Effect of heart rate reduction by 4-(N-ethyl-N-phenyl-amino)-1,2-dimethyl-6-(methylamino)pyrimidinium chloride on infarct size in dog

Heart rate (HR) reduction may reduce the severity of myocardial ischemia. ZD7288 (4-(N-ethyl-N-phenylamino)-1,2-dimethyl-6-(methylamino)pyrimidinium++ + chloride) is a novel bradycardic agent with a specific effect on the sinoatrial node without having any other direct effects on the heart. In the present study, the effect of ZD7288 on infarct size and regional myocardial function during regional myocardial ischemia and reperfusion was investigated. Seventeen anesthetized open chest dogs (control, n = 8, and ZD7288, n = 9) underwent 1 h of left anterior descendent artery (LAD) occlusion followed by 6 h of reperfusion. In one group, ZD7288 was given intravenously (0.7 mg/kg body weight) 45 min before LAD occlusion. Regional myocardial function was assessed by sonomicrometry as systolic wall thickening fraction (sWTF) in the anteroapical (interest region, IR) and the posterobasal wall (control region, CR). Ischemic regional myocardial blood flow (RMBF) was determined by colored microspheres and infarct size (IS) by triphenyltetrazolium staining. ZD7288 injection decreased HR from 104 +/- 5 to 74 +/- 3 bpm (mean +/- SEM, p < 0.001 vs control, vs baseline), but did not change sWTF. During reperfusion, sWTF of the IR was significantly greater in the ZD7288 group (26 +/- 12 vs -14 +/- 13%, 1 h reperfusion, p < 0.05), while sWTF of CR stayed equal (120 +/- 13 vs 111 +/- 16%, p = ns). IS was markedly reduced in the ZD7288 group (4.7 +/- 1.8 vs 18.0 +/- 5.2% of IR, p < 0.05). There was no difference in ischemic endocardial RMBF (ZD7288 11.0 +/- 4.3 vs control 12.3 +/- 6.5 ml/min/100 g, p = ns). ZD7288 reduces HR without having direct effects on regional myocardial function. This HR reduction leads to a smaller IS and to a better regional functional recovery.

Inotropic effects of glyceryl trinitrate and spontaneous NO donors in the dog heart

BACKGROUND

In vitro, NO has a biphasic effect on myocardial inotropy. To determine the inotropic effect of NO in vivo, we investigated the activity of glyceryl trinitrate (GTN) and the NO donors S-nitroso-N-acetyl-D,L-penicillamine (SNAP) and sodium-(2)-1-(N,N-diethyl-amino)-diazen-1-ium-1,2-diolat+ ++ (DEA/NO) in dogs.

METHODS AND RESULTS

Eight anesthetized open-chest dogs were instrumented for measurement of left ventricular and aortic pressures (tip manometers) and coronary flow (ultrasonic flow probes). Regional myocardial function was assessed by sonomicrometry as systolic wall thickening (sWT), mean systolic thickening velocity (Vs), and regional myocardial stroke work index (RSW). GTN, SNAP, and DEA/NO were infused into the left anterior descending coronary artery (LAD) to achieve defined coronary plasma concentrations of GTN, SNAP (both 10 to 100 micromol/L), and DEA/NO (2 to 20 micromol/L). All drugs increased LAD flow and myocardial contractile function in the LAD-dependent myocardium within the first 120 seconds. The greatest inotropic effect was noted after infusion of DEA/NO (20 micromol/L), which increased sWT by 9.7+/-3.1% from 28.5+/-2.2%, Vs by 10.3+/-3.4% from 9.1+/-1.1 mm/s, and RSW by 7.1+/-2.1% from 200.0+/-22.1 mm Hg x mm (P<.05). At the same time, systemic hemodynamics remained unchanged. Prevention of the flow response to GTN by external narrowing of the LAD did not influence the inotropic effect of GTN.

CONCLUSIONS

Organic nitrates and NO donors evoke a small but constant positive inotropic effect in vivo that is not caused by coronary vasodilation.

Halothane reduces reperfusion injury after regional ischaemia in the rabbit heart in vivo

