Modifications of long-term heart rate variability produced in an experimental model of diet-induced metabolic syndrome

Metabolic syndrome (MetS) has been linked to a higher prevalence of cardiac arrhythmias, the most frequent being atrial fibrillation, but the mechanisms are not well understood. One possible underlying mechanism may be an abnormal modulation of autonomic nervous system activity, which can be quantified by analysing heart rate variability (HRV). Our aim was to investigate the modifications of long-term HRV in an experimental model of diet-induced MetS to identify the early changes in HRV and the link between autonomic dysregulation and MetS components. NZW rabbits were randomly assigned to control (n = 10) or MetS (n = 10) groups, fed 28 weeks with high-fat, high-sucrose diet. 24-hour recordings were used to analyse HRV at week 28 using time-domain, frequency-domain and nonlinear analyses. Time-domain analysis showed a decrease in RR interval and triangular index (Ti). In the frequency domain, we found a decrease in the low frequency band. Nonlinear analyses showed a decrease in DFA-α1 and DFA-α2 (detrended fluctuations analysis) and maximum multiscale entropy. The strongest association between HRV parameters and markers of MetS was found between Ti and mean arterial pressure, and Ti and left atrial diameter, which could point towards the initial changes induced by the autonomic imbalance in MetS.

Altered atrial restitution dynamics and refractoriness in metabolic syndrome due to up-regulation of potassium repolarizing currents increases susceptibility to atrial fibrillation

Background

Metabolic alterations, such as Metabolic Syndrome (MS), describe an association of factors including diabetes, hypertension, obesity and dyslipidemia, linked to higher risk and prevalence of overall cardiovascular disease, arrhythmogenesis and sudden cardiac death. Obese and diabetic patients have shown an increased risk for developing atrial fibrillation (AF). However, underlying mechanisms are not understood.

Purpose

To study the effects of MS and obesity remodeling in atrial restitution dynamics, frequency-dependent adaptation, refractoriness and its potential susceptibility to AF.

Methods

Electrophysiological experimental data from High-fat (HF-O, standard rabbit chow with an additional 15% fat) and Hig-fat High-Sucrose Metabolic Syndrome (HFHS-MS, 10% hydrogenated coconut oil and 5% lard, 15% high-sucrose dissolved in water) rabbit models were used to adjust computational models atrial electrophysiology remodeling under each condition. Additionally, isoproterenol and AF conditions were considered to challenge both in-silico models. Validation and sensitivity analysis were performed for each model parameters. Computational simulations in conditions of pacing at different pacing cycle lengths was assessed at 100, 125, 150, 200, 250, 350, 450, 500, 650, 750, 850, 1000 ms. Restitution dynamics were automatically determined and analyzed, as well as restitution slopes and presence of automaticity, early after-depolarizations, alternans and cardiac arrhythmia induction.

Results

Shortening of action potential duration and refractoriness in the left atrium was observed under HFHS-MS. Upstroke velocity, maximum excitability and sodium availability were altered both in HF-O and HFHS-MS. HF-O remodeling showed presence of alternans at high pacing frequencies. Repolarization restitution was shortened in conditions of ISO and MS-AF. Restitution slopes were >1 in HF-O and HFHS-MS, which was correlated to higher susceptibility to AF, and further increased in MS-AF. Under MS-AF, abbreviation in APD in both atria, resulted in increased reentrant frequencies in AF, which was exacerbated under IK1 up-regulation, increasing atrial vulnerability.

Conclusions

HFHS-MS underlies modifications in atrial electrophysiology including shorter refractoriness in HFHS-MS, as well as modifications in atrial excitability, which may be pro-arrhythmic mainly at high frequency rates. This could be explained in part by an up-regulation of outward potassium channels. These results could partially explain increased susceptibility for AF in MS.

Funding Acknowledgement

Type of funding sources: None.

Endurance training increases ventricular refractoriness and wavelength of the cardiac impulse without participation of parasympathetic postganglionic neurons. A study in isolated rabbit heart

Background

Endurance physical training plays a protective role in against ventricular fibrillation (VF), but the exact underlying mechanisms are not completely understood. It is well-known that modifications in myocardial ventricular properties such as refractoriness, conduction velocity and wavelength are key in the initiation and maintenance of VF; furthermore, vagus nerve stimulation has prophylactic effects on malignant arrhythmias and VF. On the other hand, parasympathetic nervous system activity is increased in trained individuals, which in turn affects different ventricular electrophysiological properties. We hypothesized that physical training increases conduction velocity and wavelength, and that these changes are mediated by myocardial cholinergic neurons.

