (p < 0.05) and remained unchanged when ischemia was prolonged to 90 min. In the swine receiving atenolol, HR was reduced from 117 +/- 14 to 93 +/- 7 beats/min (p < 0.05) 5 min after drug administration and decreased further to 87 +/- 10 beats/min when ischemia was prolonged to 90 min. After 10 min of ischemia, AWT in the placebo, UL-FS 49, and atenolol group was decreased to 7.0 +/- 5.5, 6.4 +/- 3.5, and 6.2 +/- 3.3% (all p < 0.05 vs. control), respectively. The reduction in ENDO was also comparable among the three groups. In the placebo group, AWT remained unchanged when ischemia was prolonged to 90 min (4.4 +/- 2.6%). In swine receiving atenolol, AWT tended to increase (13.6 +/- 10.5%), whereas in swine receiving UL-FS 49, AWT was significantly increased to 21.4 +/- 7.1% (p < 0.05 vs. 10-min ischemia and vs. the placebo and atenolol groups). IS was significantly reduced in swine receiving atenolol (3.9 +/- 3.5%) or UL-FS 49 (5.8 +/- 4.6%) as compared with the placebo-group (10.4 +/- 8.9%).(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Adenosine Triphosphate; Animals; Atenolol; Benzazepines; Blood Pressure; Bradycardia; Cardiovascular Agents; Coronary Circulation; Disease Models, Animal; Female; Heart; Heart Rate; Injections, Intravenous; Lactates; Male; Myocardial Infarction; Myocardial Ischemia; Myocardium; Oxygen Consumption; Phosphocreatine; Reperfusion Injury; Swine; Swine, Miniature

Myocardium reperfused following ischemia may contain regions that are adequately perfused but temporarily dysfunctional or metabolically abnormal, and regions that are persistently ischemic. By examining heterogeneity in the inorganic phosphate (Pi) resonance in 31P NMR spectra obtained for isolated perfused young v old hypertensive rat hearts made globally ischemic and then reperfused, areas of persistent intracellular acidosis (pHi about 6) were distinguished from recovering tissue (pHi about 7). The extent of persistent regional acidosis reported by Pi heterogeneity in the 31P NMR spectrum of the reperfused heart correlates well with (1) whole heart flow deficit measured as coronary flow, (2) the decrease in extracellular (primarily vascular) 23Na NMR resonance area measured using 23Na NMR and shift reagent, and (3) regional flow deficits identified using perfusate-borne dye markers. Persistent intracellular acidosis during reperfusion was observed only in the hearts of aged hypertensive rats, confirming that the vasculature of these animals is more susceptible to ischemic injury than both younger hypertensive rats and age-matched controls. The portion of the heart that is reperfused following only 16 min of global ischemia is metabolically abnormal, showing incomplete recovery of ATP and pH.

Topics: Adenosine Triphosphate; Aging; Animals; Energy Metabolism; Heart; Hydrogen-Ion Concentration; Hypertension; Magnetic Resonance Spectroscopy; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Phosphates; Phosphocreatine; Rats; Rats, Inbred SHR; Rats, Inbred WKY

1. The effects of OPC-18790, a novel positive inotropic agent, on cardiac function and myocardial energy metabolism in the guinea-pig isolated heart with ischaemia were studied by 31P-magnetic resonance spectroscopy (MRS) and compared with those of amrinone and dobutamine. 2. Cardiac ischaemia was induced by intracoronary infusion of 15 microns microspheres to reduce coronary perfusion flow (CPF) by 50%. Microsphere embolisation caused a 40% decrease in left ventricular systolic pressure (LVSP), cardiac contractility measured by peak of ventricular pressure development (LVdP/dt) and slightly reduced heart rate. There was also a decrease in ATP and creatine phosphate (PCr) by 20%, an increase in inorganic phosphate (Pi) by 25% and an acidic shift of intracellular pH in the ischaemic heart. 3. In the ischaemic heart, OPC-18790, amrinone and dobutamine were applied at concentrations which increased LVdP/dt by about 60%. These compounds increased LVP by 15% to 30% and increased CPF by about 10%. Amrinone and dobutamine but not OPC-18790 increased heart rate. When these drugs produced the haemodynamic changes described above, amrinone and dobutamine reduced ATP and PCr, increased Pi and produced further intracellular acidosis, whereas, OPC-18790 did not change these parameters. 4. Cardiac pacing at 285 beats min-1 produced decreases in LVP, LVdP/dt and CPF by about 30%, 20%, 5%, respectively and an increase in Pi, decreases in PCr and ATP, and intracellular acidosis. 5. These results suggest that degradation of high energy phosphate compounds closely relates to increase in heart rate in the ischaemic heart. Positive inotropic agents without chronotropic action seem to be beneficial in support of the ischaemic heart.

Topics: Adenosine Triphosphate; Amrinone; Animals; Cardiac Pacing, Artificial; Cardiotonic Agents; Coronary Circulation; Dobutamine; Energy Metabolism; Guinea Pigs; Heart; Heart Rate; In Vitro Techniques; Magnetic Resonance Spectroscopy; Male; Myocardial Contraction; Myocardial Ischemia; Phosphocreatine; Quinolones; Ventricular Function, Left

Although left ventricular hypertrophy (LVH) is frequently associated with impaired coronary vasodilator reserve, it is uncertain whether this leads to myocardial ischemia under physiological conditions. The goal of the present study was to determine whether swine with moderate LVH exhibit metabolic evidence of ischemia when myocardial oxygen requirements are increased.. Myocardial metabolism was evaluated in an open-chest anesthetized preparation at baseline and during dobutamine infusion in 13 adolescent pigs with moderate LVH induced by supravalvular aortic banding and 12 age-matched control pigs. Transmural myocardial blood flow was quantified with radioactive microspheres; the ratio of phosphocreatine to ATP (PCr/ATP) in the anterior LV free wall was measured by 31P-nuclear magnetic resonance; and anterior wall lactate release was quantified from the arterial-coronary venous difference in 14C- or 13C-labeled lactate. In a subset of 5 animals from each group, the metabolic fate of exogenous glucose was determined from the transmyocardial difference in 6-14C-glucose and its metabolites 14C-lactate and 14CO2. Coronary reserve, as assessed by the ratio of blood flow during adenosine infusion to baseline blood flow, was significantly lower in the LVH pigs compared with controls (3.5 +/- 0.4 versus 5.5 +/- 0.4 mL/g.min, P < .05); however, transmural myocardial blood flow was similar in both groups of pigs, both at baseline and with dobutamine stimulation, probably reflecting the higher coronary perfusion pressure in the LVH pigs. At baseline, PCr/ATP tended to be lower in the LVH pigs (P = .09) but decreased similarly with dobutamine infusion in both groups. Isotopically measured anterior wall lactate release did not differ between the groups at baseline, nor did the increase in lactate release differ during dobutamine stimulation. The uptake of glucose, lactate, and free fatty acids did not differ between the groups in the basal state. However, during dobutamine stimulation, glucose uptake was greater in the LVH group (0.84 +/- 0.09 mumol/g.min versus 0.59 +/- 0.08 mumol/g.min, P < .05). In a subset of animals, 14C-glucose was used to assess glucose oxidation. These data showed that the LVH animals had a greater rate of glucose oxidation (0.6 +/- 0.10 versus 0.28 +/- 0.08 mumol/g.min, P < .05) and a greater rate of glucose conversion to lactate (0.20 +/- 0.04 versus 0.09 +/- 0.02 mumol/g.min, P < .05) compared with the control pigs.. These results suggest that despite their reduced coronary vasodilator reserve and the absence of a greater rise in myocardial blood flow to compensate for a substantially higher LV double product, pigs with this model of moderate LVH do not exhibit a greater susceptibility to myocardial ischemia during dobutamine stress. However, LVH pigs exhibit significantly greater use of exogenous glucose during dobutamine stress, as evidenced by increases in both glucose oxidation and anaerobic glycolysis.

Topics: Adenosine Triphosphate; Animals; Cardiac Pacing, Artificial; Dobutamine; Energy Metabolism; Glycolysis; Hemodynamics; Hypertrophy, Left Ventricular; Magnetic Resonance Spectroscopy; Myocardial Ischemia; Myocardium; Oxygen Consumption; Phosphocreatine; Phosphorus Isotopes; Substrate Specificity; Swine; Ventricular Function, Left

The benefit of cardioplegic cardiac arrest for the protection of immature myocardium is controversial. We therefore investigated the efficacy of (1) topical hypothermia alone, (2) slow cooling by coronary perfusion hypothermia, and (3) cardioplegic cardiac arrest for the protection of isolated immature rats hearts (28 days) during 8 hours of global ischemia at 10 degrees C. The study was conducted in hearts from rats that were kept hypoxemic by lifelong exposure to simulated high altitude. Left ventricular function, endothelial function, the metabolic status, and the extent of myocardial injury were all assessed. Topical hypothermia provided superior protection in hypoxic hearts, with recovery of the maximum developed left ventricular pressure by 70.6% +/- 18.0% (mean +/- standard deviation) of its preischemic value (p < 0.01 versus slow cooling and versus cardioplegic protection). The same pattern of recovery was observed among control hearts. The degree of recovery of endothelial function after sole topical hypothermia measured 54% +/- 36% in hypoxic hearts and 62% +/- 37% in control hearts, but was not recordable in any of the other groups. Creatine kinase leakage and the myocardial high-energy content did not differ significantly among any of the groups. Rapid cooling by topical hypothermia alone provides superior protection in chronic hypoxic, immature rat hearts versus the protection conferred by slow cooling. St. Thomas' Hospital cardioplegic solution II does not afford additional protection. Endothelial injury caused by cold asanguineous perfusates, including cardioplegia, interferes with the recovery of vascular function, which, in turn, may limit mechanical function.

Topics: Adenosine Triphosphate; Animals; Bicarbonates; Blood Gas Analysis; Calcium Chloride; Cardioplegic Solutions; Cell Hypoxia; Chronic Disease; Creatine Kinase; Endothelium, Vascular; Fetal Heart; Heart Arrest, Induced; Heart Function Tests; Hypothermia, Induced; In Vitro Techniques; Magnesium; Male; Myocardial Ischemia; Myocardial Reperfusion Injury; Oxygen Consumption; Phosphocreatine; Potassium Chloride; Rats; Rats, Wistar; Sodium Chloride; Time Factors; Ventricular Function, Left

Rabbit hearts were subjected to 24-h cold ischaemic storage (at 0 degree-2 degrees C in melting ice) after initial flushing with either St Thomas' cardioplegic solution (STS) or modified lactobionate/raffinose solution (LR), and the status of phosphorylated energy metabolites was measured by 31phosphorus nuclear magnetic resonance (P NMR) spectroscopy. In both groups signals for ATP and phosphocreatine (PCr) were still detectable by 31P NMR after 24 h, and there was significantly more ATP in the LR group (P < 0.01). The hearts were then subjected to coronary reperfusion via an aortic cannula using the same storage solution (either STS or LR) at 6 degrees-8 degrees C, which was oxygenated. In both groups PCr recovered within 30 min of cold reperfusion, and by 60 min PCr was significantly higher in the LR group (P < 0.001). Also, levels of ATP were maintained at higher values during cold reperfusion i the LR group. These studies suggest two important points: (1) the general supply of phosphorylated high-energy intermediates of hearts during cold ischaemic storage is better preserved using LR, and (2) brief cold reperfusion may be used to restore energy metabolism in hearts before re-implantation.

Topics: Adenosine Triphosphate; Animals; Cardioplegic Solutions; Cryopreservation; Energy Metabolism; Heart; Hypothermia, Induced; Magnetic Resonance Spectroscopy; Male; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Organ Preservation; Phosphocreatine; Phosphorus Isotopes; Rabbits; Resuscitation

Limitation of myocardial injury and infarction has been demonstrated by interventions such as ischemic preconditioning or the use of pyruvate as a substrate, which reduces glycogen content before, and acidosis during, ischemia. An isolated perfused rat heart model of global ischemia was employed to test the hypothesis that glycogen depletion reduces ischemic injury as measured by creatine kinase release. 31P-nuclear magnetic resonance spectroscopy was used to measure high-energy phosphates (ATP and phosphocreatine), phosphomonoesters (PME), and intracellular pH. Compared with control glucose-perfused hearts with normal glycogen content (1.49 +/- 0.13 mg Glc/g wet wt), glycogen-depleted pyruvate, ischemic preconditioned, and glycogen-depleted glucose hearts all had reduced glycogen content before ischemia (0.62 +/- 0.16, 0.81 +/- 0.10, and 0.67 +/- 0.12 mg Glc/g wet wt, respectively; P = 0.003) and significantly higher pH at the end of ischemia (5.85 +/- 0.02, 6.33 +/- 0.06, 6.24 +/- 0.04, and 6.12 +/- 0.02 in control, glycogen-depleted pyruvate, preconditioned, and glycogen-depleted glucose-perfused hearts, respectively; P < 0.01), although acidification during the initial phase of ischemia was differentially affected by the three interventions. Glycogen-depleted pyruvate and preconditioned hearts had reduced PME accumulation, greater recovery of function and phosphocreatine, and lower creatine kinase release on reperfusion, whereas glycogen-depleted glucose-perfused hearts were similar to control hearts. In summary, glycogen depletion by these three methods limits the fall in pH during global ischemia, although glycogen depletion in the absence of preconditioning does not limit ischemic injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adenosine Triphosphate; Animals; Creatine Kinase; Disease Models, Animal; Glucose; Glycogen; Glycolysis; Hydrogen-Ion Concentration; In Vitro Techniques; Intracellular Fluid; Magnetic Resonance Spectroscopy; Male; Myocardial Ischemia; Perfusion; Phosphates; Phosphocreatine; Rats; Rats, Sprague-Dawley; Ventricular Function, Left

We investigated changes in pHi during ischaemia-reperfusion of isolated rat hearts using phosphorus nuclear magnetic resonance spectroscopy (31P NMR). Hearts were separated into three groups according to the perfusion buffer: bicarbonate-buffered Krebs solution, HEPES-buffered Krebs solution, or bicarbonate-buffered Krebs solution plus 10(-6) M 5-(N-ethyl-N-isopropyl) amiloride (EIPA). In HEPES buffer and in bicarbonate buffer plus EIPA, pH at the end of 30 min of ischaemia and pH oscillations observed during early reperfusion were lower than in bicarbonate buffer. Thus, the presence of two pH regulation mechanisms (Na(+)-H+ antiport and Na(+)-HCO3- symport) was confirmed in the isolated rat heart, while in HEPES buffer, pH was regulated by Na(+)-H+ antiport, and in bicarbonate buffer plus EIPA, by Na(+)-HCO3- symport. When cardiac contraction was inhibited by 10 mM 2, 3-butanedione 2-monoxime (BDM), we observed, in all cases, a less pronounced decrease in pHi at the end of ischaemia, and in pHi oscillations at the onset of reperfusion. These effects were similar to those observed with 150 x 10(-8) M verapamil and might thus be related to a decrease in intracellular calcium. However, with BDM, a greater reduction in the pH recovery rate was observed only in HEPES buffer, suggesting a possible phosphatase-like effect affecting the Na(+)-H+ exchange. Whatever the buffer used, the protective effect of BDM was reflected by an increase in the rate pressure product, which was not observed with verapamil.