In addition to having anti-ischaemic effects, halothane can protect isolated rat hearts and isolated cardiomyocytes against reperfusion injury of the "oxygen paradox" type. The aim of this study was to investigate if halothane can also protect against myocardial reperfusion injury in vivo. Twenty-two rabbits anaesthetized with alpha-chloralose underwent 30 min of occlusion of a major coronary artery and 2 h of subsequent reperfusion. Seven animals received 1 MAC of halothane for the first 15 min of reperfusion (halothane group), and eight animals served as untreated controls (controls group). In seven additional animals, the haemodynamic effects of halothane were antagonized by an i.v. infusion of noradrenaline (halothane-noradrenaline group). We measured cardiac output (CO) by an ultrasonic flow probe around the ascending aorta, left ventricular pressure (LVP) by a tip manometer and infarct size by triphenyltetrazolium staining. Baseline LVP was mean 92 (SEM 4) mm Hg and CO was 289 (16) ml min-1. During coronary occlusion, LVP was reduced to 86 (4)% of baseline and CO to 84 (4)% (similar in all groups). During halothane administration at reperfusion, LVP declined further to 55 (6)% of baseline and CO to 66 (9)% (P < 0.05 halothane group vs control group). Noradrenaline prevented the reduction in LVP (halothane-noradrenaline group 87 (5)% of baseline, control group 84 (6)% and reduction in CO (halothane-noradrenaline group 89 (5)%, control group 83 (6)%. Infarct size was 49 (6)% of the area at risk in controls and was reduced markedly by administration of halothane to 32 (3)% in the halothane group (P < 0.05) and to 30 (3)% in the halothane-noradrenaline group (P < 0.05). Treatment with halothane during the early reperfusion period after myocardial ischaemia protected the myocardium against infarction in vivo, independent of the haemodynamic effect of halothane.

[Effect of magnesium on infarct size after coronary occlusion. Animal experiment studies]

In addition to its antiarrhythmic and antithrombotic effects magnesium is said to have a beneficial effect in patients with acute myocardial infarction. Magnesium can protect myocardial tissue after coronary occlusion and reduces infarct size in experimental models of ischaemia and reperfusion, though the given doses of magnesium are relatively high and differ from clinically reachable serum concentrations. We tested 2 hypotheses in a dog model of ischaemia-reperfusion: 1. The protective effect may be due to a direct, local influence of magnesium on myocardial reperfusion injury. 2. Systemic magnesium treatment with low doses comparable to clinical study regiments may reduce myocardial infarct size. Anaesthetized open chest dogs underwent 1 h of left anterior descending artery occlusion followed by 6 h of reperfusion. 1. Ten animals received intracoronary magnesium aspartate (Mg i.c.) or vehicle infusion (control i.c.) for the first hour of reperfusion to increase regional Mg-concentration by 2 mmol/l. 2. Fourteen animals received intravenous infusion with magnesium potassium aspartate (Mg-K i.v.) or vehicle infusion (control i.v.), beginning 1 h before occlusion until the end of the 6 h reperfusion period. Regional magnesium concentration in the Mg i.c.-group increased to 2.7 +/- 1.00 mmol/l at 45 min of reperfusion. Intravenous infusion raised serum magnesium from 0.71 +/- 0.03 mmol/l to 1.29 +/- 0.14 mmol/l in the Mg-K i.v. group (5 min of reperfusion, p < 0.01 vs. baseline). Infarct size after 6 h reperfusion (TTC staining) was similar in both groups of intracoronary treatment (Mg i.c., 20.6 +/- 5.0; control, 24.4 +/- 8.7% of area at risk; p = n.s.) and intravenous treatment (Mg-K i.v. 18.1 +/- 14.8; control 14.1 +/- 12.2% of area at risk; p = n.s.). Neither regional nor systemic magnesium leads to a clinically relevant reduction of infarct size in the regional ischaemic-reperfused dog heart when it is given in clinically usable doses. The beneficial action of systemic Mg is probably not due to an early direct protective effect on ischaemic-reperfused myocardium but to its antiarrhythmic and antithrombotic effects. Possibly only to high doses of Mg applied under experimental conditions can reduce infarct size.

Effect of halothane on myocardial reoxygenation injury in the isolated rat heart

Several studies have reported a protective effect of halothane on myocardial injury in an ischaemia-reperfusion situation. It is unclear if the protection is a result of the haemodynamic effects of halothane or if halothane has a specific action on ischaemia or reperfusion pathomechanisms. To examine this question, we have used an isolated rat heart model where heart rate (300 beat min-1), ventricular volume and coronary flow are constant. Left ventricular developed pressure (LVDP) and release of creatine kinase (CK) were measured as variables of myocardial performance and cellular injury, respectively. Five control hearts were subjected to 35 min of low-flow (2 ml min-1) anoxic and substrate-free perfusion and were then perfused for 1 h with the oxygenated buffer. In the treatment groups, halothane 0.4 mmol litre-1 was added during the first 30 min of anoxic perfusion (n = 5) or during the first 30 min of reoxygenation (n = 5). In five additional hearts, the effect of halothane 0.4 mmol litre-1 was tested under normoxic conditions. Mean basal CK release was 0.29 (SEM 0.13) iu g-1 min-1 and LVDP was 105.5 (4.0) mm Hg. Under normoxic conditions, halothane reduced LVDP to 52.0 (2.6) mm Hg. In control hearts, the major cell injury occurred at the onset of reoxygenation (CK release increased to 149.1 (9.1) iu g-1 min-1) and functional recovery after 1 h of reoxygenation was poor (control LVDP, 14.2(2.)% of baseline). Halothane during anoxia attenuated myocardial injury only moderately (CK release 50.2(5.7) iu g-1 min-1) and LVDP recovered to 30.8(3.0)% (each P < 0.05 vs control). When halothane was administered at reoxygenation, CK release was reduced to 10.1 (0.9) iu g-1 min-1 and LVDP recovered to 69.4(4.9)% (each P < .05 vs control). We conclude that halothane not only attenuated ischaemic injury but had a specific protective action against reoxygenation injury.