Methods

To test this hypothesis, ten rabbits were submitted to a six-week endurance training protocol and twenty controls were not trained (divided in control group, n=10 and sham group n=10). After training, rabbits were euthanized and their hearts excised, isolated and perfused in a Langendorff system. A pacing electrode and a plaque with 240 recoding electrodes acquiring at 1 KHz were positioned on the left ventricle (LV). Extraestimulus test using four different pacing cycle lengths (90% basal cycle length, 250, 200 and 150 ms) was performed before and after atropine (1μM, control and trained groups) or vehicle (tyrode, sham group) infusion. We studied 1) LV effective refractory period (ERP), 2) LV functional refractory period (FRP), 3) LV conduction velocity (CV), and 4) LV wavelength, determined as LV FRP x CV. Factorial ANOVA (mixed model) was used for statistical analysis (p<0.05).

Results

Before parasympathetic blockade, LV FRP increased in trained animals (Figure, B) whereas no difference was found in LV CV between trained and control animals at any pacing cycle length (Figure, A). In consequence, LV wavelength increased in trained animals (Figure, C). There were no changes in LV ERP, FRP, CV and wavelength when comparisons were made within groups before and after atropine infusion. In sham animals, vehicle infusion or time-course of the experiment did not modify LV FRP, ERP, CV and wavelength.

Conclusion

Physical training increases LV wavelength, which can be one electrophysiological mechanism by which endurance training could protect against VF. Since modifications of ventricular refractoriness and wavelength do not seem dependent of intrinsic parasympathetic nervous system activity, other intrinsic mechanisms could be implied and warrant further research.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III, Generalitat Valenciana

Time and frequency domain analysis of long-term heart rate variability in an experimental model of diet-induced metabolic syndrome

Background

Metabolic syndrome (MetS) is defined as the set of at least three of the following conditions: central obesity, elevation of triglycerides, decreased in high-density lipoproteins, systemic hypertension and glucose intolerance. MetS is linked with a high prevalence of cardiovascular disease, including sudden cardiac death and atrial arrhythmias, which may be a consequence of changes related to the structure, function and autonomic control of the heart. One of the underlying mechanisms responsible could be the alteration of sinus node automaticity. Heart rate variability (HRV) analysis is a useful non-invasive tool for evaluating alterations in neural control of cardiac automaticity.

Purpose

To examine the changes in long-term HRV using time- and frequency- domain analyses in an experimental model of diet-induced MetS which develops all its components.

Methods

Male NZW rabbits were randomly assigned to control (n=10) or MetS group (n=10), fed with high-fat (10% coconut oil and 5% lard) and high sucrose (15% dissolved in water) diet during 28 weeks. At week 28, 24 hour ECG recording was performed (eMotion Faros 180, Mega Electronics®, 1 kHz). We analyzed 60 minutes of RR time series, comparing day (from 8:00 to 19:59 h) and night (from 20:00 to 7:59 h), and quantified the standard parameters of time and frequency domains: 1) Time domain: RR, SDNN, triangular index (Ti), RMSSD and TINN; 2) Frequency domain: very low (VLF), low (LF), high frequency (HF), and LF/HF index. Multivariate analysis of variance (MANOVA, factorial model) was used for statistical analysis (p<0.05).

Results

Time domain analysis showed a decrease in RR interval (p<0.001) and geometrical Ti (p=0.036) in MetS animals (Figure, A-B), indicative of an increased heart rate. The rest of parameters in the time domain (SDNN, RMSSD, TINN) were not modified. Further, in the frequency domain at FFT spectrum, we did find a significant decrease in the LF band (p=0.032) in MetS animals (Figure, C). The rest of the frequency domain parameters (VLF, HF and LF/HF index) remained unchanged.

Conclusion

MetS decreased RR interval duration and triangular index, suggesting an increased sympathetic activity during day and night. Those changes were reflected in LF modifications, and might be attributable to a deficiency in sympathetic-parasympathetic control, which requires adjustments to maintain normal autonomic balance. Collectively, these results could give insight into the autonomic mechanisms that underlie increased atrial arrhythmia susceptibility in MetS.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Generalitat Valenciana, University of Valencia

Simultaneous atrial and ventricular restitution and fibrillation analyses using a low-cost scalable panoramic whole-heart optical mapping configuration for whole-heart imaging of translational models

Introduction

Optical mapping (OM) is the primary method for imaging electrophysiologically relevant parameters from the outer surface of Langendorff-perfused hearts. However, current panoramic OM systems are financially challenging, require multiple sensors to map wide areas of the surface with overlapping regions and missing areas of interest due to the intrinsic shape of the heart. We proposed different panoramic configurations to dynamically characterize atrial and ventricular function during arrhythmia and, in presence of a coronary occlusion.