Topics: Adenosine Triphosphate; Animals; Bicarbonates; Carrier Proteins; Diacetyl; Heart; Hydrogen-Ion Concentration; In Vitro Techniques; Kinetics; Magnetic Resonance Spectroscopy; Male; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Phosphocreatine; Rats; Rats, Wistar; Sodium-Bicarbonate Symporters; Sodium-Hydrogen Exchangers; Time Factors; Verapamil

The aims of this study were to assess (1) whether contractile dysfunction caused by ischaemia under hyperkalaemic conditions ("cardioplegic ischaemia") is associated with impaired energy production or abnormalities in regulation of contractility and (2) whether hyperkalaemia itself contributes to contractile dysfunction. We used 31P and 23Na NMR spectroscopy in conjunction with measurements of mechanical function and oxygen consumption in Langendorff perfused pig hearts to evaluate the mechanism of contractile failure caused by (1) total global cardioplegic (17 mM [K+]) ischaemia (36 degrees C, 50 min KCl arrest, 45 min ischaemia, 20 min reflow with high KCl) and (2) KCl arrest alone (115 min) without flow cessation. KCl arrest plus ischaemia and subsequent reperfusion (Group I) resulted in decreases in ATP (mean +/- S.D.; 61 +/- 13% of initial, n = 5; P < 0.01) and pressure-rate product (PRP) (31 +/- 9%, n = 17; P = 0.0001) while phosphocreatine (PCr), Pi, total creatine (Cr) and intracellular Na+ levels were unaffected. KCl arrest itself (Group II, n = 6) did not affect PCr, ATP or total Cr levels but decreased the PRP to 59 +/- 12% (P < 0.001). Oxygen consumption rates (Vo2) were reduced in both groups to similar levels (67 +/- 18, P < 0.01 and 77 +/- 13%, P < 0.02, respectively). The efficiency of energy conversion to mechanical work (PRP/delta VO2) decreased to 51 +/- 15 (P < 0.001) and 67 +/- 13% (P < 0.012) of initial levels, respectively. To assess metabolic and contractile reserves of post-ischaemic (n = 7) and KCl-treated (n = 3) hearts, the effects of isoproterenol (Iso) and increased Ca2+ were compared with those in normal beating hearts (Group III, n = 3). In all groups treatment with Iso (0.1 micron) greatly increased PRP (to 526 +/- 116, 203 +/- 16 and 198 +/- 8% of the level prior to stimulation (baseline), P < 0.01, respectively) and Vo2 (162 +/- 9, 153 +/-16 and 128 +/-10% of baseline, P < 0.05, Respectively). Increasing [Ca2+] from 1 to 1.66 mM produced less stimulation than Iso: PRP increased to 195 +/- 23, 156 +/- 13 and 163 +/- 22% (P < 0.05) and Vo2 increased to 138 +/- 22 (P < 0.05), 115 +/- 4 and 120 +/- 10% of baseline in Groups I, II and III, respectively.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Adenosine Diphosphate; Adenosine Triphosphate; Animals; Energy Metabolism; Hydrogen-Ion Concentration; In Vitro Techniques; Kinetics; Magnetic Resonance Spectroscopy; Models, Cardiovascular; Myocardial Contraction; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Phosphocreatine; Phosphorus; Potassium Chloride; Swine; Temperature; Time Factors

Low flow ischemia with stable hemodynamic function can result in partial metabolic recovery characterized by an increase in phosphocreatine (PCr). Prior data suggest that glycolytic production of adenosine triphosphate (ATP) may be critical for this recovery and that the ATP produced by oxidative phosphorylation alone may be insufficient. This study tested the hypotheses that, during moderate low flow ischemia, (a) metabolic recovery is dependent on glycolytic production of ATP, and, therefore, (b) a mitochondrial substrate such as pyruvate alone is inadequate to allow metabolic recovery. High energy phosphates, pH, and lactate release were measured during 2 h of moderate low flow ischemia. Hearts were perfused with either a glycolytic plus mitochondrial substrate (glucose, insulin and pyruvate) or a mitochondrial substrate alone (pyruvate). Flow reductions required to reduce PCr by approximately 8% resulted in stable and equal reductions of rate-pressure product in each group. PCr recovered fully during the ischemic period in control hearts with glycolytic substrate, associated with preservation of normal end-diastolic pressure, and increased lactate release during the first hour of ischemia. Reperfusion of these hearts restored hemodynamic function and increased PCr above baseline values. In contrast, the use of pyruvate alone as a substrate resulted in a progressive fall of PCr during ischemia, increased end-diastolic pressure, and no significant increase in lactate release. Reperfusion in these hearts restored hemodynamic function, but did not result in normalization of PCr. Both groups had significant reductions in ATP during ischemia. Recovery of PCr during ongoing moderate low flow ischemia is observed in the presence of mixed glycolytic and mitochondrial substrates (glucose, insulin and pyruvate) but is not observed with pyruvate as a sole mitochondrial substrate. These data support a critical role for glycolytic flux under these conditions, suggesting that ATP generated solely by oxidative phosphorylation is not sufficient to promote metabolic recovery or maintain diastolic function during moderate low flow ischemia.

Topics: Adenosine Diphosphate; Adenosine Triphosphate; Animals; Coronary Circulation; Glucose; Glycolysis; Insulin; Lactates; Magnetic Resonance Spectroscopy; Male; Models, Biological; Myocardial Ischemia; Myocardial Reperfusion; Oxidative Phosphorylation; Phosphocreatine; Pyruvates; Pyruvic Acid; Rats; Rats, Sprague-Dawley

Ischaemic injury was produced in the dog heart by occluding the left anterior descending coronary artery just below the second diagonal branch for the duration of 3 h. A prostacyclin analogue, ZK 36374 (Iloprost) was administered (10 micrograms/kg) just before the coronary artery occlusion. During 3 h occlusion ATP levels in the ischaemic area declined from 65.4 +/- 7.1 mM/g protein in sham-operated group to 31.5 +/- 5.2 microM/g protein in no-drug group and to 44.1 +/- 5.0 microM/g protein in Iloprost group. Creatine phosphate decreased from 112 +/- 14 microM/g protein, to 81 +/- 10 microM/g protein in no-drug group and to 95 +/- 12 microM/g protein in Iloprost group. The energy charge (ATP + 0.5 ADP/ATP + ADP + AMP) decreased slightly but not significantly in no-drug and Iloprost group. Three hours of LAD occlusion produced a significant fall in SOD activity in the ischaemic heart in comparison to the non-ischaemic and Iloprost-treated hearts.

Topics: Adenine Nucleotides; Animals; Dog Diseases; Dogs; Iloprost; Male; Myocardial Ischemia; Myocardium; Phosphocreatine; Superoxide Dismutase; Time Factors; Vasodilator Agents

Topics: Adenine Nucleotides; Animals; Cold Temperature; Creatine; Diastole; Guanosine Triphosphate; Heart; In Vitro Techniques; Myocardial Ischemia; Myocardial Reperfusion; NAD; Nucleotides; Organ Preservation; Phosphocreatine; Rats; Rats, Wistar; Time Factors

Topics: Adenosine Triphosphate; Animals; Creatine Kinase; Ergothioneine; Glutathione; Glutathione Disulfide; Heart; In Vitro Techniques; Lactates; Myocardial Ischemia; Myocardial Reperfusion; Myocardial Reperfusion Injury; Myocardium; NAD; Phosphocreatine; Rabbits

The effects of riboflavin and its derivatives such as FAD, FMN and lumichrome on the levels of high energy phosphate compounds (ATP and creatine phosphate) and intracellular pH in ischemic reperfused rat hearts were investigated using a Langendorff perfusion technique. 31P-NMR study showed a decrease in the levels of high energy phosphate compounds and pH values in myocardium after 30 min global ischemia and a slight recovery of these levels after a 30 min reperfusion following ischemia. However, in all the hearts perfused with riboflavin and its derivatives during ischemia-reperfusion, a marked recovery of high energy phosphate compounds and pH values were observed. In addition, the cardiac mitochondrial respiratory function was protected from ischemia-reperfusion injury. These results suggest that riboflavin, FAD, FMN, and lumichrome have a protective effect against ischemia-reperfusion injury to rat myocardium in vitro. It is assumed that these substances exert their effect directly in the extracellular space.

Topics: Adenosine Triphosphate; Animals; Flavin Mononucleotide; Flavin-Adenine Dinucleotide; Flavins; Hydrogen-Ion Concentration; Male; Myocardial Ischemia; Myocardial Reperfusion Injury; Myocardium; Phosphocreatine; Rats; Rats, Wistar; Riboflavin

Depending on its duration, temporary myocardial ischemia leads to a disturbance of myocardial function before irreversible cellular necrosis is developed. Mechanical, electrical, and metabolic disturbances were suggested to be possible mechanisms accounting for the altered mechanical performance in ischemic hearts. To further investigate the alteration of myocardial energy metabolism on the subcellular level, we determined, by means of nonaqueous fractionation, the cytosolic-mitochondrial distribution of high-energy phosphates and other metabolites (ATP, ADP, phosphocreatine, creatine, and inorganic phosphate) in ischemic (zero-flow) guinea pig hearts after isolated perfused working heart preparation. Additional experiments using 31P nuclear magnetic resonance spectroscopy were performed to determine pHi and [Mg2+]i changes during global ischemia. The total ATP content of myocardial tissue dropped only slowly to 76% of control ATP at 10 minutes and to 51% at 30 minutes and reached almost zero at 60 minutes of ischemia. However, striking differences were observed on the subcellular level: While cytosolic phosphocreatine was almost completely consumed after 3 minutes of ischemia (from 19.1 +/- 1.6 to 3.3 +/- 0.5 mmol/L), ATP concentration in the cytosol decreased within 30 minutes from 8.4 +/- 0.6 to only 5.4 +/- 0.9 mmol/L. Mitochondrial ATP was rapidly and linearly reduced to 60% after 5 minutes of ischemia and was nearly unmeasurable after a further 20 minutes. Thus, in contrast to the breakdown of phosphocreatine in cytosol, the only slight alteration of cytosolic ATP reveals a reduction in cytosolic ATP utilization. Moreover, the unaffected cytosolic-mitochondrial difference in the phosphorylation potential of ATP demonstrates the intact function of the ADP/ATP carrier during early ischemia. These results might indicate a disturbance of the functional coupling between carrier and phosphocreatine kinase (phosphocreatine shuttle), which could be of importance for the early contractile failure in myocardial ischemia.

Topics: Adenosine Diphosphate; Adenosine Triphosphate; Animals; Chromatography, High Pressure Liquid; Cytosol; Guinea Pigs; In Vitro Techniques; Magnetic Resonance Spectroscopy; Mitochondria, Heart; Models, Cardiovascular; Myocardial Contraction; Myocardial Ischemia; Myocardium; Phosphates; Phosphocreatine; Phosphorylation

Acute postischemic cardiac dysfunction was studied in isolated reperfused rat hearts. Postischemic administration of neither verapamil nor ribose and adenine resulted in an increase of myocardial ATP content. However, administration of verapamil combined with ribose and adenine achieved an enhanced recovery of high-energy phosphates.

Topics: Adenine; Adenine Nucleotides; Adenosine Triphosphate; Animals; Calcium; Heart; Male; Myocardial Ischemia; Myocardial Reperfusion; Phosphocreatine; Rats; Rats, Wistar; Ribose; Verapamil

This study evaluated the importance of ATP-dependent potassium channels (KATP) for ischemic preconditioning (IP) in swine. Swine were studied because due to the sparsity of their innate collateral circulation infarct size (IS) development closely resembles that observed in humans. Ninety minutes of ischemia at a blood flow reduction sufficient to reduce regional myocardial work by 90% caused 13.2 +/- 8.9% (SD) IS of the area at risk. A single cycle of 10-min preconditioning ischemia followed by 15-min reperfusion reduced IS after 90 min of ischemia to 2.8 +/- 2.7%. The epicardial monophasic action potential duration at 50% repolarization (MAP50) was decreased more markedly during the initial 10 min of the prolonged ischemia than during the first 10 min of the preconditioning ischemic period (84 +/- 4 vs. 89 +/- 2%). Transmural myocardial adenosine (ADO) uptake was reversed to net release during both ischemic periods and during the initial phase of reperfusion. Glibenclamide (0.5 mg/kg, followed by 50 micrograms/min i.v.) abolished the reduction in MAP50 without altering ADO release. Glibenclamide did not alter IS per se (13.0 +/- 7.6%) but abolished the beneficial effect of IP (IS: 13.6 +/- 6.2%). Thus blockade of KATP with glibenclamide abolishes the IS-reducing effect of IP in swine but does not reduce ADO release.