Effect of inotropic stimulation on the synchrony of left ventricular wall motion in a dog model of myocardial stunning

BACKGROUND

Reperfusion after short coronary occlusion induces regional myocardial dysfunction ("stunning"), including asynchrony of left ventricular (LV) wall motion. Contractile function of stunned myocardium can be increased by inotropic stimulation, but whether this has an influence on wall motion asynchrony is unknown.

METHODS

In six anaesthetized dogs, the effect of inotropic stimulation on regional myocardial function, and LV asynchrony was tested after the induction of regional stunning (by 15 min of left circumflex artery side branch occlusion). Regional myocardial function was assessed as mean systolic wall thickening velocity (Vswt) by sonomicrometry in the stunned (posterobasal wall) and normal myocardium (anteroapical wall), and LV asynchrony by the phase difference (phi) of the first Fourier transform of the wall thickness signals.

RESULTS

In the stunned myocardium, Vswt decreased from 8.6 +/- 1.0 to 1.7 +/- 1.4 mm s-1 (mean +/- SEM), P < 0.01, and simultaneously phi increased from 10.8 +/- 3.6 to 85.7 +/- 14.3 degrees, P < 0.01. Intracoronary noradrenaline (NADR, 0.25 microgram) improved Vswt (8.3 +/- 1.4 mm s-1, P < 0.01) in the stunned region and changed phi to -38.1 +/- 18.0 degrees, P < 0.05. Systemic NADR (5 micrograms) also increased Vswt of the stunned region (to 3.8 +/- 2.1 mm s-1, P < 0.05), but left phi unchanged (82.9 +/- 19.8 degrees).

CONCLUSION

Regional function of stunned myocardium can be augmented by inotropic stimulation with noradrenaline, but this does not result in an improvement of LV wall motion asynchrony during systemic inotropic stimulation.

Unilateral changes of sympathetic tone to the heart impair left ventricular function

BACKGROUND

Different regions within the left ventricle are preferentially supplied by the left or right sympathetic system. In order to characterize different influences of left vs right sympathetic lateralization on LV function, haemodynamic effects of right and left stellate ganglion stimulations (RSGS and LSGS) as well as a right sympathetic block (RSB) were compared.

METHODS

Seven alpha-chloralose anaesthetized open chest dogs were instrumented for measurement of LV pressure (tip manometers) and regional LV wall thickness (WT, sonomicrometry) in the antero-apical wall (AW, innervated by right stellate ganglion) and postero-basal wall (PW, left stellate ganglion). Timing of regional myocadial wall motion was evaluated by the phase of the first Fourier transform of the WT signals, LV asynchrony by the phase difference (phi) between both regions, and LV diastolic function by the time constant of isovolumic relaxation (tau). Measurements were performed before and after RSB (5 ml of lidocaine 1%); in 6 dogs of this group, RSGS and LSGS (4 V, 0.2 ms, 20 Hz) were performed before RSB. In order to investigate a regional inotropic stimulation without systemic effect, 6 additional dogs received intracoronary noradrenaline injections (NIC, 0.25 microgram) into the left circumflex artery perfused myocardium.

RESULTS

LSGS and NIC led to an earlier PW-motion within the cardiac cycle (phase reduction by 40.0 +/- 15.0 degree (SEM) and 55.5 +/- 11.2 degrees) and RSGS induced an earlier AW-motion (by 33.7 +/- 15.2 degrees). After RSB, AW-motion was delayed (38.1 +/- 9.2 degrees). The consequence was an asynchronous wall motion pattern after all interventions (change in phi: LSGS-64.7 +/- 18.7 degrees, RSGS 41.1 +/- 15.7 degrees, NIC -74.5 +/- 17.4 degrees, RSB -52.6 +/- 14.6 degrees), and a prolonged relaxation (tau increase: RSGS 9.4 +/- 1.9, NIC 8.3 +/- 1.5, RSB 3.7 +/- 0.8 ms).

CONCLUSION

Unilateral increases as well as decreases of sympathetic tone to the heart result in an asynchronous wall motion pattern and an impaired LV relaxation.