Methods

We devised both a multi-sensor and a single sensor system integrated with the perfusion circuit comprising sensor elements, a control system for led illumination, electrical stimulation and sensing of physiological variables. Two configurations were tested: A multi-sensor panoramic approach including different camera views and, a precision near-ellipsoidal curved mirror (highly concentrated reflectance in the range 380nm-800nm), with exponential profile and diameter to harbor small to large hearts was used. Twelve-rabbits and two pig hearts were included in the study. OM was performed using di-4 ANDBQPQ near-infrared dye and 5–10uM blebbistatine. Initial camera calibration was done using a fishnet-like pattern and nylon landmarks. We characterized signal-tonoise ratios (SNR) of reconstructed action potentials (AP) and obtained parametric maps of the activation process. A custom-built computational pipeline for accurate motion compensation and AP reconstructions was used. Hearts were stimulated until ventricular fibrillation (VF) was induced with and without presence of a coronary occlusion in the LADartery (LADCO).

Results

High SNRs spatial maps were obtained after AP reconstruction (42.24±4.23dB,stimulated; 23.31±5.24dB,VF) in the most restrictive set-up, the single-sensor near-ellipsoidal configuration. Quantified activation and repolarization dynamic restitution properties were assigned to anatomically labelled scale-invariant areas in the atrium and ventricles during the induction process. Atrial and ventricular restitution dynamics could be reconstructed and analyzed simultaneously. Slower conduction (CT) and higher dispersion in repolarization (DoR) was observed after LADCO in LV (CT: 13.4±5.31ms-vs-22.42±6.82ms,DoR:23.24±4.23ms-vs-38.03±9.17ms,p<0.05). During VF, more heterogeneous activation patterns, enhanced left-to-right VV spectral gradient profiles, and spatially constraint shorter-lived filaments, partially explained the disturbances observed during LADCO. Results obtained with a direct multiple sensor configuration allowed for complete tracking of dominant sources, yet presenting overlapped information.

Conclusion

Hereby results comparing two low-cost configurations for panoramic imaging are presented and validated for the study of cardiac propagation throughout the whole epicardial surface for the study of arrhythmia, drug interventions and cardiovascular disease.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): CIBERcv

CaMKII inhibition reduces electrical activation heterogeneities caused by mechanical stretch in the myocardium

Introduction

Ca2+/calmodulin-dependant protein kinase II (CaMKII) activity in cardiomyocytes plays a crucial role in their contractility. Increased CaMKII signalling has been associated with mechanical stretch, often caused in the border zone of myocardial infarction. CaMKII upregulation causes a mishandling of intracellular calcium, a precursor of multiple pro-arrhythmic mechanisms, such as early afterdepolarisations.

Purpose

In this study, we aim to quantify the effects of KN-93 -a CaMKII inhibitor- on wave dynamics, in order to investigate its effectiveness as an anti-arrhythmic agent.

Methods

An isolated Langendorff model was constructed based on rabbit hearts (n=18) and posteriorly induced to fibrillation. An epicardial multielectrode array (121 electrodes) was used for recording the electrical activity. Mechanical stretch was induced by pushing the anterior myocardial wall from the left-ventricular cavity. Then, a frequency analysis was conducted for the following conditions: before drug infusion, during infusion, during infusion plus stretch, and during infusion post-stretch. Nine hearts represented the untreated group, and the other nine were infused with KN-93 at a concentration of 10 nM (less than 3% of the IC50 value).

Results

Prior to stretch induction, KN-93 caused no effects in the spectral concentration (SC) and average dominant frequency (ADF) calculated on the infused rabbit hearts. Nevertheless, intrasubject measurements revealed statistically significant differences (p<0.05) between hearts infused with KN-93 and the untreated ones when stretch was induced. Changes in SC were milder in the treated than the untreated group (−6% vs −33%). Also, the stretch-induced increase in ADF was more limited in the treated group (+17% vs +40%). Hearts infused with KN-93 shown a higher resistance to stretch-induced electrical abnormalities, potentially due to better regulated intracellular calcium dynamics.