Topics: Action Potentials; Adenosine Triphosphate; Animals; Blood Glucose; Coronary Circulation; Coronary Vessels; Female; Glyburide; Glycogen; Heart; Heart Rate; Humans; Male; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Phosphocreatine; Potassium Channels; Regression Analysis; Swine; Swine, Miniature; Time Factors; Ventricular Function, Left

We examined whether opening of the ATP-sensitive potassium (KATP) channels in the ischemic myocardium plays an important cardioprotective role during ischemia. Dogs were anesthetized with sodium pentobarbital (30 mg/kg, i.v.). Sixty minutes after treatment of the dog with glibenclamide (0.3 or 3 mg/kg, i.v.), the LAD was ligated. At 3 or 15 min after LAD ligation, left ventricular tissue was taken from the ischemic region to measure tissue metabolite levels. After ischemia, the tissue levels of ATP and creatine phosphate decreased to 49-74% and 26-34%, respectively, and lactate level increased to 380-660%. Ischemia (either 3 or 15 min) increased the levels of G6P and F6P and decreased the FDP level, indicating the inhibition of glycolysis. Glibenclamide at either dose decreased the level of blood glucose by 20-30% and increased the blood insulin level twice. The decrease in ATP and increase in lactate due to ischemia were significantly enhanced by glibenclamide at a dose of 3 mg/kg. The increase in G6P due to 15 min of ischemia were also enhanced significantly by 0.3 and 3 mg/kg of glibenclamide. Glibenclamide worsened the metabolic alterations produced by ischemia. These results suggest that KATP channels that can be inhibited by glibenclamide may perform some functions in the ischemic myocardium.

Topics: Adenosine Monophosphate; Adenosine Triphosphate; Animals; Blood Glucose; Blood Pressure; Disease Models, Animal; Dogs; Energy Metabolism; Female; Fructosephosphates; Glucose-6-Phosphate; Glucosephosphates; Glyburide; Heart; Heart Rate; Insulin; Male; Myocardial Ischemia; Myocardium; Phosphocreatine; Potassium Channels

This study was undertaken in order to obtain information on the mode of reaction of the contractile apparatus after different forms of cardiac arrest, global ischemia and reperfusion, as well as on possible correlations between the contraction state of myofibrils and biochemical parameters. During the survival time, before the level of 3 mumol/gww creatine phosphate (CP) is reached, the contraction state shows only minor changes. During the revival time in which ATP tissue concentrations decay to 4 mumol/gww, the contribution of ATP, lactate, anorganic phosphate (Pa) and acidosis to the degree of relaxation depends on the method of cardiac arrest. At defined biochemical values, the degree of relaxation is comparable after aortic cross clamping (ACC) and St. Thomas perfusion, but significantly different compared to HTK perfusion. Thus, during the revival time, the relaxation of sarcomeres depends predominantly on the composition of the solutions used for cardiac arrest. The re-entry of contraction below 3 mumol/gww ATP is correlated with the ATP concentration, independent of the form of cardiac arrest. Reperfusion after HTK or St. Thomas cardioplegia and reversible ischemia leads to the focal formation of contraction bands, which do not occur during ischemia. This contraction state is significantly more pronounced after reperfusion of St. Thomas arrested hearts. Thus, the contraction state of myofibrils is influenced not only by alterations in metabolite concentrations, but also by the composition of cardioplegic solutions and by the characteristic conditions (sufficient energy, oxygen and Calcium) during reperfusion.

Topics: Adenosine Triphosphate; Animals; Calcium; Dogs; Energy Metabolism; Heart Arrest; Lactates; Muscle Contraction; Muscles; Myocardial Ischemia; Myocardial Reperfusion; Myofibrils; Oxygen; Phosphocreatine

A technique is presented for MRI tagging in the presence of inhomogeneous B1 fields. A rectangular tagging grid is produced with B1-insensitive adiabatic pulses in a magnetization preparation period that precedes image acquisition. Phantom results demonstrate that the method is well-suited to surface coil experiments. The technique is applied to a canine model of myocardial ischemia to track the spatially dependent wall motion of the left ventricle during the cardiac cycle. Transmural 31P spectra are acquired from the same double-tuned surface coil, with tagging and spectroscopy performed for the first time, during normal, ischemic, and recovery conditions for the same animal.

Topics: Adenosine Triphosphate; Animals; Coronary Vessels; Diastole; Dogs; Fourier Analysis; Image Enhancement; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Magnetics; Models, Cardiovascular; Models, Structural; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Phosphates; Phosphocreatine; Phosphorus; Systole; Ventricular Function, Left

Topics: Adenine Nucleotides; Animals; Calcium; Energy Metabolism; Ferrets; Homeostasis; Magnetic Resonance Spectroscopy; Male; Myocardial Contraction; Myocardial Ischemia; Myocardium; Phosphocreatine; Time Factors

The mechanisms by which ischemic preconditioning (IPC) protects against reperfusion (RP) injury are unknown. The purpose of this study was to relate IPC to postischemic mechanical function, vascular reactivity, and bioenergetics. Isolated perfused rat hearts were randomized to two groups. Control (CTRL) hearts underwent 25 min of global, 37 degrees C ischemia and 40 min RP. IPC hearts underwent 2.5 min ischemia and 10 min RP followed by 25 min ischemia and 40 min RP (RP40). Left ventricular developed pressure (DP) and coronary flow were continuously measured. 31P NMR spectra determined phosphocreatine and ATP concentrations in parallel hearts every 5 min. Results are means +/- SEM; n = 6/group. Significance was assumed for P < 0.05 by paired (within groups) and unpaired (between groups) t test. CTRL heart DP recovered to 35 +/- 4% of preischemic (PI) DP by RP40 (P < 0.001), while IPC heart DP reached 99 +/- 4% (P = NS vs PI; P < 0.001 vs CTRL). CTRL coronary flow recovered to only 75 +/- 3% of PI (P < 0.001) by RP40. IPC coronary flow exceeded baseline during RP (RP40 = 118 +/- 3%, P < 0.001 vs CTRL; P < 0.05 vs PI). After 25 min ischemia, CTRL heart ATP fell to 40 +/- 4% of PI (P < 0.001) while the IPC group fell to only 60 +/- 4% (P < 0.05 IPC vs CTRL; P < 0.001 vs PI). IPC preserves more end-ischemic ATP compared to CTRL hearts with a resultant improvement in mechanical function during reperfusion. Only preconditioned hearts preserve the adaptive mechanism(s) responsible for postischemic vasodilatation.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adenosine Triphosphate; Animals; Coronary Circulation; Energy Metabolism; Heart; In Vitro Techniques; Male; Myocardial Ischemia; Myocardial Reperfusion; Myocardial Stunning; Phosphocreatine; Rats; Rats, Sprague-Dawley

The level of systemic hypoxia required to alter neonatal myocardial metabolism and its resultant effect on tolerance to global ischemia is unknown. This study examines myocardial purine nucleotides, glycogen (MG), lactate, creatine phosphate (CP) and the subsequent tolerance to ischemia in hearts exposed to varying levels of hypoxia (2 h). Three-day-old swine were randomly allocated into five study groups. Animals were anaesthetized and ventilated (2 h) with varying mixtures of medical air and nitrogen to achieve their target PaO2 (mmHg): normoxia (PaO2 = 80, n = 18), mild (PaO2 = 60, n = 10), moderate (PaO2 = 40, n = 12), moderately-severe (PaO2 = 30, n = 7) and severe (PaO2 = 20, n = 9). Arterial blood gases verified PaO2 and normal PaCO2 (39.5 +/- 0.5 mmHg). Subsequently, the heart was exposed and the metabolic profile determined from a freeze-clamp LV biopsy. The heart was excised and tolerance to ischemia determined by time (min) to ischemic contracture onset (TICo) and peak (TICp). The results demonstrated a tendency to decreased MG with progressive hypoxia which reached significance in severe hypoxia (6.6 +/- 2.7 mumol/g, P < 0.05). Despite a doubling of myocardial lactate with moderately-severe hypoxia, increases only reached significance with severe hypoxia (27.8 +/- 6.3 mumol/g, P < 0.0001). Despite the reduction in LV adenosine triphosphate (ATP) with severe hypoxia (2.16 +/- 0.68 mumol/g, P < 0.05), CP was unaltered.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adenosine Diphosphate; Adenosine Monophosphate; Adenosine Triphosphate; Animals; Animals, Newborn; Blood Gas Analysis; Glycogen; Hypoxia; Inosine Monophosphate; Lactates; Male; Myocardial Ischemia; Myocardium; Phosphocreatine; Severity of Illness Index; Swine; Time Factors

Phosphorus-31 nuclear magnetic resonance and left ventricular pressure development (dP/dt) were used to test the hypothesis that age-related differences in myocardial functional recovery after ischemia and cold crystalloid cardioplegia (CCC) are the result of an inverse relationship between recovery and the decrease in intracellular pH (pHi) during ischemia. Neonatal (3-8 days) and adult rabbit hearts were Langendorff perfused using two protocols: (1) control--30 min perfusion, 30 min global ischemia, 2 h reperfusion; (2) CCC--the same except ischemia was initiated after a 4-min infusion of cold hyperkalemic solution. Analysis of variance and the Tukey test showed the following significant differences between the protocols (p < 0.05). CCC decreased inorganic phosphate (Pi) during ischemia in both age groups, but more in adult hearts, and decreased Pi during reperfusion in adult hearts. CCC increased pHi during ischemia and ATP during ischemia and reperfusion in both age groups but more in adult hearts. CCC increased dP/dt during reperfusion only in adult hearts. The results are consistent with the hypothesis.

Topics: Adenosine Triphosphate; Aging; Animals; Animals, Newborn; Cold Temperature; Crystallization; Heart Arrest, Induced; Hydrogen-Ion Concentration; Magnetic Resonance Spectroscopy; Myocardial Ischemia; Myocardial Reperfusion; Phosphates; Phosphocreatine; Potassium; Pressure; Rabbits; Ventricular Function, Left

The metabolic changes of myocardial ischemia in patients with coronary artery disease assessed by 31P magnetic resonance spectroscopy (MRS) have been reported previously. A significant decrease in the ratio of phosphocreatine (PCr) to ATP during handgrip exercise in a group of patients with severe coronary artery disease has been demonstrated. However, there are no reports at present that directly compare cardiac 31P MRS data with exercise 201Tl myocardial scintigraphy, now established as one of the most important clinical methods to assess myocardial ischemia. The purpose of this study was to investigate whether 31P MRS with handgrip exercise testing is able to detect myocardial ischemia, demonstrated by exercise 201Tl scintigraphy.. Twenty-seven patients with severe stenosis of the left anterior descending coronary artery (> or = 75%) and 11 normal control subjects composed the present study. Patients were divided into two groups on the basis of exercise 201Tl scintigraphy: a reversible 201Tl defect group (RD[+]) who demonstrated redistribution at the late image and a fixed 201Tl defect group (RD[-]). While lying supine within the magnet, subjects performed handgrip exercise at 30% of maximal force once in every two cardiac cycles. 31P MR spectra were collected before and during handgrip exercise. Data were corrected for the saturation factor. ANOVA revealed significant differences among the three groups with respect to the mean +/- SD PCr/ATP ratio at rest (control, 1.85 +/- 0.28 > RD(+), 1.60 +/- 0.19 > RD(-), 1.24 +/- 0.30; P < .05). The PCr/ATP ratio decreased significantly from 1.60 +/- 0.19 at rest to 0.96 +/- 0.28 during exercise (P < .001) in the RD(+) group (n = 15). However, in the RD(-) group (n = 12), the ratio did not change significantly during handgrip exercise (1.24 +/- 0.30 at rest versus 1.19 +/- 0.28 during exercise). Similarly, the ratio did not change in the control group (n = 11) (1.85 +/- 0.28 at rest versus 1.90 +/- 0.23 during exercise).. Contrary to normal subjects or patients with fixed thallium defects, the PCr/ATP ratio was significantly altered by exercise in patients with reversible thallium defects. These results suggest that 31P MRS with handgrip exercise testing is a sensitive method for detecting myocardial ischemia.

Topics: Adenosine Triphosphate; Coronary Disease; Exercise; Exercise Test; Female; Heart; Humans; Magnetic Resonance Spectroscopy; Male; Middle Aged; Myocardial Ischemia; Myocardium; Phosphocreatine; Sensitivity and Specificity; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

The biochemical and mechanical effects of a new calcium ion channel antagonist, fantofarone ((2-isopropyl-1-((4-(3-(N-methyl-N-(3,4-dimethoxy-beta-phenethyl)-amino) propyloxy)benzenesulfonyl))-indolizine), on isovolumic perfused rat heart have been assessed by using 31P nuclear magnetic resonance (NMR) spectroscopy together with simultaneous monitoring of myocardial mechanical function. Cytosolic pH and phosphocreatine, adenosine triphosphate and inorganic phosphate contents were monitored by using 31P NMR. Heart rate, coronary flow and left ventricular developed pressure were measured routinely to assess mechanical function. Perfusion with 10 nM, 100 nM or 1 microM fantofarone for a period of 48 min did not cause any measurable metabolic changes. However, coronary vasodilatation and a partial positive inotropic effect were noted. A 15-min pretreatment with 100 nM did not protect against the deleterious effects of an 18-min period of normothermic, zero-flow ischemia. In contrast, a 20-min pretreatment period with 1 microM fantofarone significantly improved the recovery of mechanical performance, metabolic activity and pH after the same 18 min of ischemia. While only a slight protection of the ATP pool was noted during the ischemic period, major beneficial effects were observed during the reperfusion period, such that reflow was characterized by high recoveries of left ventricular pressure and rate pressure product (70-80%), low end diastolic pressure (< 10 mm Hg), significant recovery of ATP content (to 55%), a complete repletion of the phosphocreatine pool and a fast return of cytosolic pH to normal value.

