Reduction in the severity of myocardial infarction by sulfinpyrazone

Pathophysiology of cyclooxygenases in cardiovascular homeostasis

Cyclooxygenase (COX) catalyzes the conversion of arachidonic acid into prostaglandin H(2) (PGH(2)), which is subsequently converted to the prostanoids PGE(2), PGI(2), PGF(2alpha), and thromboxane A(2). COX has 2 distinct membrane-anchored isoenzymes: COX-1 and COX-2. COX-1 is constitutively expressed in most normal tissues; COX-2 is highly induced by proinflammatory mediators in the setting of inflammation, injury, and pain. Inhibitors of COX activity include conventional nonselective nonsteroidal anti-inflammatory drugs and selective nonsteroidal anti-inflammatory drugs, such as COX-2 inhibitors. The adverse effects of COX inhibitors on the cardiovascular system have been addressed in the last few years. In general, COX inhibitors have many effects, but those most important to the cardiovascular system can be direct (through the effects of prostanoids) and indirect (through alterations in fluid dynamics). Despite reports of detrimental human cardiovascular events associated with COX inhibitors, short, long, and lifetime preclinical toxicology studies in rodents and nonrodents have failed to identify these risks. This article focuses on the expression and function of COX enzymes in normal and pathologic conditions of the cardiovascular system and discusses the cardiovascular pathophysiologic complications associated with COX inhibition.

Autonomic mechanisms in heart rate variability after isoproterenol-induced myocardial damage in rats

The effect of isoproterenol-induced myocardial damage on heart rate variability was examined in conscious, unrestrained, male, Sprague-Dawley rats. We used power spectrum analysis of beat-to-beat heart rate to study the levels and interaction of sympathetic and parasympathetic neural influences on the heart. One day after isoproterenol (80 mg/kg s.c.), mean heart rate was significantly elevated when compared to controls (isoproterenol 413.9 b.p.m. +/- 7.7 S.E.M.; saline 368.8 b.p.m. +/- 12.8 S.E.M.; P less than 0.05), even though the low frequency and respiratory components of the power spectrum were not different between the two groups. By contrast, a week after isoproterenol administration, heart rate was normal; however, variability in low frequency and respiratory areas of the power spectrum was significantly increased suggesting an abnormal sympathovagal balance. An imbalance in autonomic regulation of cardiac automaticity could account for the 27% incidence of arrhythmias in rats given isoproterenol. These results indicate that autonomic responses associated with isoproterenol-induced myocardial ischemia differ from those in human and in animal models of myocardial infarction.

A protective effect of sulphinpyrazone against coronary occlusion-induced shortening of myocardial refractory periods in the rat

The hearts of anaesthetized, artificially ventilated rats were exposed, and the left coronary artery occluded. The diastolic threshold voltage for stimulation (DTV), the duration of the bipolar electrogram (DBE) and the functional refractory period (FRP) of the ischaemic area were measured at minute intervals for an hour after occlusion. Coronary occlusion caused a rise in DTV, a prolongation of the DBE and a biphasic change in the FRP, with an initial prolongation phase (1-4 min) followed by a decline to below pre-occlusion values (5-15 min). Episodes of ventricular tachyarrhythmia (VT) were most frequent during the period 5-15 min after the onset of occlusion of the coronary artery. This coincided with the period when FRP was minimal and the difference between DBE and FRP was maximal. Pretreatment of rats with sulphinpyrazone (2.5-40 mg kg-1) or indomethacin (5-20 mg kg-1) protected against the episodes of coronary occlusion-induced VT and against the associated decline in FRP of the ischaemic muscle. Sulphinpyrazone was more effective than indomethacin in this respect and a combination of the two drugs was approximately as effective as sulphinpyrazone alone. It was concluded that sulphinpyrazone protects rats against coronary occlusion-induced episodes of VT by reducing the risk of ventricular action potential re-entry. This effect is probably due to protection against the ischaemia-induced shortening of the myocardial FRP.

A direct protective effect of sulphinpyrazone on ischaemic and reperfused rat hearts

Initiation of 60 min ischaemia to rat isolated hearts produced a depression in developed tension and heart rate. Subsequent reperfusion caused a greatly exacerbated creatine phosphokinase (CPK) efflux and limited functional recovery. Sulphinpyrazone (100 ng ml-1 and 1 microgram ml-1) significantly reduced CPK release, particularly after reperfusion, the lower concentration being more effective. A reduction in the mechanical depression during ischaemia and enhanced recovery after reperfusion were seen only with 100 ng ml-1 sulphinpyrazone. Heart rate and coronary perfusion pressure were unaffected by drug treatment. The reduction in reperfusion-induced CPK efflux by 100 ng ml-1 sulphinpyrazone was maximal when the drug was present throughout the perfusion period although some protection was evident when sulphinpyrazone was present either during ischaemia or reperfusion only. An enhanced recovery in contractility was seen only when the drug was present throughout all phases of perfusion. It is suggested that sulphinpyrazone exerts a direct protective effect on the heart particularly during reperfusion. The degree of protection is critically dependent on the concentration of sulphinpyrazone.

Protection from arrhythmias of cultured heart cells by nonsteroidal antiinflammatory drugs

The nonsteroidal antiinflammatory drugs: acetylsalicylic acid, salicylic acid, sulfinpyrazone and indomethacin were tested at 10(-10) - 10(-5) M for their effect on arrhythmias of monolayer cultures of neonatal rat heart myocytes. Arrhythmias produced by reoxygenation were prevented or significantly reduced (p less than or equal to 0.05) by either indomethacin or salicylic acid at 10(-9) M. Acetylsalicylic acid and sulfinpyrazone, while not significantly anti-arrhythmic, produced consistent numerical inhibition of arrhythmias at 10(-9) M.

Electrophysiological and mechanical effects of sulphinpyrazone on isolated rat atria

Clinical trials suggest that sulphinpyrazone reduces the incidence of sudden death in patients having suffered a myocardial infarction. To investigate possible direct antiarrhythmic properties of sulphinpyrazone, we carried out experiments on spontaneously beating and electrically stimulated isolated rat atrial preparations. Dose-response curves for electrophysiological and mechanical effects of sulphinpyrazone were obtained. Increasing doses of sulphinpyrazone decreased the spontaneous atrial frequency, prolonged the sinus node recovery time after overdrive pacing, slightly increased the electrical threshold for excitation and decreased the contractile force. Although the mechanism by which sulphinpyrazone may reduce the incidence of sudden cardiac death is still not settled, the present study demonstrates direct electrophysiological and mechanical effects of the drug at high concentrations.

Protective effect of sulfinpyrazone against catecholamine metabolite adrenochrome-induced arrhythmias

Single intravenous injection of adrenochrome (10 to 50 mg/kg body weight), an oxidation product of catecholamines, has been shown to induce arrhythmias and cause death in anesthetized rats in a dose-dependent manner. Sulfinpyrazone, which is an inhibitor of platelet aggregation, was found to protect animals from these adrenochrome effects. It is suggested that sudden death due to arrhythmias in patients following the first attack of myocardial infarction of during other stressful situations may be linked to the formation of adrenochrome from abnormally high catecholamine levels in blood. Furthermore, results presented here also suggest that the reduction in the mortality rate of patients on sulfinpyrazone therapy may involve an antiarrhythmic property of the drug.