Intracoronary magnesium is not protective against acute reperfusion injury in the regional ischaemic-reperfused dog heart

Intravenous magnesium lowers mortality in patients with suspected myocardial infarction. We tested the hypothesis that the protective effect may be due to a direct, local influence of magnesium on myocardial reperfusion injury in a dog model of ischaemia/reperfusion. Ten anaesthetized open chest dogs underwent 1 h of left anterior descending artery (LAD) occlusion and 6 h of reperfusion. The animals received intracoronary (i.c.) magnesium aspartate (Mg, n = 5) or vehicle infusion (n = 5) for the first hour of reperfusion. Mg infusion was adapted to actual LAD flow (ultrasonic flow probe) to increase regional plasma concentration by 4 mmol L-1. Regional myocardial function was measured as percent systolic wall thickening (sWTh, sonomicrometry). Intracoronary Mg increased LAD flow during application (at 15 min reperfusion; Mg, 194 +/- 44 (mean +/- SD); control, 116 +/- 41 mL min-1 100 g-1, P < 0.01). sWTh decreased during coronary occlusion from 14.3 +/- 7.1% to -4.7 +/- 2.7% in the control group and from 14.8 +/- 2.5% to -4.1 +/- 3.1% in the Mg group. Throughout the reperfusion period wall function remained depressed in both groups to a similar degree (control, -3.5 +/- 1.8%; Mg, -3.0 +/- 1.9% at 6 h reperfusion). Global haemodynamics were not different. Infarct size after 6 h reperfusion (TTC staining) was similar in both groups (Mg, 20.6 +/- 5.0; control, 24.4 +/- 8.7% of area at risk). Regional magnesium application (i.c.) to post-ischaemic reperfused myocardium had no influence on infarct size or post-ischaemic regional wall function in this model.(ABSTRACT TRUNCATED AT 250 WORDS)

Intracoronary SIN-1C during reperfusion reduces infarct size in dog

Reperfusion of ischemic myocardium may aggravate the ischemic state of injury and thus augment infarct size (reperfusion injury). The aim of this study was to reduce infarct size by an intervention at the time of reperfusion that acts only on a reperfusion-specific pathomechanism. It was investigated whether SIN-1C, a metabolite of molsidomine, can protect against reperfusion injury in canine hearts in vivo. Ten anesthetized open chest dogs underwent 1 h of left anterior descendent artery (LAD) occlusion and were randomly assigned to receive either intracoronary SIN-1C or vehicle infusion as a placebo during the first hour of reperfusion. The infusion was adjusted to LAD flow to achieve a regional blood concentration of 5 x 10(-3) M. Infarct size was assessed by triphenyltetrazolium staining after 6 h of reperfusion. Left ventricular pressure (LVP) was similar in both groups (SIN-1C: 101 +/- 6, placebo: 89 +/- 6 mm Hg, mean +/- SEM, n = 5) at the beginning of the experiment and did not change significantly thereafter from baseline values in both groups. During SIN-1C infusion, the LAD flow was increased (SIN-1C: 195 +/- 38, control: 86 +/- 17 ml/min/100 g at 30 min of reperfusion, p < 0.05), while systemic hemodynamics remained unaltered. A reduction in infarct size (percent of area at risk) was seen in the SIN-1C group (11.4 +/- 2.8%) compared with the placebo group (24.4 +/- 3.9%, p < 0.05). Infusion of papaverin (5 x 10(-5) M) following an identical protocol caused a similar vasodilation as SIN-IC, but did not reduce infarct size in five additional dox experiments.(ABSTRACT TRUNCATED AT 250 WORDS)

Left stellate ganglion block impairs left ventricular function

Stellate ganglion block (SGB) is an established procedure for the diagnosis and treatment of chronic pain. SGB results in an acute sympathetic denervation of a part of the left ventricular (LV) wall innervated by the blocked ganglion, which may impair regional contractility. The resulting imbalance of myocardial contractility in different LV regions may affect LV function adversely by increasing LV asynchrony. Seven anesthetized open chest dogs were instrumented for measurement of aortic and LV pressure (tip manometers), cardiac output (CO, thermodilution), and regional LV wall thickness (WT, sonomicrometry) in the anteroapical (predominantly innervated by the right stellate ganglion) and posterobasal wall (left stellate ganglion). The contractility of both regions was assessed using the relationship between preload recruitable stroke work and end-diastolic WT relationship (MW). The timing of regional myocardial wall motion was evaluated by means of the phase of the first harmonic of the Fourier transform of the WT signals, LV asynchrony by the phase difference (PD) between both regions, and LV diastolic function by the time constant of isovolumic relaxation (tau). Measurements were performed before and after left SGB (LSGB). Mean arterial pressure was 105 +/- 25 (mean +/- SD) before and 97 +/- 10 mm Hg after LSGB (not significant). CO remained unchanged (3.09 +/- 1.03 vs 2.93 +/- 1.07 L/min). LSGB significantly reduced contractility in the posterobasal myocardium (MW -162 +/- 26 vs -80 +/- 7 mm Hg; P < 0.01), accompanied by a delay of regional wall motion within the cardiac cycle (phase 202 +/- 18 vs 223 +/- 17 degrees; P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Regional contractile blockade at the onset of reperfusion reduces infarct size in the dog heart