Topics: Adenosine Triphosphate; Animals; Calcium Channel Blockers; Coronary Circulation; Cytosol; Heart; Heart Rate; Hydrogen-Ion Concentration; In Vitro Techniques; Indolizines; Intracellular Fluid; Magnetic Resonance Spectroscopy; Male; Myocardial Ischemia; Myocardial Reperfusion Injury; Myocardium; Perfusion; Phenethylamines; Phosphocreatine; Phosphorus; Rats; Rats, Wistar; Ventricular Function, Left

The mechanical effects of ischemic contracture may be important in the development of irreversible cellular damage as it increases mechanical stress on sarcolemmal membranes and restricts endocardial perfusion. To assess the relative importance of these mechanical effects compared with decreased energy supply in the development of irreversible injury, the effects of inhibiting ischemic contracture with 2,3-butanedione monoxime (BDM), an agent that disrupts excitation-contraction coupling, were delineated in isovolumically contracting isolated rabbit hearts. Administration of 20 mmol/L BDM in 12 hearts subjected to 60 minutes of low-flow ischemia prevented ischemic contracture (left ventricular end-diastolic pressure [LVEDP], 12 +/- 3 compared with 48 +/- 14 mm Hg in 20 control hearts; P < .001), reduced membrane damage (creatine kinase [CK] release, -54% compared with control hearts; P < .05), and enhanced functional recovery during reperfusion (left ventricular developed pressure [LVDP], 86 +/- 10% of baseline compared with 56 +/- 23% in control hearts; P < .01). These observations were not related to increased intracavitary pressure and its effects on flow distribution, since venting the left ventricle in additional hearts did not result in improved function during reperfusion. Although it would be tempting to conclude that BDM protected ischemic myocardium by preventing ischemic contracture, administration of BDM was also associated with reduced depletion of ATP during ischemia, perhaps related to diminished energy demand. To distinguish between the relative importance of inhibiting contracture from provision of adequate energy, the period of ischemia was extended to 120 minutes. BDM still prevented ischemic contracture (LVEDP, 10 +/- 6 mm Hg) and preserved ATP stores, but it did not prevent membrane damage (CK release, 483 +/- 254 U/g dry weight) or contractile failure during reperfusion (LVDP, 68 +/- 7% of baseline). In contrast, increasing the rate of anaerobic glycolysis during ischemia by doubling glucose and insulin in the presence of BDM markedly decreased membrane damage (CK release, 114 +/- 72 U/g dry weight; P < .05) and contractile failure during reperfusion (LVDP, 88 +/- 7% recovery of baseline; P < .01). These results suggest that insufficient energy production is primarily responsible for myocardial ischemic damage, whereas mechanical effects of ischemic contracture appear to play only a minor role.

Topics: Animals; Creatine Kinase; Diacetyl; Energy Metabolism; Glucose; Glycogen; Lactates; Lactic Acid; Myocardial Contraction; Myocardial Ischemia; Myocardial Reperfusion; Myocardial Reperfusion Injury; Phosphocreatine; Potassium; Rabbits; Ventricular Function, Left

Myocardial ischemia is characterized by a decrease in phosphocreatine (PCr) and Mg(2+)-ATP contents as well as an accumulation of myosin ATPase reaction products (inorganic phosphate [P(i)], protons, and Mg(2+)-ADP). The possibility that these metabolites play a role in rigor tension development was checked in rat ventricular Triton X-100-skinned fibers. Rigor tension was induced by stepwise decreasing [Mg(2+)-ATP] in the presence or in the absence of 12 mmol/L PCr. To mimic the diastolic ionic environment of the myofibrils, [free Ca2+] was set at 100 nmol/L (pCa 7); [free Mg2+], at 1 mmol/L; and ionic strength, at 160 mmol/L. In control conditions (pH 7.1, with no added P(i) or Mg(2+)-ADP), the pMg(2+)-ATP for half-maximal rigor tension (pMg(2+)-ATP50) was 5.07 +/- 0.03 in the presence of PCr. After withdrawal of PCr, the pMg2+)-ATP50 value was shifted toward higher Mg(2+)-ATP values (3.57 +/- 0.03). Addition of 20 mmol/L P(i) shifted the pMg(2+)-ATP50 to 3.71 +/- 0.04 (P < .05) in the absence of PCr and in the opposite direction to 4.98 +/- 0.02 (P < .01) in the presence of PCr. Acidic pH (6.6) strongly increased pMg(2+)-ATP50 in both the absence (3.90 +/- 0.03, P < .001) and presence (5.44 +/- 0.02, P < .001) of PCr. Conversely, Mg(2+)-ADP (250 mumol/L) decreased pMg(2+)-ATP50 to 3.26 +/- 0.06 (P < .001) in the absence of PCr; at pMg(2+)-ATP 4, no rigor tension was observed until PCr concentration was decreased to < 2 mmol/L. At acidic pH, maximal rigor tension was lower by 29% compared with control conditions, whereas in the presence of Mg(2+)-ADP, maximal rigor tension developed to 143% of the control value; P(i) had no effect. The tension-to-stiffness (measured by the quick length-change technique) ratio was lower in rigor (no PCr and pMg(2+)-ATP 6) than during Ca2+ activation in the presence of both PCr and ATP. Compared with control rigor conditions, this parameter was unchanged by Mg(2+)-ADP and decreased by acidic pH, suggesting a proton-induced decrease in the amount of force per crossbridge. In addition to their known effects on active tension, Mg(2+)-ADP and protons affect rigor tension and influence ischemic contracture development. It is concluded that ischemic contracture and increased myocardial stiffness may be mediated by a decreased PCr and local Mg(2+)-ADP accumulation. This emphasizes the importance of myofibrillar creatine kinase activity in preventing ischemic contracture.

Topics: Adenosine Diphosphate; Adenosine Triphosphate; Animals; Contracture; Creatine Kinase; Hydrogen-Ion Concentration; Myocardial Contraction; Myocardial Ischemia; Papillary Muscles; Phosphocreatine; Phosphorus; Phosphorylation; Rats

The hemodynamic effects of acute and long-term administration of creatine phosphate were studied in 23 patients with heart failure (NYHA classes II and III) under stabilized treatment. Acute creatine phosphate (5 g i.v.) induced a significant increase of the ejection fraction (FE) and of other parameters of cardiac contractility. Once these improvements of cardiac contractility were obtained by acute treatment, further significant increases in cardiac function were observed if treatment was continued for six days, i.e. telesystolic diameter and volume, as well as parietal stress were significantly reduced, and ejection fraction and shortening fraction were significantly increased. Creatine phosphate treatment has a favourable influence on the hemodynamics of patients with an obvious contractility deficit and chronic ischemia of the myocardium.

Topics: Acute Disease; Aged; Cardiomyopathy, Dilated; Chronic Disease; Drug Evaluation; Echocardiography; Female; Heart Failure; Hemodynamics; Humans; Male; Middle Aged; Myocardial Ischemia; Phosphocreatine

Capacity for ATP resynthesis during recovery from ischemia or hypoxia is limited to the size of the adenine nucleotide pool, which is determined in part by the activity of cytosolic 5'-nucleotidase (5'-NT): AMP-->adenosine plus inorganic phosphate (Pi). To define in vivo regulation of 5'-NT, we used the tools of 31P nuclear magnetic resonance (NMR), spectroscopy and chemical assay to measure the substrates (AMP), products (Pi, adenosine, and its catabolites), and inhibitors (Pi and H+) of 5'-NT in isolated perfused rat hearts exposed to hypoxia (where pH remains near 7) and no flow, global ischemia (where pH falls to 6.1). We estimated 5'-NT reaction velocity, assessed the relative contributions of Pi and H+ to enzyme inhibition, and defined the consequences of changes in 5'-NT activity on ATP resynthesis after hypoxia and ischemia. We conclude that (a) 5'-NT is activated during hypoxia and early ischemia but is inhibited during prolonged ischemia, (b) H+ (pH < 6.2) is a potent inhibitor of 5'-NT, and (c) differences in AMP accumulation are sufficient to explain the differences in the capacity for net ATP resynthesis in ischemic and hypoxic tissue. These observations have implications for our understanding of heterogeneity of ischemic injury and myocardial protection during ischemia.

Topics: 5'-Nucleotidase; Acidosis; Adenosine Triphosphate; Animals; Blood Pressure; Coronary Circulation; Heart; Heart Rate; In Vitro Techniques; Kinetics; Magnetic Resonance Spectroscopy; Male; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Phosphates; Phosphocreatine; Rats; Rats, Sprague-Dawley; Time Factors

Isolated canine hearts were preserved for 12 h at 5 degrees C followed by normothermic reperfusion for 2 h. Dogs were divided into two groups: group 1 (n = 7) received a nondepolarizing preservation solution in multidose, and group 2 (n = 6) received single-flushed University of Wisconsin (UW) solution, both administered in multidose fashion. At the end of reperfusion, the myocardial adenosine triphosphate concentration and left ventricular systolic and diastolic function were preserved better in groupl than in group 2. Myocardial mitochondrial ultrastructural integrity was identical in the two groups. These results suggested that in a 12-h heart preservation, nondepolarizing solution administered in multidose fashion protects the myocardium from the deleterious effects of hypothermia and cardioplegia better than UW solution.

Topics: Adenine Nucleotides; Adenosine; Adenosine Triphosphate; Allopurinol; Animals; Cardioplegic Solutions; Dogs; Glutathione; Heart; Heart Arrest, Induced; Insulin; Mitochondria, Heart; Models, Animal; Myocardial Ischemia; Myocardium; Organ Preservation; Organ Preservation Solutions; Phosphocreatine; Raffinose; Reperfusion; Ventricular Function, Left

Effects of iloprost, which is a stable prostacyclin analogue, on the ischemic myocardium were examined in the open-chest dog heart in terms of biochemical parameters. Ischemia was initiated by ligating the left anterior descending coronary artery. When the coronary artery was ligated for 3 min, the levels or glycogen, fructose-1,6-diphosphate (FDP), adenosine triphosphate and creatine phosphate decreased, and the levels of glucose-6-phosphate (G6P), fructose-6-phosphate (F6P), lactate, adenosine diphosphate and adenosine monophosphate increased. During ischemia, therefore, energy charge potential was significantly decreased from 0.89 +/- 0.01 to 0.82 +/- 0.01, and ([G6P] + [F6P])/[FDP] and [lactate]/[pyruvate] ratios were significantly increased from 1.75 +/- 0.30 to 29.05 +/- 5.70 and 13 +/- 3 to 393 +/- 112, respectively. Iloprost (0.1, 0.3, or 1 microgram.kg-1) was injected intravenously 5 min before the onset of ischemia. Iloprost (0.1, 0.3, and 1 micrograms.kg-1) reduced the ischemia-induced decrease in energy charge potential to 94, 74, and 86%, respectively, the increase in ([G6P] + [F6P])/[FDP] to 38, 29, 32%, respectively, and the increase in [lactate]/[pyruvate] to 67, 45, 65%, respectively. These results suggest that iloprost lessens the myocardial metabolic derangements produced by ischemia, and the most potent effect was obtained at the dose of 0.3 microgram.kg-1.

Topics: Adenosine Diphosphate; Animals; Dogs; Energy Metabolism; Female; Fructosediphosphates; Glucose-6-Phosphate; Glucosephosphates; Glycogen; Heart; Hemodynamics; Iloprost; Lactates; Male; Myocardial Ischemia; Phosphocreatine

The effects of LP-805, a newly developed vasodilator, on changes in the myocardial energy and carbohydrate metabolism induced by ischaemia were studied in open-chest anaesthetized dogs. Ischaemia was induced by ligating the left anterior descending coronary artery for 3 min. The myocardial energy stores were depleted, and the levels of glycolytic intermediates were altered 3 min after the onset of ischaemia. Energy change potential was decreased, and ([G6P] + [F6P])/[FDP] and [lactate]/[pyruvate] ratios were increased by ischaemia. These findings indicated that the myocardial metabolism was converted from an aerobic to an anaerobic type by ischaemia. LP-805 (10, 30, or 100 micrograms kg-1) was injected intravenously 5 min before the onset of ischaemia. LP-805 prevented the myocardial energy depletion and alterations of myocardial carbohydrate metabolism due to ischaemia, indicating that it appeared to convert the anaerobic metabolism back to aerobic metabolism in the ischaemic myocardium. In conclusion, LP-805 may reduce the ischaemic influence on the myocardium.

Topics: Adenine Nucleotides; Anaerobiosis; Animals; Carbohydrate Metabolism; Dogs; Energy Metabolism; Female; Hemodynamics; Lactates; Male; Myocardial Ischemia; Myocardium; Phosphocreatine; Pyrazoles; Pyrimidines; Pyruvates; Vasodilator Agents

Gradual reperfusion improves recovery of the pump function of isolated guinea pig heart subjected to total ischemia. This effect is associated with the restoration of higher myocardial contents of ATP, adenine nucleotides, total Cr, and lactate level close to preischemic one, and reduced losses of tissue Cr, glutamate, and aspartate. Positive correlations between energy and functional indices in reperfused hearts indicate that resumption of aerobic energy production may be a crucial factor for postischemic functional recovery. The importance of metabolism of glutamate and aspartate for recovery of cardiac function is confirmed by good correlations between the pools of these amino acids and of ATP, adenine nucleotides, and the total Cr. The results suggest that a decrease in energy demand during the early phase of reperfusion promotes achievement of a better metabolic and functional status in the postischemic heart.

