Experimentelle Herzhypertrophie

Regulation of Coronary Blood Flow During Exercise

Exercise is the most important physiological stimulus for increased myocardial oxygen demand. The requirement of exercising muscle for increased blood flow necessitates an increase in cardiac output that results in increases in the three main determinants of myocardial oxygen demand: heart rate, myocardial contractility, and ventricular work. The approximately sixfold increase in oxygen demands of the left ventricle during heavy exercise is met principally by augmenting coronary blood flow (∼5-fold), as hemoglobin concentration and oxygen extraction (which is already 70–80% at rest) increase only modestly in most species. In contrast, in the right ventricle, oxygen extraction is lower at rest and increases substantially during exercise, similar to skeletal muscle, suggesting fundamental differences in blood flow regulation between these two cardiac chambers. The increase in heart rate also increases the relative time spent in systole, thereby increasing the net extravascular compressive forces acting on the microvasculature within the wall of the left ventricle, in particular in its subendocardial layers. Hence, appropriate adjustment of coronary vascular resistance is critical for the cardiac response to exercise. Coronary resistance vessel tone results from the culmination of myriad vasodilator and vasoconstrictors influences, including neurohormones and endothelial and myocardial factors. Unraveling of the integrative mechanisms controlling coronary vasodilation in response to exercise has been difficult, in part due to the redundancies in coronary vasomotor control and differences between animal species. Exercise training is associated with adaptations in the coronary microvasculature including increased arteriolar densities and/or diameters, which provide a morphometric basis for the observed increase in peak coronary blood flow rates in exercise-trained animals. In larger animals trained by treadmill exercise, the formation of new capillaries maintains capillary density at a level commensurate with the degree of exercise-induced physiological myocardial hypertrophy. Nevertheless, training alters the distribution of coronary vascular resistance so that more capillaries are recruited, resulting in an increase in the permeability-surface area product without a change in capillary numerical density. Maintenance of α- and ß-adrenergic tone in the presence of lower circulating catecholamine levels appears to be due to increased receptor responsiveness to adrenergic stimulation. Exercise training also alters local control of coronary resistance vessels. Thus arterioles exhibit increased myogenic tone, likely due to a calcium-dependent protein kinase C signaling-mediated alteration in voltage-gated calcium channel activity in response to stretch. Conversely, training augments endothelium-dependent vasodilation throughout the coronary microcirculation. This enhanced responsiveness appears to result principally from an increased expression of nitric oxide (NO) synthase. Finally, physical conditioning decreases extravascular compressive forces at rest and at comparable levels of exercise, mainly because of a decrease in heart rate. Impedance to coronary inflow due to an epicardial coronary artery stenosis results in marked redistribution of myocardial blood flow during exercise away from the subendocardium towards the subepicardium. However, in contrast to the traditional view that myocardial ischemia causes maximal microvascular dilation, more recent studies have shown that the coronary microvessels retain some degree of vasodilator reserve during exercise-induced ischemia and remain responsive to vasoconstrictor stimuli. These observations have required reassessment of the principal sites of resistance to blood flow in the microcirculation. A significant fraction of resistance is located in small arteries that are outside the metabolic control of the myocardium but are sensitive to shear and nitrovasodilators. The coronary collateral system embodies a dynamic network of interarterial vessels that can undergo both long- and short-term adjustments that can modulate blood flow to the dependent myocardium. Long-term adjustments including recruitment and growth of collateral vessels in response to arterial occlusion are time dependent and determine the maximum blood flow rates available to the collateral-dependent vascular bed during exercise. Rapid short-term adjustments result from active vasomotor activity of the collateral vessels. Mature coronary collateral vessels are responsive to vasodilators such as nitroglycerin and atrial natriuretic peptide, and to vasoconstrictors such as vasopressin, angiotensin II, and the platelet products serotonin and thromboxane A2. During exercise, ß-adrenergic activity and endothelium-derived NO and prostanoids exert vasodilator influences on coronary collateral vessels. Importantly, alterations in collateral vasomotor tone, e.g., by exogenous vasopressin, inhibition of endogenous NO or prostanoid production, or increasing local adenosine production can modify collateral conductance, thereby influencing the blood supply to the dependent myocardium. In addition, vasomotor activity in the resistance vessels of the collateral perfused vascular bed can influence the volume and distribution of blood flow within the collateral zone. Finally, there is evidence that vasomotor control of resistance vessels in the normally perfused regions of collateralized hearts is altered, indicating that the vascular adaptations in hearts with a flow-limiting coronary obstruction occur at a global as well as a regional level. Exercise training does not stimulate growth of coronary collateral vessels in the normal heart. However, if exercise produces ischemia, which would be absent or minimal under resting conditions, there is evidence that collateral growth can be enhanced. In addition to ischemia, the pressure gradient between vascular beds, which is a determinant of the flow rate and therefore the shear stress on the collateral vessel endothelium, may also be important in stimulating growth of collateral vessels.