An important mechanism of lethal myocardial reperfusion injury is the development of cellular hypercontracture at the onset of reperfusion. Hypercontracture can lead to cytolysis by mutual mechanical disruption of myocardial cells. 2,3-Butanedione monoxime (BDM) inhibits myofibrillar cross-bridge cycling and may therefore reduce infarct size in ischaemic reperfused myocardium. This study investigated whether a temporary presence of BDM protects against myocardial reperfusion injury in an intact-animal preparation. Anaesthetized open-chest dogs (n = 10) underwent 1 h of left anterior descendent artery (LAD) occlusion and received intracoronary BDM (25 mM, n = 5) or vehicle (n = 5) for 65 min starting with an anoxic local infusion 5 min before reperfusion. Infarct size was assessed by triphenyltetrazolium staining after 6 h reperfusion. The infusion of BDM was accompanied by a transient reduction of left ventricular systolic pressure from 84.3 +/- 11.2 mm Hg during occlusion to 66.4 +/- 9.9 mm Hg at 30 min reperfusion (mean +/- SD, P < 0.01 vs. control). LAD-flow and regional wall motion in the area at risk showed no difference between groups. Infarct size (% of area at risk) was reduced from 24.4 +/- 8.7 (control) to 6.6 +/- 2.0% (BDM) (P < 0.01). The results demonstrate that development of necrosis in reperfused myocardium can be greatly reduced by temporary presence of the contractile inhibitor BDM at the onset of reperfusion.

Adenosine A2-receptor activation at reperfusion reduces infarct size and improves myocardial wall function in dog heart

Reestablishment of blood supply to ischemic myocardium leads to biochemical and cellular changes which are believed to reduce the amount of potentially salvageable myocardium (reperfusion injury). In this situation, adenosine is known to have myocardial protective properties. Activation of adenosine A2-receptors may account for most of the beneficial effects of adenosine in reperfusion injury because A2-receptor activation mediates vasodilation, inhibits neutrophil adhesion to vascular endothelium and diminishes generation of free radicals by neutrophils, thus acting on some of the key mechanisms of reperfusion injury such as postischemic vascular dysfunction and neutrophil-mediated damage. Therefore, we investigated the effect of an intracoronary A2-agonist, CGS 21680, on regional postischemic myocardial function (measured as wall thickening) and infarct size [determined by triphenyltetrazolium chloride (TTC) staining]. Fourteen anesthetized open-chest dogs underwent 1-h left anterior descending artery (LAD) occlusion and 6-h reperfusion and were randomly assigned to receive intracoronary CGS 21680 or to serve as control. The drug was infused for 60 min starting 5 min before reperfusion with a concentration of 10(-7) M at a rate of 10 ml/min under anoxic conditions. The infusion was then continued for the first 55 min of reperfusion with 10(-6) M at a rate of 1 ml/min. Intracoronary infusion of CGS 21680 led to significant improvement in regional wall function in postischemic myocardium (p < 0.05 vs. control). Thickening fraction (percentage of baseline) increased from -13.1 +/- 13.7% (mean +/- SD) during occlusion to 15.3 +/- 29.8% at 30 min of reperfusion in the CGS 21680 treatment group and remained at this level throughout the reperfusion period.(ABSTRACT TRUNCATED AT 250 WORDS)

Afterload dependent prolongation of left ventricular relaxation: importance of asynchrony

OBJECTIVE

Acute increases in afterload and in left ventricular asynchrony both independently prolong left ventricular isovolumetric relaxation. The aim of the study was to investigate whether an increased left ventricular afterload augments left ventricular asynchrony, which in turn could mediate the afterload dependent prolongation of left ventricular isovolumetric relaxation.

METHODS

Seven chloralose anaesthetised open chest dogs were instrumented with a left ventricular pressure gauge and two pairs of ultrasonic wall thickness crystals in the antero-apical and postero-basal left ventricular wall. At a constant heart rate of 149(SEM 7) beats.min-1, left ventricular pressure was acutely increased by brief manual clamping of the descending (AOCD) and ascending AOCA) thoracic aorta. Left ventricular asynchrony was quantified by the phase difference of the first Fourier harmonic between postero-basal and antero-apical wall motion. Global left ventricular relaxation was measured as the time constant of isovolumetric pressure fall, tau. Regional myocardial relaxation was assessed as the mean rate to half end diastolic thinning.

RESULTS

AOCD increased left ventricular peak systolic pressure from 141.9(6.9) mm Hg to a maximum of 182.0(5.1) mm Hg and tau from 34.3(2.4) ms to 48.0(5.0) ms (p less than 0.05). Simultaneously, phase difference increased markedly during AOCD, from 12.7(3.5) degrees to 24.4(2.2) degrees (p less than 0.05). At matched left ventricular peak systolic pressures, AOCA increased tau from 33.4(2.5) ms to only 42.5(4.3) ms (p less than 0.05 v control and AOCD). Concomitantly, the increase in phase difference was smaller and statistically non-significant, at 13.7(2.9) degrees v 17.1(2.5) degrees. During 13 out of the 14 aortic clampings (7 AOCD, 6 AOCA), tau correlated linearly with phase difference [mean r = 0.74(0.03)]. In contrast to their effects on global left ventricular relaxation and asynchrony, neither AOCD nor AOCA influenced the rate to half end diastolic thinning.