Topics: Adenine Nucleotides; Adenosine Triphosphate; Amino Acids; Animals; Aspartic Acid; Cardiac Output; Energy Metabolism; Glutamates; Glutamic Acid; Guinea Pigs; Heart; In Vitro Techniques; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Nitrogen; Phosphocreatine

Hemodynamic and biochemical changes were studied on 36 white ELCO-rabbits, seven adult older than 150 days, seven immatures between 21 and 27 days, and seven neonatals between 7 and 14 days. Five supplementary hearts of each age group served for preischemic biochemical values. Protection during 60 min of global ischemia was provided by topical cooling and selective coronary perfusion with Bretschneider cardioplegia (8 degrees C). A comparison between pre- and postischemic results showed decreases in coronary flow in the adult (p < 0.004), aortic flow (p < 0.04), cardiac output (p < 0.02), and stroke volume (p < 0.02) in the neonate. The preservation of ATP and CP was sufficient in the adult and immature myocardium, whereas a significant decrease in neonatal ATP was found (p < 0.01). According to these findings we consider immature myocardium to be more resistant against ischemia than the two other age groups. The apparatus used is a development of the conventional working heart, but combines a physiological flow-pressure relation, with instruments guaranteeing high accuracy, devices for drug application, and fits for different sizes of hearts. Therefore, this new approach promises to be of clinical relevance for investigations on the improvement of myocardial protection in both adults and children.

Topics: Adenosine Triphosphate; Aging; Animals; Heart; Hemodynamics; Hypothermia, Induced; Models, Cardiovascular; Myocardial Ischemia; Myocardium; Phosphocreatine; Rabbits; Time Factors

Cardiac mechanics and metabolic performance were studied in isolated perfused hearts of heat-acclimated (AC) rats (at 34 degrees C for 1 mo) and their age-matched controls (C). Diastolic and systolic pressures, coronary flow, and the appearance of ischemic contracture (IC) were measured during progressive graded ischemia, total ischemia (TI), and reperfusion. ATP, phosphocreatine, and intracellular pH were measured during TI and reperfusion with the use of 31P-nuclear magnetic resonance spectroscopy. Systolic pressure was greater in AC hearts than in C hearts (P < 0.0001). During 50% of perfusion pressure 15 and 46% of AC and C hearts, respectively, showed IC (P < 0.001). During 25% of perfusion pressure 85% of the hearts in both groups developed IC. The onset of IC in AC hearts was delayed compared with in C hearts. On reperfusion 93 and 66% of AC and C hearts, respectively, resumed contraction. Recovery of diastolic pressure was 78 and 36% for the AC and C hearts, respectively (P < 0.05). During TI ATP declined by 0.94 and 1.20 mumol/min in AC and C hearts, respectively, resulting in 21 +/- 2.8% preservation of the ATP pool in AC hearts after 30 min of TI (P < 0.001). The AC group also showed a delayed decline in intracellular pH (P < 0.001). The data suggest beneficial effects of heat acclimation on the heart, which were exhibited by greater pressure generation and by the emergence of protecting features during ischemia and reperfusion, possibly via energy-sparing mechanisms.

Topics: Acclimatization; Adenosine Triphosphate; Animals; Body Weight; Heart; Hot Temperature; In Vitro Techniques; Magnetic Resonance Spectroscopy; Male; Myocardial Contraction; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Organ Size; Phosphates; Phosphocreatine; Rats

The aim of the present study was to identify components of ischaemia involved in the induction of preconditioning. Isolated rat hearts (n = 8 per group) were perfused with bicarbonate buffer. Following 10 min aerobic perfusion they were randomised and subjected to 5 min periods during which the perfusion conditions were: (i) normal aerobic perfusion (controls); (ii) zero flow ischaemia; (iii) low flow ischaemia (10% of control O2 delivery); (iv) hypoxia (10% of control O2 delivery); or (v) acidosis (pH 6.4). After these periods of "preconditioning", all hearts underwent 5 min aerobic perfusion followed by 40 min zero flow global ischaemia and 35 min reperfusion. Contractile function was measured at the beginning and at the end of the experiment. Despite profound differences in coronary flow during preconditioning, substantial and similar protection was observed in all groups preconditioned by transiently limiting oxygen delivery. Recovery of cardiac output was 66.7 +/- 6.3%, 58.7 +/- 5.1% and 62.6% +/- 3.3% in the zero flow, low flow and hypoxic groups, respectively, vs 31.0 +/- 3.0% in controls (all P < 0.05). In hearts subjected to acidosis there was no protection (recovery of cardiac output 38.1 +/- 2.7%). Impairment of oxygen delivery appears to be the principle component of ischaemia responsible for the induction of preconditioning. Metabolite accumulation appears to play no significant role.

Topics: Acidosis; Adenosine Triphosphate; Animals; Creatine Kinase; Extracellular Space; Heart; Hypoxia; Male; Myocardial Contraction; Myocardial Ischemia; Myocardium; Oxygen; Phosphocreatine; Rats; Rats, Wistar; Regional Blood Flow; Reperfusion Injury

We previously demonstrated that ATP-sensitive K+ channels (KATP) protect the guinea pig myocardium against ischemia-reperfusion injury (Cole et al., Circ. Res. 69: 571-581, 1991), but the cellular alterations leading to ischemic injury affected by KATP remain to be defined. This study investigates the relationship between activation of KATP and preservation of high-energy phosphates during global no-flow ischemia in arterially perfused guinea pig right ventricular walls. Electrical and mechanical activity were recorded via intracellular microelectrodes and a force transducer. Glibenclamide (10 and 50 microM) and pinacidil (10 microM) were used to modulate KATP. ATP and creatine phosphate (CP) levels were determined at the end of no-flow ischemia by enzymatic analysis. Preparations were subjected to 1) 20 min no-flow +/- glibenclamide (10 or 50 microM), 2) 30 min no-flow +/- pinacidil (10 microM) or pinacidil (10 microM) and glibenclamide (50 microM), or 3) 40 or 50 min of control perfusion before rapid freezing in liquid nitrogen. Pinacidil (10 microM) enhanced ischemic shortening of action potential duration (APD) and early contractile failure, prevented ischemic contracture, and inhibited high-energy phosphate depletion during ischemia. Glibenclamide (50 microM) inhibited the effects of pinacidil (10 microM) on electromechanical function and preservation of ATP and CP. Glibenclamide (10 microM) alone inhibited the early decline in APD and produced earlier ischemic contracture but did not enhance ATP or CP depletion compared with untreated tissues during 20 min of no-flow. Glibenclamide (50 microM) produced a greater inhibition of APD shortening in early ischemia, further decreased the latency to ischemic contracture, and caused enhanced ischemic depletion of ATP. The data indicate the changes in electrical activity induced by KATP indirectly preserve high-energy phosphates and reduce injury associated with ischemia. However, the data also suggest the possible presence of additional mechanisms for cardioprotection by KATP.

Topics: Action Potentials; Adenosine Triphosphate; Animals; Glyburide; Guanidines; Guinea Pigs; Heart; In Vitro Techniques; Membrane Potentials; Myocardial Contraction; Myocardial Ischemia; Myocardium; Phosphocreatine; Pinacidil; Potassium Channels; Reperfusion Injury; Vasodilator Agents

The role of ionic derangements in preconditioned hearts (PC) was assessed by measuring pHi, high-energy phosphates (HEP) and [Mg2+] by 31P NMR. Control (C) Langendorff rat hearts were subjected to 30' ischemia and 30' reflow. PC underwent 4x(2' ischemia + 3' reperfusion) before prolonged ischemia and reflow. In this model, the contractile recovery of PC hearts at the end of reflow (rate-pressure product RPP: 50 +/- 12% vs. 5 +/- 5% of C, p = 0.004) is not related to higher HEP or pHi levels than in C. [Mg2+]i increased significantly during ischemia both in C and PC organs; upon reperfusion its level remained significantly high in C (p < 0.001), while it regained the normal value in PC hearts. This behavior might improve in turn the SR calcium handling in PC organs, eventually contributing to the contractile recovery.

Topics: Adenosine Triphosphate; Animals; Energy Metabolism; Heart; Heart Rate; Homeostasis; Hydrogen-Ion Concentration; In Vitro Techniques; Magnesium; Magnetic Resonance Spectroscopy; Male; Myocardial Contraction; Myocardial Ischemia; Myocardial Reperfusion; Phosphates; Phosphocreatine; Rats; Rats, Sprague-Dawley; Time Factors

The effect of the water-soluble fraction of Crataegus (Crataegus extract) on the cardiac mechanical and metabolic function was studied in the isolated, perfused working rat heart during ischemia and reperfusion. Ischemia (15 min) was produced by removing afterload pressure, and reperfusion (20 min) was produced by returning it to the original pressure. In the control (no drug) heart, ischemia decreased mechanical function to the lowest level, which did not recover even after the end of reperfusion. Crataegus extract (0.01 or 0.05%) was applied to the heart from 5 min before ischemia through the first 10 min after reperfusion. With the high concentration of Crataegus extract (0.05%) the mechanical function recovered during reperfusion incompletely without increasing coronary flow, but the low concentration of Crataegus extract (0.01%) did not. In the heart treated with the high concentration of Crataegus extract, the reperfusion-induced recovery of the energy metabolism was accelerated, and the level of lactate during ischemia was lower than that in the control heart, although the myocardial levels of free fatty acids during ischemia and reperfusion were not greatly affected. These results demonstrate that Crataegus extract (0.05%) has a cardioprotective effect on the ischemic-reperfused heart, and that the cardioprotective effect is not accompanied by an increase in coronary flow.

Topics: Adenine Nucleotides; Animals; Blood Pressure; Coronary Circulation; Fatty Acids, Nonesterified; Heart; Heart Rate; In Vitro Techniques; Lactates; Male; Myocardial Contraction; Myocardial Ischemia; Myocardial Reperfusion Injury; Myocardium; Perfusion; Phosphocreatine; Plant Extracts; Plants, Medicinal; Rats; Rats, Sprague-Dawley

Short term hibernating myocardium is characterised by a decrease in contractile function in proportion to the reduced blood flow, the recovery of creatine phosphate despite ongoing ischaemia, a recruitable inotropic reserve, and the absence of necrosis. During acute myocardial ischaemia systolic wall thickening decreases and post-ejection wall thickening develops. The extent of post-ejection thickening during severe ischaemia correlates with the recovery of contractile function during reperfusion. Whether the extent of post-ejection wall thickening can also distinguish short term hibernating myocardium from more severely ischaemic, infarcting myocardium and thus predict the amount of viable tissue was tested in 13 anaesthetised pigs.. The left anterior descending coronary artery (LAD) was cannulated and perfused at constant flow. After control measurements of regional myocardial blood flow (with radiolabelled microspheres) and wall thickening (sonomicrometry), coronary inflow was reduced to produce a reduction in regional contractile function by 60-100%. After 85 minutes of ischaemia, dobutamine was infused into the LAD for five minutes to determine the extent of inotropic reserve. Transmural biopsies were taken to measure regional myocardial creatine phosphate content and infarct size was determined after two hours of reperfusion by staining with triphenyl tetrazolium chloride.. The extent of post-ejection wall thickening after 85-90 minutes of ischaemia correlated with the myocardial creatine phosphate content (r = 0.812, n = 11, p < 0.01) and the extent of the dobutamine recruitable inotropic reserve (r = 0.783, n = 7, p < 0.05). A negative correlation existed between the extent of post-ejection wall thickening and % infarct size (r = -0.699, n = 10, p < 0.05 for the transmural piece of tissue containing the ultrasonic crystals; r = -0.743, n = 10, p < 0.05 for the area of the left ventricle at risk). Finally, post-ejection wall thickening after 85-90 minutes of ischaemia correlated with the recovery of contractile function at 30 minutes reperfusion (r = 0.657, n = 10, p < 0.05).. The extent of post-ejection wall thickening may indicate the amount of viable tissue after 85-90 minutes of low flow ischaemia. The greater the post-ejection wall thickening, the more myocardium is successfully hibernating.

Topics: Animals; Myocardial Ischemia; Myocardium; Phosphocreatine; Regional Blood Flow; Stroke Volume; Swine; Swine, Miniature; Time Factors

This study investigated the effects of ischemic preconditioning on myocardial carnitine-linked metabolism and high-energy phosphates in the canine model of ischemia and reperfusion.. Anesthetized dogs underwent 1 hour of coronary artery occlusion and 4.5 hours of reperfusion. The dogs were randomly assigned to a control group (no intervention for 30 minutes), a preconditioned group (four repeated episodes of 3 minutes of mechanical coronary occlusion, each followed by 5 minutes of reperfusion), and a coronary cyclic flow variation (CFV) group (coronary artery stenosis and endothelial injury, resulting in an average of four episodes of platelet thrombosis and dislodgment). After completion of the protocol, ATP, creatine phosphate, and long-chain acyl carnitine concentrations were studied in both nonischemic and previously ischemic myocardium.. In Part I of this study (Ovize et al., Circulation 1992, 85:779-789), it was reported that both mechanical occlusion and CFV before sustained occlusion resulted in a decrease in infarct size. In the present paper, we report changes in high-energy phosphates and long-chain acyl carnitine in these groups. Control, preconditioned, and CFV groups showed similar depletion in ATP content and "overshoot" in creatine phosphate stores. Control dogs exhibited a significant accumulation of long-chain acyl carnitine in the previously ischemic tissue (219 +/- 61 vs 131 +/- 38 nmoles/g wet weight in the nonischemic tissue; P < 0.05). No significant increase in long-chain acyl carnitine occurred in the mechanically preconditioned and CFV groups.. These results indicate that brief episodes of transient ischemia before sustained coronary occlusion prevent long-chain acyl carnitine accumulation in the ischemic and reperfused canine myocardium.