Conclusion

CaMKII inhibitors show cardioprotective potential, even at very low concentrations. Further research is required to investigate the therapeutic use of these compounds in conditions of intracellular calcium mishandling and its concomitant life-threatening consequences, such as heart failure or Torsade de Pointes.

KN-93 reduces stretch-induced changes

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): Universitat de València; Generalitat Valenciana - Prometeo; Carlos III, CIBERCV

P1605Increased irregularity and spectral complexity of the intrinsic pacemaker beat-to-beat variability correlates with increased metabolic syndrome components

Background

Metabolic syndrome (MetS) is becoming one of the future potential leading risk factors for heart and cardiovascular disease. MetS relates to a condition associated with at least three metabolic risk factors raising risk for health diseases concomitantly such as diabetes, stroke, hypertension, obesity and dyslipidemia. This can lead to chest pain, heart attack, heart damage and overall higher prevalence of cardiovascular disease, atrial fibrillation and sudden cardiac death. One of the underlying mechanisms of the progressive remodeling in presence of MetS components could be altered automaticity, which would reflect modifications of sinus node activity. These phenomena can be evaluated analyzing the components of heart rate variability (HRV).

Purpose

Our aim was to examine the modifications of sinus node variability in an isolated heart model of diet-induced obesity and MetS.

Methods

Male NZW rabbits were randomly assigned to high-fat (HF, n=8), control (HF-C, n=7), high-fat, high-sucrose (HFHS, n=9), and control (HFHS-C, n=9) groups, fed with their respective diets during 18/28 weeks. After euthanasia their hearts were isolated in a Langendorff system. We recorded 10–15 minutes of spontaneous activity. Short RR time series were analyzed, and standard HRV parameters were determined with special interest in the time-course of spectral, time-frequency and non-linear components. One-way ANOVA, Kruskal-Wallis test and bivariate correlations were used for statistical analysis (p<0.05).

Results

We did find an increase in the complexity and irregularity of intrinsic pacemaker activity as shown by modifications of entropy (ApEn: p=0.011 vs HF, p=0.002 vs HF-C, p=0.019 vs HFHS-C) and the complexity index (CI: p=0.006 vs HF, p=0.047 vs HF-C, p=0.027 vs HFHS-C) in HFHS animals (Figure). Higher dispersion on RR differences distributions was observed in the HFHS group. Time-frequency spectral heterogeneity increased in HFHS group (p=0.002 vs HF, p=0.050 vs HF-X, p=0.027 vs HFHS-C) even though no differences were found in standard time and frequency-domain analyses. High-band and low-band spectral concentration ratios showed decreased organization in HFHS when compared to HF (p=0.002) and controls HFHS-C (p=0.027) and HF-C (p=0.050). Interestingly, animal weight and glucose intolerance were highly correlated with the modifications of intrinsic pacemaker variability.

Modifications of intrinsic IHRV.

Conclusions

Modifications of intrinsic HRV seemed to be reliant on the number of components of MetS present, given that only HFHS group showed significant changes towards an increased complexity and irregularity of intrinsic pacemaker variability.

Acknowledgement/Funding

This work was partially supported by: GV2015-062, CB16/11/00486.

Modifications of mechanoelectric feedback induced by 2,3-butanedione monoxime and Blebbistatin in Langendorff-perfused rabbit hearts

AIM

Myocardial stretching is an arrhythmogenic factor. Optical techniques and mechanical uncouplers are used to study the mechanoelectric feedback. The aim of this study is to determine whether the mechanical uncouplers 2,3-butanedione monoxime and Blebbistatin hinder or modify the electrophysiological effects of acute mechanical stretch.

METHODS

The ventricular fibrillation (VF) modifications induced by acute mechanical stretch were studied in 27 Langendorff-perfused rabbit hearts using epicardial multiple electrodes and mapping techniques under control conditions (n = 9) and during the perfusion of 2,3-butanedione monoxime (15 mM) (n = 9) or Blebbistatin (10 μm) (n = 9).

RESULTS

In the control series, myocardial stretch increased the complexity of the activation maps and the dominant frequency (DF) of VF from 13.1 ± 2.0 Hz to 19.1 ± 3.1 Hz (P < 0.001, 46% increment). At baseline, the activation maps showed less complexity in both the 2,3-butanedione monoxime and Blebbistatin series, and the DF was lower in the 2,3-butanedione monoxime series (11.4 ± 1.2 Hz; P < 0.05). The accelerating effect of mechanical stretch was abolished under 2,3-butanedione monoxime (maximum DF = 11.7 ± 2.4 Hz, 5% increment, ns vs baseline, P < 0.0001 vs. control series) and reduced under Blebbistatin (maximum DF = 12.9 ± 0.7 Hz, 8% increment, P < 0.01 vs. baseline, P < 0.0001 vs. control series). The variations in complexity of the activation maps under stretch were not significant in the 2,3-butanedione monoxime series and were significantly attenuated under Blebbistatin.