CONCLUSIONS

(1) left ventricular asynchrony may increase during an acute augmentation of left ventricular afterload; (2) this increased left ventricular asynchrony possibly contributes to the afterload dependent prolongation of left ventricular isovolumetric relaxation rate.

Contribution of postsynaptic alpha 2-adrenoceptors to reflex sympathetic constriction of stenotic coronary vessels

Increases in the activity of efferent cardiac sympathetic nerves by 35 +/- 9% were induced by 60 s bilateral occlusion of the common carotid arteries (BCO) in anesthetized dogs. Under control conditions the reflex rise in sympathetic nerve activity enhanced left ventricular pressure (115 +/- 4 mm Hg) by 47% and regional myocardial oxygen consumption (9.7 +/- 1.1 ml/min.100 g) by 56%. Simultaneously, end-diastolic circumflex coronary resistance (0.99 +/- 0.11 mm Hg.min.100 g/ml) decreased by 16%. After exhaustion of coronary dilator reserve by production of a severe coronary stenosis, BCO enhanced left ventricular pressure (107 +/- 4 mm Hg) by 49%, oxygen consumption of the poststenotic area (7.6 +/- 0.8 ml/min.100 g) increased by 21%, and circumflex coronary resistance (0.54 +/- 0.05 mm Hg.min.100 g/ml) also increased by 19%. The reflex increase in coronary resistance during BCO was abolished after infusion of the alpha 2-adrenoceptor antagonist rauwolscine (0.2 mg/kg i.v.). Administration of rauwolscine, however, did not prevent the reflex increase of left ventricular pressure and regional myocardial oxygen consumption. Comparable increases in poststenotic coronary resistance during BCO were found in dogs which either received propranolol (2 mg/kg i.v.) or in which the reflex rise in mean aortic pressure was limited to 13 +/- 3 mm Hg. In both experimental groups, rauwolscine also effectively prevented the BCO-induced rise in coronary resistance. In contrast, the reflex increase of total peripheral resistance was not significantly reduced by rauwolscine, but was blunted after additional administration of the selective alpha 1-adrenoceptor antagonist prazosin (1.2 mg/kg i.v.). We conclude that: 1) Poststenotic coronary vasoconstriction occurs during shortlasting increases in efferent cardiac sympathetic discharge within the physiological range. 2) This increase in poststenotic coronary resistance is significantly reduced after administration of the alpha 2-adrenoceptor antagonist rauwolscine. 3) In contrast to poststenotic coronary resistance, functionally innervated alpha 2-adrenoceptors are of minimal importance for the reflex increase in total peripheral resistance.

Pain and myocardial ischemia: the role of sympathetic activation

In a first series, we tested whether the relative ischemia distal to a severe stenosis on the left circumflex coronary (CX) artery increases the activity of cardiac sympathetic (CS) nerves which, in turn, may result in a poststenotic vasoconstriction and an aggravation of ischemia. In 23 anesthetized, vagotomized dogs, an acute stenosis that reduced CX blood flow to 50% of control was produced and maintained for 20 min. The activity of postganglionic CS nerves increased by 23 +/- 4% within 20 min. In parallel, poststenotic coronary resistance increased from 0.48 +/- 0.03 (SEM) to 0.61 +/- 0.03 mm Hg.min.100 g/ml, resulting in a net lactate production after 15 min. The selective alpha 2-adrenoceptor antagonist rauwolscine (0.2 mg/kg i.v.; n = 6) and the calcium antagonist nifedipine (10 micrograms/kg i.v.; n = 6) prevented the progressive increase in poststenotic resistance and the net lactate production, but still permitted an increase in CS activity. Segmental anesthesia of CS nerves with epidural infiltration of procaine at segments C7-T6 (n = 6) prevented the sympathetic activation, the progressive increase in poststenotic resistance and the net lactate production. In six additional dogs with intact vagus nerves, CS activation and a concomitant increase in poststenotic resistance resulting in myocardial ischemia were also found. These data suggest a vicious cycle between poststenotic coronary vasoconstriction and CS activation, resulting in severe myocardial ischemia. In a second series, stimulation of high-threshold somatic afferents (= nociceptive stimulation: NCS) was used to cause reflex CS activation. The superficial peroneal nerve was electrically stimulated in 14 anesthetized, vagotomized dogs. With intact CX arteries, a 1 min stimulation resulted in a pronounced increase in CX blood flow and perfusion pressure. In contrast, NCS in the presence of a severe stenosis on the CX artery increased end-diastolic poststenotic coronary resistance by 96 +/- 15% due to a reflex activation of CS nerve fibers. This activation was markedly reduced after injection of fentanyl (27 micrograms/kg i.v.; n = 6). Injection of naloxone (60 micrograms/kg) restored the original effect. Systolic wall thickening (WT; sonomicrometry) in the CX artery-perfused myocardium was increased during NCS (10.9 +/- 3.9 (SD) vs. 13.6 +/- 5.0%) in additional five dogs with intact coronary arteries. In the presence of a stenosis on the CX artery, systolic WT was reduced to 7.0 +/- 2.5% and was further decreased to 4.6 +/- 2.3% during NCS. The additional deterioration of systolic regional function during NCS was prevented after i.v. injection of fentanyl, as was the increase in poststenotic coronary resistance.(ABSTRACT TRUNCATED AT 400 WORDS)