Topics: Acetylcarnitine; Adenosine Triphosphate; Animals; Carnitine; Coronary Circulation; Dogs; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Phosphocreatine

We studied the effects of the potent Na/H exchange inhibitor methylisobutyl amiloride (MIA, 1 microM) on post-ischemic ventricular recovery and energy metabolic status in spontaneously contracting, isolated rat and guinea-pig hearts subjected to 45 min zero-flow ischemia followed by reperfusion. For both species, MIA was added either 15 min prior to ischemia and was present throughout reperfusion or was added at the time of reperfusion only. In control rat hearts, force recovery after 30 min of reperfusion was 25.6 +/- 6.0% of the pre-ischemic value whereas in hearts pre-treated with MIA recovery was enhanced to 55.4 +/- 9% (P < 0.05). Elevation of resting tension during the first 20 min of reperfusion was also significantly reduced by MIA pre-treatment. When MIA was added at the time of reperfusion only, recovery was generally lower than that seen with MIA pre-treatment although significantly higher values were seen through much of the reperfusion period. In rat hearts, MIA reduced the time required for return to sustained contractile recovery particularly in those hearts where the drug was added prior to ischemia (control, 11.4 +/- 2.7 min; MIA, 2.6 +/- 0.5 min, P < 0.05). Similar effects of MIA pre-treatment were seen in guinea-pig hearts in terms of contractile recovery, time to recovery and reduction in resting tension although MIA addition at the time of reperfusion was without beneficial effect either on the magnitude of contractile recovery or time required for restoration of function. In guinea-pig hearts, recovery of function was accompanied by substantial bradycardia. However, maintenance of ventricular rate through electrical pacing exerted no significant influence on the protective effects of MIA pre-treatment. There was no effect of MIA on energy metabolites in reperfused rat hearts or paced guinea-pig hearts, although in spontaneously contracting guinea-pig hearts improved recovery of function was associated with significantly higher levels of high energy phosphates. No effects of tissue metabolites were seen in ischemic non-reperfused hearts irrespective of treatment. The protective effects of MIA were not related to diminished release of creatine kinase during reperfusion. Our results demonstrate marked protective effects of MIA, on the reperfused rat and guinea-pig myocardium. These studies also demonstrate, for the first time, that the effects of amiloride analogues are not species specific and further support the concept that Na/H exch

Topics: Adenine Nucleotides; Amiloride; Animals; Creatine Kinase; Glycogen; Guinea Pigs; Heart; Heart Rate; Hydrogen-Ion Concentration; In Vitro Techniques; Ion Transport; Lactates; Male; Myocardial Contraction; Myocardial Ischemia; Myocardial Reperfusion Injury; Myocardium; Phosphocreatine; Rats; Rats, Sprague-Dawley; Sodium-Hydrogen Exchangers

In the isolated, perfused working rat heart, ischemia (15 min) decreased mechanical function and also the tissue levels of ATP and creatine phosphate, and increased the tissue levels of lactate and free fatty acids including arachidonic acid. Reperfusion (20 min) did not restore mechanical function, but restored changes of metabolites incompletely except for free fatty acids, which changed further during reperfusion. Drugs were given 5 min before ischemia until the end of ischemia or for the first 10 min after reperfusion. Both dl- and d-propranolol (10 and 30 microM) decreased mechanical function, accelerated the recovery of mechanical function during reperfusion following ischemia, and attenuated ischemia reperfusion-induced metabolic changes. The attenuation of reperfusion-induced metabolic changes was more marked when these drugs were present during reperfusion. d-Propranolol showed a cardioprotection similar to that by dl-propranolol. Timolol (50 microM) did not accelerate the recovery of mechanical function during reperfusion, and did not attenuate the reperfusion-induced metabolic changes. These results suggest that d-propranolol, like dl-propranolol, has a cardioprotective effect which is probably due to its membrane stabilizing (or sodium channel blocking) action.

Topics: Adenosine Triphosphate; Animals; Coronary Circulation; Fatty Acids, Nonesterified; Male; Myocardial Ischemia; Myocardial Reperfusion; Phosphocreatine; Propranolol; Rats; Rats, Sprague-Dawley; Stereoisomerism

The exact mechanisms underlying reperfusion (RP) injury are unclear but are thought to involve toxic oxygen metabolites such as H2O2. The purpose of our study was to determine whether increasing endogenous catalase (CAT) stores would protect creatine kinase (CK) activity and improve bioenergetics and mechanical function during RP. Rats (n = 6/group) were pretreated with myristic acid (MA) or nothing 6 to 12 hr prior to cardiectomy. Hearts were Langendorff perfused and developed pressure (DP) was monitored during 25 min of 37 degrees C ischemia and 10 or 40 min of RP. CK activity was determined at baseline, end ischemia, and 40 min RP. CAT activity and H2O2 production was assayed at baseline, end ischemia, and 10 min RP. 31P NMR spectra were continuously acquired to determine ATP and phosphocreatine (PCr) concentrations. MA-pretreated hearts demonstrated elevated CAT stores (121 +/- 4%, P < 0.05). No H2O2 was produced during ischemia, and both groups generated significant but equal amounts of H2O2 at RP 10 (P < 0.001 vs preischemia (PI), P = NS between groups). By RP 40, MA-pretreated hearts recovered more DP than did control hearts (75 +/- 5% of PI vs 35 +/- 4% of PI, P < 0.001) and retained more CK activity as well (66 +/- 4% vs 52 +/- 2%, P < .05). PCr/ATP ratios of control hearts were abnormally elevated above baseline and that of MA hearts during RP (2.4 +/- 0.1 vs 1.85 +/- 0.08, P < 0.05 at RP 40).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adenosine Triphosphate; Animals; Catalase; Creatine Kinase; Energy Metabolism; Heart; In Vitro Techniques; Magnetic Resonance Spectroscopy; Male; Myocardial Contraction; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Peroxides; Phosphocreatine; Phosphorus; Rats; Rats, Sprague-Dawley

This study investigates how far mitochondrial swelling in the ischemic heart is influenced by factors pertaining to anaerobic energy turnover. Canine hearts were arrested by aortic cross clamping or cardioplegically with St. Thomas or HTK solution and incubated at 25 degrees C in the solution used for cardiac arrest. Samples of the left ventricle were taken at the end of cardiac arrest and during ischemia for structural evaluation and biochemical analysis. The extracellular pH in the interventricular septum was measured. Mitochondrial swelling was determined with the surface to volume ratio, a parameter independent of the reference space. Values obtained for different swelling were related to defined metabolite concentrations and pHe values to establish possible correlations between structural and biochemical parameters in the ischemic heart. At the onset of ischemia and during the breakdown of creatine phosphate (CP) to 3 mumol/g wet weight mitochondrial volume depends on the method of cardiac arrest and does not increase significantly in any of the three groups. The degree of mitochondrial swelling after depletion of CP correlates with the decline in ATP independent of the form of cardiac arrest. Characteristic values of the surface to volume ratio ascertained at different times of ischemia for all groups correspond to determined ATP concentrations. Acid pHe values seem to intensify mitochondrial swelling. With increased lactate concentrations mitochondria swell, but first initially the degree of swelling differs significantly in the forms of cardiac arrest investigated. Thus, the surface to volume ratio is a powerful and valid ultrastructural parameter, which makes correlations between mitochondrial structure and metabolism possible and furthermore indicates a strong correlation between mitochondrial swelling and ATP-concentration in the ischemic heart.

Topics: Adenosine Triphosphate; Animals; Dogs; Hydrogen-Ion Concentration; Lactates; Lactic Acid; Microscopy, Electron; Mitochondria, Heart; Mitochondrial Swelling; Myocardial Ischemia; Myocardium; Phosphocreatine

The aim was to examine differences between the postischaemic functional and biochemical recovery of adult and aged hypertrophied hearts.. Isolated hypertrophied hearts of adult and aged spontaneously hypertensive rats (SHRadult; SHRaged) and normal hearts of age matched Wistar-Kyoto rats (WKYadult; WKYaged) were perfused in an ejecting heart preparation. Haemodynamic function was monitored before and after 45 min of ischaemia. Coronary effluent samples and tissue biopsies were taken for biochemical analysis.. After ischaemia, in SHRadult and WKYadult the maximum positive first derivative of the left ventricular pressure (dP/dtmax) was restored to 105% and 97% respectively of the preischaemic values. Left ventricular developed pressure recovered to 80% (SHRadult) and 97% (WKYadult), while cardiac output reached 71% (SHRadult) and 99% (WKYadult) of preischaemic levels. In SHRaged and WKYaged the dP/dtmax recovered to 26% and 60% respectively (both p < 0.05 compared to the preischaemic values). The left ventricular developed pressure recovered to 36% in SHRaged and to 73% in WKYaged (both p < 0.05), while cardiac output was restored to 6% in SHRaged and 38% in WKYaged (both p < 0.05). Throughout reperfusion, left ventricular end diastolic pressure remained significantly elevated in SHRaged, and was associated with a prominent subendocardial underperfusion, suggesting an impaired diastolic functional recovery. Overall haemodynamic recovery was significantly better in the WKYaged than in the SHRaged. The preischaemic total adenine nucleotides content was comparable in all groups, but creatine phosphate levels were significantly lower in both aged groups than in adult groups. In all but the WKYadult, the total adenine nucleotides were depressed upon reperfusion, while creatine phosphate normalised, except in SHRaged. SHRaged lost more lactate dehydrogenase and tended to lose more xanthine and uric acid than other groups.. The aged hypertrophied heart shows a higher vulnerability to ischaemic damage than the adult hypertrophied heart. This phenomenon is associated with subendocardial underperfusion, increased membrane damage and inadequate recovery of creatine phosphate levels.

Topics: Adenosine Diphosphate; Adenosine Triphosphate; Aging; Animals; Cardiomegaly; Heart; Hypertension; Myocardial Ischemia; Myocardium; Perfusion; Phosphocreatine; Rats; Rats, Inbred SHR; Rats, Inbred WKY

1. The benzoylguanidine derivative Hoe 694 ((3-methylsulphonyl-4- piperidino-benzoyl) guanidine methanesulphonate) was characterized as an inhibitor of Na+/H+ exchange in rabbit erythrocytes, rat platelets and bovine endothelial cells. The potency of the compound was slightly lower or comparable to ethylisopropyl amiloride (EIPA). 2. To investigate a possible cardioprotective role of the Na+/H+ exchange inhibitor Hoe 694, rat isolated working hearts were subjected to ischaemia and reperfusion. In these experiments all untreated hearts suffered ventricular fibrillation on reperfusion. Addition of 10(-7) M Hoe 694 to the perfusate almost abolished reperfusion arrhythmias in the rat isolated working hearts. 3. Hoe 694 reduced the release of lactate dehydrogenase (LDH) and creatine kinase (CK), which are indicators of cellular damage during ischaemia, into the venous effluent of the hearts by 60% and 54%, respectively. 4. The tissue content of glycogen at the end of the experiments was increased by 60% and the high energy phosphates ATP and creatine phosphate were increased by 240% and 270% respectively in the treated hearts as compared to control hearts. 5. Antiischaemic effects of the Na+/H+ exchange inhibitor, Hoe 694, were investigated in a second experiment in anaesthetized rats undergoing coronary artery ligation. In these animals, pretreatment with Hoe 694 caused a dose-dependent reduction of ventricular premature beats and ventricular tachycardia as well as a complete suppression of ventricular fibrillation down to doses of 0.1 mg kg-1, i.v. Blood pressure and heart rate remained unchanged. 6. We conclude that the new Na+/H+ exchange inhibitor, Hoe 694, shows cardioprotective and antiarrhythmic effects in ischaemia and reperfusion in rat isolated hearts and in anaesthetized rats. In view of the role which Na+/H+ exchange seems to play in the pathophysiology of cardiac ischaemia these effects could probably be attributed to Na+/H+ exchange inhibition.

Topics: Adenosine Triphosphate; Amiloride; Anesthesia; Animals; Blood Platelets; Cattle; Endothelium, Vascular; Erythrocyte Membrane; Female; Glycogen; Guanidines; In Vitro Techniques; Ion Exchange; Male; Myocardial Ischemia; Phosphocreatine; Potassium; Rabbits; Rats; Rats, Sprague-Dawley; Rats, Wistar; Sodium; Sulfones

1. In isolated Langendorff-perfused, electrically-paced, hearts of guinea-pigs, global low-flow-ischaemia (LFI; at 0.7 ml min-1) resulted in marked increases in the rates of release of lactate, lactate dehydrogenase (LDH) and creatine kinase (CK) over a 30 min period. At the end of the LFI period, tissue ATP content was significantly reduced from a control value of 11.8 +/- 0.8 (5) to 5.6 +/- 0.8 (5) mumol g-1 dry weight. 2. The presence of ranolazine [(+/-)-N-(2,6-dimethyl-phenyl)-4[2-hydroxy-3-(2-methoxy-phenoxyl)- propyl] - l-piperazine acetamide dihydro-chloride; RS-43285-193] at 10 microM, from 20 min prior to and during LFI, resulted in significant reductions in the release of lactate, LDH and CK during the ischaemic period and a significant preservation of tissue ATP (9.0 +/- 1.1 (6) mumol g-1 dry wt.). Ranolazine did not prevent the reductions in creatine phosphate or glycogen observed in LFI, nor did it have any significant effects on any contractile parameters before or during the LFI period. 3. Neither ranolazine nor LFI affected the total amounts of tissue pyruvate dehydrogenase (PDH) activity; however, the significant reduction in the amount of active, non-phosphorylated PDH caused by LFI (from 88.2 +/- 5.5 to 44.2 +/- 3.2% of total activity) was partially but significantly prevented by ranolazine (67.2 +/- 6.8%). This effect of ranolazine on PDH may be part of the mechanism whereby the compound reduces lactate release and preserves tissue ATP during ischaemia.