Decreased incidence of ventricular fibrillation after an acute coronary artery ligation in exercised pigs

Evidence has been presented that regular physical activity may be associated with a decreased incidence of sudden cardiac death. It has been suggested that self-selection of those engaging in regular exercise rather than the physical activity itself is a major factor in explaining these results. We therefore studied the effects of a two-month exercise program on the incidence of ventricular fibrillation after an acute ligation of the left anterior descending (LAD) coronary artery in domestic Yorkshire pigs. At the end of the exercise program, the exercised group (EG, n = 17) had a lower heart rate (10%), a 5 times higher maximum exercise capacity, a 10% larger left ventricular mass and a thicker myocardial wall during end-diastole than a sedentary group (SG, n = 13). After the animals were anesthetized, the LAD artery was occluded at one third of its distal end. Ventricular fibrillation (VF) occurred in 92% of the SG (12 out of 13) against only 30% of the EG (5 out of 17) within 1 hour after occlusion. Percentage of the area at risk was the same (9-10% of total left ventricular mass) in both the EG and SG. Transmural myocardial perfusion after coronary artery ligation was slightly larger in EG than in SG (30 vs 21 ml . min-1 . 100 g-1, p less than 0.05). Although the improvement in perfusion of the ischemic zone of the EG may have contributed to the reduced occurrence of ventricular fibrillation, other mechanisms cannot be excluded.

Chronic exercise and cardiac vascularization

Male albino rats were trained on a motorized treadmill for 8 weeks, using eight training regimens which varied in severity from 0.313 m . s-1, 3 days/week for 30 min each day, to 0.447 m . s-1, 5 days/week for 60 min each day. At the end of the 8 week training period, the animals were anesthetized and Pelikan ink infused retrogradely through the aorta, into the coronary arteries and capillaries of the heart. The hearts were sectioned, stained and examined for the number of capillaries per mm2 and the capillary/muscle fiber (C/F) ratios. Six of the eight exercise groups had capillary densities significantly lower than the density in the sedentary control group of 3,022 cap mm-2. Likewise, five of the exercise groups had significantly lower C/F ratios than the sedentary group ratio of 1.077. The difficulties inherent in identification of cardiac muscle fibers make the C/F ratio a weaker measurement for determining cardiac vascularity. The lower capillary density in the trained hearts could be produced by muscle fiber hypertrophy which would push the capillaries farther apart. It is concluded that exercise training does not stimulate the multiplication of cardiac capillaries. The beneficial effect of exercise on the heart is probably a result of enlargement of the coronary arteries or the collateral circulation.

Impact of daily work-load during pregnancy on the microstructure of the rat heart in male offspring

In two series of experiments the development of body weight, heart weight and the microstructure of the rat heart in the male offspring from exercised and control inactive mothers was followed. In 50-day-old male offspring the total body weight and heart weight did not differ; in 100-day-old male offspring the heart weight was significantly higher in those from mothers exercising daily for 1 hr (run on a treat-mill with the speed 14 to 16 m/min, i.e. mild exercise of an aerobic character) throughout pregnancy. As regards microstructure of the heart, the differences were significant both in younger and older animals. The number of exercised mothers. The capillary: fiber ratio was significantly higher and the diffusion distance significantly shorter in male offspring of exercised mothers. During the prenatal period a favorable effect of work-load for the offspring could be induced more easily even with mild aerobic and quite short daily exercise than later during postnatal life as shown by experiments reported previously.

Capacity of the terminal vascular bed during normal growth, in cardiomegaly, and in cardiac atrophy

Vascular capacity representing the terminal vascular bed was determined by albumin 131 I in the rabbit myocardium during normal and pathological growth of the heart. A considerable increase in the vascular capacity in the first postnatal weeks indicated growth of the terminal vascular bed during this period. Highest values were reached in animals approximately 6 weeks old. From this time, vascular capacity gradually decreased in relation to the increase in heart and body weight. The growth rate of the terminal vascular bed was very rapid during the first postnatal weeks and later became slower; no growth was detected in adult and old animals. Growth of the terminal vascular bed during pathological increase in heart weight followed the same trend. In young animals pathological growth of the heart was accompanied by an increase in the capacity of the terminal vascular bed; in adult animals the total capacity remained unchanged. A decrease in heart weight in animals kept on a protein-free diet was characterized by a relatively small vascular capacity.