Effect of a new alpha 2-adrenoceptor antagonist on poststenotic coronary resistance and myocardial function

The effect of the alpha 2-adrenoceptor antagonist 4-fluoro-2-(imidazoline-2-ylamino)-isoindoline maleate (BDF 8933) on poststenotic end-diastolic distal coronary resistance and poststenotic myocardial function (sonomicrometry) was investigated under control conditions and during cardiac sympathetic nerve stimulation (CSNS = electrical stimulation of the left ventrolateral cervical cardiac nerve). In 7 vagotomized, open-chest dogs end-diastolic distal coronary resistance was determined. This variable was essentially unchanged after administration of the agent. In additional 6 dogs regional myocardial function was measured as systolic wall thickening (SWT). CSNS increased SWT of the posterior circumflex-perfused myocardium from 12.7 +/- 4.6% to 21.9 +/- 8.4% (p less than 0.05) under control conditions. With a severe stenosis on the left circumflex coronary artery, SWT was reduced to 5.4 +/- 4.0% and further decreased to 2.1 +/- 5.1% (p less than 0.05) during CSNS. After i.v. injection of 150 micrograms/kg BDF 8933, poststenotic myocardial function at rest was 4.2 +/- 4.2%, and 5.6 +/- 3.6% during CSNS. Regarding to the systemic effects BDF 8933 significantly increased peak left ventricular pressure in all 13 dogs. Thus, the new alpha 2-adrenoceptor antagonist BDF 8933 at the chosen dosage prevents sympathetically induced myocardial ischemia, but increases left ventricular afterload resistance.

BRL 34915 ameliorates oxygen supply in ischemic myocardium by a simultaneous enhancement of coronary blood flow and a reduction of myocardial function

In the presence of stenotic coronary arteries, oxygen supply in the poststenotic myocardium is reduced. A counterbalancing poststenotic metabolic vasodilatation is attenuated up to 30% by an alpha 2-adrenoceptor-mediated vasoconstrictor tone. In six open-chest dogs, we determined whether cumulative intracoronary doses (1, 4, and 14 micrograms) BRL 34915, a vasodilator with additional dose-dependent cardiodepressant properties, could enhance coronary blood flow and simultaneously reduce myocardial function in poststenotic myocardium, thereby increasing oxygen supply and decreasing oxygen demand. BRL 34915 increased mean left circumflex coronary blood flow [ml/(min.100 g)] dose-dependently from 59 +/- 12.4 (mean +/- SEM) (no BRL) to 227 +/- 43.9 (14 micrograms BRL) (p less than 0.05) in intact coronary arteries and from 36 +/- 7.2 (no BRL) to 74 +/- 13.2 (14 micrograms BRL) (p less than 0.05) distal to a severe stenosis, respectively. In contrast, posterior systolic wall thickening (%), was significantly decreased only by 14 micrograms BRL from 9.7 +/- 1.82 (no BRL) to 7.8 +/- 2.07 (14 micrograms BRL) (p less than 0.05) when coronary arteries were intact and from 8.7 +/- 2.02 (no BRL) to 4.1 +/- 1.39 (14 micrograms BRL) (p less than 0.05) in poststenotic myocardium. We conclude that BRL 34915 can both enhance coronary blood flow in the poststenotic myocardium and decrease myocardial function simultaneously, potentially narrowing the gap between oxygen supply and demand.