Topics: Acetanilides; Adenosine Triphosphate; Angina Pectoris; Animals; Creatine Kinase; Female; Glycogen; Guinea Pigs; Heart; In Vitro Techniques; L-Lactate Dehydrogenase; Lactates; Lactic Acid; Myocardial Ischemia; Myocardium; Perfusion; Phosphocreatine; Piperazines; Pyruvate Dehydrogenase Complex; Ranolazine

The response of the myocardium to prolonged or chronic ischemia may differ from the well documented changes that occur acutely subsequent to the onset of hypoperfusion. Therefore, we have examined in an instrumented canine model and using spatially localized spectroscopy to achieve transmural differentiation, the myocardial HEP and Pi levels as well as wall thickening in situ during prolonged ischemia induced by sustained coronary artery stenosis. The results demonstrate that subtotal coronary artery occlusion causes immediate and transmurally inhomogeneous decreases in the myocardial HEP content and increase in the Pi/CP ratio; however, during prolonged mild hypoperfusion, metabolic changes occur which lead to statistically significant recovery of CP (but not ATP) and disappearance of Pi despite the persistence of reduced blood flow and oxygen supply. Upon release of the occlusion, the previously ischemic muscle recovered blood flow, and some (but not all) of its preischemic contractile function without parallel changes in the HEP levels. It is concluded that normal HEP and Pi levels cannot be equated with either the absence of underperfusion or insensitivity of NMR spectroscopy to ischemia. Rather, it is imperative that both functional and spectroscopic measurements are performed simultaneously to distinguish between ischemic myocardium which is adapted versus unadapted to the hypoperfusion.

Topics: 2,3-Diphosphoglycerate; Adenosine Triphosphate; Animals; Coronary Circulation; Coronary Disease; Diphosphoglyceric Acids; Dogs; Endocardium; Heart Ventricles; Magnetic Resonance Spectroscopy; Myocardial Ischemia; Myocardium; Pericardium; Phosphates; Phosphocreatine; Phosphorus; Time Factors

Adaptation to stress was produced by eight immobilizations of rats for 1 hour every other day. The effects of 25-min ischemia and subsequent 50-min reperfusion on the heart contractile function and energy metabolism were studied. In the adapted rats, the velocities of contraction and relaxation as well as the developed pressure restored during reperfusion much faster than in the controls. The NMR-study showed that a drastic fall of creatine phosphate (CP) and ATP during ischemia was followed by a rapid CP restoration, a Pi drop and a slow ATP restoration during reperfusion. In the adapted animals, the CP restoration was twice as rapid as in the controls. It is obvious that in adaptation to stress the heart function and the system of CP resynthesis appear to be significantly more resistant to ischemia stroke and this is why they restore their activity faster than in the controls.

Topics: Adaptation, Physiological; Adenosine Triphosphate; Animals; Heart; In Vitro Techniques; Magnetic Resonance Spectroscopy; Male; Myocardial Ischemia; Myocardial Reperfusion Injury; Myocardium; Phosphocreatine; Rats; Rats, Wistar; Restraint, Physical; Stress, Physiological; Time Factors

Although standard blood cardioplegia provides good myocardial protection for cardiac operations in adults, protection of the cyanotic, immature myocardium remains suboptimal. Calcium, which has been implicated in reperfusion injury and in the development of "stone heart" in mature myocardium, is routinely lowered in standard cardioplegic solutions. Immature, neonatal myocardium has lower intracellular calcium stores and is more reliant on extracellular calcium for contraction. To determine if normocalcemic cardioplegia would result in improved cardiac function in the neonatal heart, we conducted a series of experiments using an isolated, blood-perfused working heart model. Thirty-two neonatal piglet hearts (24 to 48 hours) were excised without intervening ischemia and were placed directly on a blood-perfused circuit. Baseline stroke work index was assessed. Hearts were then arrested with cold cardioplegic solution delivered at 45 mm Hg for 2 minutes: group I, low-calcium blood cardioplegic solution (Ca = 0.6 mmol/L); group II, normal-calcium blood cardioplegic solution (Ca = 1.1 mmol/L); group III, University of Wisconsin solution; and group IV, University of Wisconsin solution with added calcium (Ca = 1.0 mmol/L). Cardioplegic solution was administered every 20 minutes for 2 hours and topical hypothermia was used. Hearts were then reperfused with warm whole blood. Functional recovery, expressed as a percentage of control stroke work index, was determined minutes after reperfusion. Hearts preserved with normocalcemic cardioplegic solution (groups II and IV) had complete functional recovery at 60 minutes, whereas hearts preserved with low-calcium cardioplegic solution (groups I and III) achieved functional recoveries of only 80% and 65%, respectively, at a left atrial pressure of 9 mm Hg. Electron micrographs taken 1 hour after reperfusion showed minimal edema and only mild myofibrillar changes. They were identical in both the low-calcium and normocalcemic groups. Complete functional recovery is possible in immature myocardium when calcium is added to either blood or an intracellular crystalloid cardioplegic solution. The addition of calcium does not result in ultrastructural damage and does result in good functional recovery.

Topics: Adenosine Triphosphate; Animals; Animals, Newborn; Calcium; Cardioplegic Solutions; Heart Arrest, Induced; Microscopy, Electron; Myocardial Ischemia; Myocardium; Phosphocreatine; Stroke Volume; Swine

Intracellular sodium (Nai) concentrations rose immediately and progressively during ischemia in the isolated heart. The intracellular double quantum filtered sodium coherence (DQ) intensity also increased during ischemia. However, when normalized for Nai, the DQ intensity began to fall after 40 min of ischemia, and remained depressed during reperfusion.

Topics: Adenosine Triphosphate; Animals; Calcium; Cytoplasm; Magnetic Resonance Spectroscopy; Myocardial Ischemia; Myocardial Reperfusion; Phosphates; Phosphocreatine; Phosphorus; Rats; Rats, Sprague-Dawley; Sodium; Time Factors

The relationships between pressure rate product (PRP) and flux (PCr-->ATP) or flux(Pi-->ATP) were studied in isolated perfused rat hearts by the method of saturation transfer using 31P-NMR during the preischemic and reperfusion periods. The hearts were made ischemic for 15 min, followed by 60 min of reperfusion. PRP was almost completely depressed, and recovered to 60% of the control level (preischemic period) after reperfusion. The ATP level during reperfusion was significantly decreased, whereas there was no significant change in PCr level. Pi level of reperfused hearts was significantly higher than that in the control. Both flux(PCr-->ATP) and flux(Pi-->ATP) were significantly decreased during the reperfusion period (both p < 0.05). However, the flux(PCr-->ATP)/PRP ratio during reperfusion did not differ from that of the control. This result indicates that the decrease in flux(PCr-->ATP) was matched by a similar decrease in cardiac performance. In contrast, the flux(Pi-->ATP)/PRP ratio during reperfusion was significantly decreased compared to that of control. These results suggest that the stunned heart needs less ATP turnover in proportion to its depressed contractile activity, and flux(Pi-->ATP) may lmit the recovery of postischemic performance.

Topics: Adenosine Triphosphate; Animals; Disease Models, Animal; Magnetic Resonance Spectroscopy; Male; Myocardial Ischemia; Myocardial Reperfusion; Phosphocreatine; Phosphorus; Rats; Rats, Wistar; Ventricular Function, Left

The protective effects of sanguineous and asanguineous St. Thomas' cardioplegia (SCP and ACP) on post-ischemic vasodilator responsiveness, left ventricular developed pressure and end-diastolic pressure (LVDP and LVEDP), tissue adenosine triphosphate (ATP) and creatine phosphate (CP) contents were compared in the isolated blood-perfused rat heart. Five groups of hearts were studied: the controls (n = 8) perfused with blood (from a support rat) for 50 min (37 degrees C), versus hearts (n = 14/group) arrested by a single infusion of either cardioplegic solution (15 degrees C) prior to global ischemia (15 degrees C) and blood reperfusion (37 degrees C). After 2 or 4 h of ischemia and 50 min of reperfusion, endothelium-dependent vasodilator acetylcholine (1 microgram) induced a 10 +/- 0.5 and 8.5 +/- 0.5% reduction, respectively, in coronary resistance, in the SCP groups, but only a 6.5 +/- 0.6 and 4.5 +/- 0.5% reduction (P < 0.05), respectively, in the ACP groups. However, there were no significant differences in LVDP, LVEDP, tissue ATP and CP contents, and endothelium-independent vasodilator response to nitroglycerin between the two cardioplegic groups. In a further study, rat hearts (n = 8/group) were arrested with SCP (magnesium concentration < 0.5, 5.0 or 16.0 mmol/l, in groups 1, 2 and 3) and subjected to 4 h of global ischemia (15 degrees C) followed by 50 min of blood reperfusion (37 degrees C). At the end of reperfusion, LVDP (at a ventricular volume of 180 microliters) was 60 +/- 3.4, 72 +/- 3.5 and 70 +/- 3.2 in groups 1, 2 and 3, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acetylcholine; Adenosine Triphosphate; Analysis of Variance; Animals; Blood Pressure; Cardioplegic Solutions; Endothelium, Vascular; Female; Magnesium; Male; Myocardial Contraction; Myocardial Ischemia; Myocardial Reperfusion; Nitroglycerin; Phosphocreatine; Rats; Rats, Wistar; Time Factors; Vasodilation

Increased concentrations of intracellular H+, Na+, and Ca2+ have been observed during ischemia, and these ionic alterations have been correlated with several indexes of cell injury in a number of studies. Recently, adenosine was proposed to play a role in ischemic preconditioning, since adenosine antagonists block the protective effects of these brief intermittent periods of ischemia and reflow. In this study we evaluated the protective effects of adenosine (20 microM) on high-energy phosphate metabolism, H+ and Ca2+ accumulation, and glycolytic rate during 30 min of no-flow ischemia. Adenosine was observed to slow the onset of contracture (7.0 +/- 0.9 min) and to improve left ventricular developed pressure (62 +/- 7% of initial) during reperfusion compared with untreated hearts (5.0 +/- 0.6 min and 18 +/- 5%, respectively). Intracellular Ca accumulation at the end of 30 min of ischemia was higher in the untreated (2,835 +/- 465 nM) than in the adenosine-treated (2,064 +/- 533 nM) hearts, while intracellular pH fell more in the untreated (5.85 +/- 0.17) than in the adenosine-treated hearts (6.27 +/- 0.16). Glycolytic rate and the rate of ATP decline were significantly attenuated in the adenosine-treated hearts during ischemia. Thus adenosine treatment slowed the rate of metabolism and delayed the accumulation of H+ and Ca2+ during ischemia, resulting in better recovery of function upon reflow.

Topics: Adenosine; Adenosine Triphosphate; Animals; Calcium; Energy Metabolism; Glycolysis; Heart; Homeostasis; Hydrogen-Ion Concentration; In Vitro Techniques; Kinetics; Magnetic Resonance Spectroscopy; Male; Myocardial Ischemia; Myocardium; Phosphates; Phosphocreatine; Rats; Rats, Sprague-Dawley; Time Factors; Ventricular Function, Left

The aim was to examine the effect on cardiac function, energy metabolism, and calcium uptake of either prostaglandin I2 (PGI2, prostacyclin) or prostaglandin F2 alpha (both 28.6 nM) on the response of isolated rat hearts to 25 min of total global ischaemia with or without 30 min reperfusion.. Rat hearts were perfused by the Langendorff method and function assessed by left ventricular pressure. Energy metabolites were measured using enzymatic techniques and 45Ca2+ uptake determined by radioisotopic analysis.. Although there was no effect of either prostaglandin on contractile depression during ischaemia, both compounds accelerated the onset of and increased the magnitude of ischaemic contracture. High energy phosphate content at the end of the ischaemic period was not affected by prostaglandin treatment; however, tissue lactate levels were increased by PGI2 as was tissue calcium content. Under control conditions mean recovery of left ventricular developed pressure ranged from 66% to 83%. In the presence of PGI2 and PGF2 alpha, recovery of developed pressure was reduced to 20% and 38% of preischaemic values, respectively. The reduced recovery in developed pressure was accompanied by an approximately threefold increase in diastolic pressure (p < 0.05). The depression of functional recovery in reperfused hearts treated with prostaglandins was associated with various disturbances of cellular metabolism including depressed ATP and creatine phosphate content and increased tissue lactate and calcium following 30 min of reperfusion. A significant correlation was found between the changes in developed pressure and diastolic pressure during reperfusion and the reduction in ATP and creatine phosphate repletion. The deficit in recovery of ventricular function also correlated significantly with increased lactate and calcium accumulation in the reperfused heart.. Low concentrations of PGI2 and PGF2 alpha can depress contractile recovery of the globally ischaemic heart through a mechanism associated with altered cellular energy metabolism and increased calcium accumulation.

Topics: Adenosine Triphosphate; Animals; Blood Pressure; Calcium; Dinoprost; Energy Metabolism; Epoprostenol; In Vitro Techniques; Lactates; Lactic Acid; Male; Myocardial Contraction; Myocardial Ischemia; Myocardial Reperfusion; Myocardial Reperfusion Injury; Myocardium; Phosphocreatine; Rats; Rats, Sprague-Dawley; Ventricular Function, Left

We assessed whether local inhibition of myocardial converting enzyme by captopril and zofenopril reduces the functional and metabolic damage caused by ischemia and reperfusion. First we investigated the effects of zofenopril and captopril on the mechanical function, cellular redox state, and norepinephrine (NE) content of isolated and aerobically perfused rabbit hearts. Both drugs failed to modify the myocardial redox state. At concentrations > 10(-6) M, zofenopril, but not captopril, caused a reduction in myocardial NE content. At 10(-4) M, both drugs caused a reduction in developed pressure and an increase in diastolic pressure and release of creatine phosphokinase (CPK). Second we investigated their effects on ischemic and reperfused myocardium. Both drugs exerted a cardioprotection; zofenopril was always more potent than captopril. Recovery of developed pressure on reperfusion improved, and peak release of NE was reduced, as was release of CPK. Calcium homeostasis and mitochondrial function were maintained. Captopril had no effect on occurrence of oxidative stress during reperfusion, whereas zofenopril reduced it. In hearts treated with the converting enzyme inhibitors, peak release of NE was correlated to mitochondrial calcium content, production of ATP, and recovery of mechanical function on reperfusion. These data suggest that the cardioprotective effect of zofenopril and captopril is independent of hemodynamic changes or reduction of the toxicity of oxygen free radicals and that it could be related to a reduction in release of NE.

Topics: Adenosine Triphosphate; Angiotensin-Converting Enzyme Inhibitors; Animals; Calcium; Captopril; Creatine Kinase; Hemodynamics; In Vitro Techniques; Lactates; Male; Mitochondria, Heart; Myocardial Ischemia; Myocardial Reperfusion Injury; Myocardium; Norepinephrine; Oxidation-Reduction; Phosphocreatine; Rabbits

Topics: Adenine Nucleotides; Animals; Animals, Newborn; Cell Hypoxia; Cells, Cultured; Energy Metabolism; Guanosine Triphosphate; Heart; Heart Rate; Myocardial Contraction; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; NAD; Oxygen; Partial Pressure; Phosphocreatine; Rats

The protective effect of L-carnitine, coenzyme Q10 and their combination on haemodynamic and metabolic variables has been investigated in isolated perfused working rat hearts after 10 min of global normothermic ischaemia followed by 60 min of reperfusion. In untreated rats or in rats treated only with L-carnitine or with coenzyme Q10, this experimental condition did not induce any irreversible myocardial injury as measured by leakage of cardiac enzymes; however, it decreased some haemodynamic parameters such as cardiac output and minute work, as well as the ATP concentration and the total adenine nucleotide pool. No variations in haemodynamic and metabolic parameters were observed in the rats treated with L-carnitine plus coenzyme Q10. In the perfusate of the hearts of the rats treated with both compounds, a lower purine release (a good index of myocardial energy balance) was also obtained. Although the molecular mechanisms remain to be defined, it appears that the association of L-carnitine and coenzyme Q10 is more effective than using these compounds separately. The complementary and synergic actions of L-carnitine and coenzyme Q10 on metabolism and against peroxidation by oxygen reaction species may explain the efficacy of their association.

Topics: Animals; Carnitine; Chromatography, High Pressure Liquid; Coenzymes; Drug Combinations; Hemodynamics; In Vitro Techniques; Male; Myocardial Ischemia; Myocardial Reperfusion Injury; Myocardium; Nucleotides; Phosphocreatine; Purines; Rats; Rats, Sprague-Dawley; Ubiquinone

The aim of this study was to determine whether exercise training produces a myocardium intrinsically more tolerant to ischemic-reperfusion injury. Male Fischer 344 rats were treadmill trained for 11-16 wk at one of the following intensities: LOW (20 m/min, 0% grade, 60 min/day), moderate (MOD; 30 m/min, 5% grade, 60 min/day) or intensive (INT; 10 bouts of alternating 2-min runs at 16 and 60 m/min, 5% grade). Cardiac function was evaluated both before and after 25 min of global, zero-flow ischemia in the isolated, working heart model. Compared to hearts from sedentary (SED) rats, postischemic cardiac output (CO) and work were significantly higher in all trained groups. Percent recovery of CO (relative to preischemia) was 36.0 +/- 7.1 in SED and 61.2 +/- 6.5, 68.1 +/- 9.3, and 73.2 +/- 5.0 in LOW, MOD, and INT, respectively. Postischemic increases in stroke volume with increased preload and cardiac work at high work load were significantly higher in INT compared with SED. Coronary flow during initial retrograde reperfusion was significantly enhanced with training and correlated with subsequent recovery of CO (R2 = 0.613). Furthermore, trained hearts had higher phosphocreatine (P less than 0.05) and ATP (P less than 0.01) contents after 45 min reperfusion. It is concluded that exercise training results in an intrinsic myocardial adaptation, allowing greater recovery of cardiac pump function after global ischemia in the isolated rat heart.

Topics: Adenosine Triphosphate; Animals; Heart; In Vitro Techniques; L-Lactate Dehydrogenase; Male; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Phosphocreatine; Physical Conditioning, Animal; Rats; Rats, Inbred F344; Stroke Volume

Repeated brief episodes of ischaemia "precondition" the myocardium and protect it during a subsequent period of sustained ischaemia. We subjected isolated rat hearts to sustained ischaemia with or without reperfusion after different schedules of preconditioning. We demonstrated that preconditioning with three 5 min periods of ischaemia separated by 10 min periods of reperfusion permits better functional recovery than preconditioning with three 2 min ischaemic periods separated by 10 min of reperfusion. Preconditioned hearts had creatine phosphate and adenine nucleotide levels comparable to those in the aerobically perfused controls, and showed good functional recovery. Although the mechanisms by which preconditioning protects the heart from subsequent ischaemic damage are unclear, we speculate that preservation of mitochondrial function and oxidative energy production is involved.

Topics: Adenine Nucleotides; Animals; Creatine Kinase; Energy Metabolism; Glycogen; Heart; In Vitro Techniques; L-Lactate Dehydrogenase; Lactates; Lactic Acid; Male; Myocardial Contraction; Myocardial Ischemia; Myocardial Reperfusion Injury; Myocardium; Phosphocreatine; Rats; Rats, Sprague-Dawley; Time Factors

The effectiveness of the University of Wisconsin solution on extended myocardial preservation was examined in this study using phosphorus 31-nuclear magnetic resonance spectroscopy. Isolated perfused rat hearts were arrested and stored in four preservation solutions: group 1, modified Krebs-Henseleit solution; group 2, modified St. Thomas' Hospital solution; group 3, oxygenated modified St. Thomas' Hospital solution containing 11 mmol/L glucose; and group 4, University of Wisconsin solution. The changes in myocardial high energy phosphate profiles and the intracellular pH values were measured during 12 hours of cold (4 degrees C) global ischemia and 90 minutes of normothermic reperfusion. Following ischemia, the hearts were assessed for hemodynamic recovery and myocardial water content. During ischemia, adenosine triphosphate depletion was observed in all groups; however, after 5 hours of ischemia, the adenosine triphosphate levels were significantly higher in group 3 compared with the other groups (adenosine triphosphate levels at 6 hours in mumol/gm dry weight: group 3, 7.6; group 4, 3.2; group 2, < 1; p < 0.025). The tissue water content at the end of ischemia was lower with the University of Wisconsin solution compared with the modified St. Thomas' Hospital solution or the oxygenated modified St. Thomas' Hospital solution (in ml/gm dry weight: group 4, 3.0; group 2, 4.4; group 3, 3.9; p < 0.05). The adenosine triphosphate repletion during reperfusion was greater with the University of Wisconsin solution compared with the modified St. Thomas' Hospital solution or the oxygenated modified St. Thomas' Hospital solution (12 mumol/gm dry weight in group 4; 8.1 in group 2; 9.0 in group 3; p < 0.05). Similar findings were obtained for the recovery of left ventricular pressure (in percent of preischemic control: group 4, 70%; group 2, 42%; group 3, 52%; p < 0.01) and coronary flow (group 4, 61%; group 2, 49%; group 3, 49%; p < 0.05). These data suggest that preservation with the University of Wisconsin solution affords improved hemodynamic recovery, enhanced adenosine triphosphate repletion, and reduced tissue edema upon reperfusion; however, oxygenated St. Thomas' Hospital solution with glucose is associated with the preservation of higher myocardial adenosine triphosphate levels during prolonged cold global ischemia. In conclusion, these data indicate that the University of Wisconsin solution might improve graft tolerance of ischemia in clinical heart transp

Topics: Adenosine; Adenosine Triphosphate; Allopurinol; Animals; Bicarbonates; Body Water; Calcium Chloride; Cardioplegic Solutions; Glutathione; Heart; Hemodynamics; Hydrogen-Ion Concentration; Insulin; Magnesium; Magnetic Resonance Spectroscopy; Male; Myocardial Ischemia; Myocardium; Organ Preservation; Organ Preservation Solutions; Phosphocreatine; Phosphorus; Potassium Chloride; Raffinose; Rats; Rats, Sprague-Dawley; Sodium Chloride; Solutions; Treatment Outcome

The metabolic effects of adenosine on regionally ischemic myocardium were investigated in an open-chest rabbit model by means of phosphorus 31 nuclear magnetic resonance (NMR) spectroscopy. Sixteen anesthetized New Zealand white rabbits were subjected to thoracotomy; a reversible snare occluder was placed around a large branch of the left circumflex coronary artery, and an NMR surface coil was positioned adjacent to the myocardium perfused by this vessel. The animals were placed in a 2.0 T CSI spectrometer (GE Medical Systems, Fremont, Calif.), and baseline spectra were acquired. Eight animals were treated with intravenous adenosine (25 mg/kg), and eight rabbits served as control subjects. All animals were subjected to a 10-minute period of ischemia followed by a period of reperfusion. NMR spectra were acquired during both intervals. During the occlusion period, expected increases in inorganic phosphate levels and decreases in phosphocreatine levels were observed in both groups; however, inorganic phosphate increased less in adenosine-treated animals (adenosine: 33 +/- 2.8% total spectral area during occlusion vs control: 41 +/- 3.1%) and phosphocreatine diminished less with adenosine (adenosine: 26 +/- 3% vs control: 13 +/- 1.2%; p < 0.002). No significant differences were seen in beta-adenosine triphosphate levels. In both groups the metabolite levels during reperfusion recovered to near baseline values, although phosphocreatine remained slightly higher in the treated group during early reperfusion. An apparent cardioprotective effect of adenosine on relative phosphocreatine and inorganic phosphate levels can be observed in intact rabbits by means of phosphorus 31 NMR spectroscopy.

Topics: Adenosine; Adenosine Triphosphate; Animals; Heart; Magnetic Resonance Spectroscopy; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Phosphates; Phosphocreatine; Phosphorus; Rabbits

Experiments were conducted on a model of an isolated functioning rat heart to study myocardial protection by normothermic cardioplegic reperfusion (NCR) with phosphocreatine (PC) in 30-minute total ischemia at 37 degrees C. Five series of experiments were performed: (1) cardioplegia (K+ 30 mM/l, Mg2+ 15 nM/l, osmolarity 330 MOSM/l), ischemia, NCR not applied; (2) the same solution was introduced in the preischemic period, ischemia, NCR (K+ 15 mM/l, Mg2+ 15 mM/l, osmolarity 360 MOSM/l); (3) with the same experimental schedule, PC (10 mmol/l) was added to the cardioplegic solution in the preischemic period; (4) in a similar experiment PC was added in the stage of NCR; (5) PC administered in the preischemic stage and in NCR. Restoration of heart functional parameters, rate and ejection of lactate dehydrogenase into the perfusate were compared. The results of the experiment bear evidence that NCR protects the myocardium from reperfusion damage in normothermic ischemia. The optimal cardioprotective effect of PC is produced when it is administered in the preischemic stage. PC added to the solution for NCR has no positive effect on the restoration of heart functional parameters.

Topics: Animals; Cardioplegic Solutions; Heart; In Vitro Techniques; Male; Myocardial Ischemia; Myocardial Reperfusion; Myocardial Reperfusion Injury; Phosphocreatine; Rats; Rats, Wistar; Temperature

It was examined whether lactate influences postischaemic hemodynamic recovery as a function of the duration of ischaemia and whether changes in high-energy phosphate metabolism under ischaemic and reperfused conditions could be held responsible for impairment of cardiac function. To this end, isolated working rat hearts were perfused with either glucose (11 mM), glucose (11 mM) plus lactate (5 mM) or glucose (11 mM) plus pyruvate (5 mM). The extent of ischaemic injury was varied by changing the intervals of ischaemia, i.e. 15, 30 and 45 min. Perfusion by lactate evoked marked depression of functional recovery after 30 min of ischaemia. Perfusion by pyruvate resulted in marked decline of cardiac function after 45 min of ischaemia, while in glucose perfused hearts hemodynamic performance was still recovered to some extent after 45 min of ischaemia. Hence, lactate accelerates postischaemic hemodynamic impairment compared to glucose and pyruvate. The marked decline in functional recovery of the lactate perfused hearts cannot be ascribed to the extent of degradation of high-energy phosphates during ischaemia as compared to glucose and pyruvate perfused hearts. Glycolytic ATP formation (evaluated by the rate of lactate production) can neither be responsible for loss of cardiac function in the lactate perfused hearts. Moreover, failure of reenergization during reperfusion, the amount of nucleosides and oxypurines lost or the level of high-energy phosphates at the end of reperfusion cannot explain lactate-induced impairment. Alternatively, the accumulation of endogenous lactate may have contributed to ischaemic damage in the lactate perfused hearts after 30 min of ischaemia as it was higher in the lactate than in the glucose or pyruvate perfused hearts. It cannot be excluded that possible beneficial effects of the elevated glycolytic ATP formation during 15 to 30 min of ischaemia in the lactate perfused hearts are counterbalanced by the detrimental effects of lactate accumulation.

Topics: Adenosine; Adenosine Triphosphate; Animals; Energy Metabolism; Glucose; Glycogen; Guanosine Triphosphate; Heart; Hypoxanthine; Hypoxanthines; In Vitro Techniques; Inosine; Inosine Monophosphate; Kinetics; Lactates; Male; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Phosphocreatine; Pyruvates; Rats; Rats, Inbred Lew; Time Factors; Xanthine; Xanthines