Poststenotic ischaemic myocardial dysfunction induced by peripheral nociceptive stimulation

Sympathetic activation increases cardiac performance, and the increased myocardial oxygen demand is adequately met by an increase in coronary blood flow after metabolic coronary dilation under normal conditions. Distal to a severe coronary stenosis, however, activation of cardiac sympathetic nerves induces myocardial ischaemia by alpha 2-adrenergic coronary constriction. Activation of cardiac sympathetic nerves is one of the autonomous reactions associated with acute somatic pain. Therefore we investigated the effects of acute somatic pain on regional myocardial function distal to a severe coronary stenosis. In 5 anaesthetized, vagotomized dogs activation of cardiac sympathetic nerves was achieved by electrical stimulation of the nervus peronaeus superficialis. To analyse regional myocardial function, myocardial wall thickness was continuously measured by sonomicrometry in the circumflex-perfused posterior and in the anterior (control) myocardium. Under control conditions, nociceptive stimulation increased systolic wall thickening of the posterior myocardium from 10.9 +/- 3.9% to 13.6 +/- 5.0%. With a severe stenosis on the left circumflex coronary artery, systolic wall thickening was reduced to 7.0 +/- 2.5% and further decreased to 4.6 +/- 2.3% during nociceptive stimulation. Intravenous injection of 27 micrograms/kg fentanyl prevented the deterioration of poststenotic myocardial function during nociceptive stimulation.

CONCLUSION

Acute somatic pain can induce ischaemic myocardial dysfunction distal to a severe coronary stenosis by activation of cardiac sympathetic nerves. Fentanyl not only prevents the pain sensation but also poststenotic ischaemic myocardial dysfunction.

Augmentation of cardiac reflexes in the cat by the calcium antagonist verapamil

The effect of intravenous and intrapericardial administration of verapamil on cardiac reflexes was studied in chloralose-anesthetized cats. Cardiac reflexes were induced by either intrapericardial application of serotonin (80 micrograms/kg) and dimethylphenylpiperazinium iodide (DMPP) (20 micrograms/kg) or by occlusion of the ascending aorta for 30 s. Intrapericardial application of verapamil (3 and 6 micrograms/kg) did not change the epicardial chemoreflexes, whereas intravenous administration of verapamil in the normal clinical dose enhanced the cardiac reflexes induced by chemical or mechanical stimulation. These results indicate that verapamil does not act directly on the vagal afferent nerve fibers in the epicardium of the heart. We suggest that the augmentation of cardiac reflexes by verapamil might be caused by an action of verapamil on the sinoaortic baroreflex or baroreceptors.

Quinidine attenuates sympathetically induced poststenotic myocardial ischemia

Beside its antiarrhythmic properties, which in particular are used for the treatment of atrial fibrillation, quinidine is known to have alpha-adrenoceptor blocking properties. On the other hand, atrial fibrillation is reported to cause activation of the sympathetic nervous system which, in turn, reduces coronary blood flow when the coronary reserve is already compromised. Therefore, we tested the effect of quinidine (3 mg/kg i.v.) on the coronary vasculature during electrical stimulation of cardiac sympathetic nerves in the presence and absence of a stenosis on the left circumflex coronary artery. In 7 anesthetized dogs the end-diastolic distal coronary resistance during cardiac sympathetic nerve stimulation in the presence of a severe stenosis on the left circumflex coronary artery increased by 18% before, and decreased by 17% after administration of quinidine. We conclude that quinidine inhibits the vasoconstriction of poststenotic coronary arteries during cardiac sympathetic nerve stimulation and thus might prevent a poststenotic stress-induced myocardial ischemia.

Evidence against the adenosine-catecholamine antagonism in the canine heart in situ

Adenosine has been reported to attenuate the positive inotropic effects of catecholamines in isolated heart preparations of rodents. These results were not confirmed in anesthetized dogs during intracoronary infusion of isoprenaline. However, these experiments did not establish the effects of adenosine on the inotropic effects of endogenously released catecholamines. Therefore cardiac sympathetic nerve stimulation was performed in 5 anesthetized, vagotomized dogs. The left circumflex coronary artery was perfused at a constant pressure of 130 +/- 4 mmHg. The contractile function of the circumflex-perfused myocardium was analyzed by sonomicrometry. Cardiac sympathetic nerve stimulation at 1, 2, 5, 10 and 20 Hz increased systolic segment shortening in a frequency-dependent manner from 10.9 +/- 2.6 at control to 15.3 +/- 3.4% at 20 Hz. During intracoronary infusion of adenosine (50 micrograms/kg/min) cardiac sympathetic nerve stimulation still increased systolic segment shortening from 9.9 +/- 3.5 at control to 16.3 +/- 4.5% at 20 Hz. The lack of an adenosine-catecholamine antagonism in the present experiments was not due to the sequence of procedures, nor to the marked flow increase induced by adenosine, since systolic segment shortening at rest was reduced during adenosine infusion, and since during intracoronary infusion of papaverine and sodium nitroprusside similar results were obtained. The observation of an adenosine-catecholamine antagonism in rodents should be restricted to this species at present.

An easy and quick implantation procedure for the measurement of myocardial wall thickness using sonomicrometry

Ultrasonic techniques for the measurement of ventricular dimensions are widely used in acute and chronic experiments. Implantation of ultrasonic crystals is associated with reversible and irreversible myocardial damage which might limit the interpretation of the obtained results, in particular during acute experiments. We therefore developed a sonomicrometric device which can be easily and quickly implanted, and thus reduces the reversible myocardial damage induced by prolonged surgical implantation.