CONCLUSION

The accelerating effect and increased complexity of myocardial activation during VF induced by acute mechanical stretch are abolished under the action of 2,3-butanedione monoxime and reduced under the action of Blebbistatin.

Approach to seizures in the neonatal period: a European perspective

In the neonatal period, seizures rank among the most common neurological symptoms, often indicating an underlying serious neurological condition. It is remarkable that although new tools have been incorporated into the diagnosis of neonatal seizures, there is no consensus about the therapeutic approach among different doctors and institutions. Hence, although phenobarbital is still considered the initial drug of choice, the protocols reported in the literature show a great variability in the approach to treatment of refractory seizures. We used a questionnaire to gain information regarding the treatment of seizures in the neonatal period in different European institutions.

CONCLUSION

We conclude that phenobarbital is still the initial drug of choice followed by benzodiazepines, except in preterm infants with a birth weight below 1800 g. In refractory seizures, the use of continuous lidocaine infusion is most common. Of note, clinical studies with newer drugs have been mostly performed in the United States but not in Europe.

[Clinical assessment of peritoneal drainages for necrotizing enterocolitis. A Bayesian approach]

AIM

To assess effectiveness of peritoneal drainages for necrotizing enterocolitis.

MATERIAL AND METHODS

Retrospective cohort study (years 2000 to 2006). Laparotomy or patient's death were considered as failure.

STUDY VARIABLES

sex, gestational age, weight at delivery, Apgar score at minutes 1 and 5, modified Bell score, radiology and ventilatory status.

RESULTS

25 patients were diagnosed with necrotizing enterocolitis and treated with peritoneal drainages. Sample's Bell score was: 13(52%) Ia, 6 (24%) IIa, 5 (20%) IIb, and 1 (4%) IIIa. Mean gestational age was 31.8 (+/- 4.2) weeks, and mean weight 1,564 (+/- 810) g. Patients classified as Bell I presented statistically significat differences compared with Bell II-III as for radiology (unspecific), delivery weight (lower) and ventilatory status (higher mechanical ventilation rates). For the 12 patients with Bell scores II-III, peritoneal drains were enough for 5 cases (41.7%) and failed in 7 (58.3%), who were operated on. Multivariate analysis (logistic regression) was not able to show any conection with collected variables. However, a bayesian analysis using data from similar studies showed that the probability for drainage success rate to be higher than 50% is 99%.

CONCLUSIONS

In our centre, 52% of peritoneal drainages were used in patinets with low clinical suspect for necrotizing enetrocolitis, maybe in relation with their lower body weight and need for ventilatory support. In patients affected with necrotizing enterocolitis, drainages were effective in 41.7%. Although limited for its retrospective nature, our study suggests that peritoneal drainages can be curative in, at least, 50% of patients with necrotizing enterocolitis without pneumoperitoneum and clinical signs of peritonitis.

A halocin acting on Na+/H+ exchanger of haloarchaea as a new type of inhibitor in NHE of mammals

The capability of halocin H6 (a bacteriocin-like protein produced by haloarchaea Haloferax gibbonsii) to inhibit Na+/H+ exchanger (NHE) in mammalian cells and its cardio-protective efficacy on the ischemic and reperfused myocardium were evaluated in the present study. H6 inhibits NHE activity (measured by a flow cytometry method) in a dose-dependent form of cell lines of mammalian origin (HEK293, NIH3T3, Jurkat and HL-1) as well as in primary cell culture from human skeletal muscle (myocytes and fibroblasts). In vivo, an ischemia-reperfusion model in dogs by coronary arterial occlusion was used (two hours of regional ischemia and three hours of reperfusion). In animals treated with halocin H6 there was a significant reduction of premature ventricular ectopic beats and infarct size, whereas blood pressure and heart rate remained unchanged. Up to date, halocin H6 is the only described biological molecule that exerts a specific inhibitory activity in NHE of eukaryotic cells.

Co-administration of pentoxifylline and thiopental causes death by acute pulmonary oedema in rats

BACKGROUND AND PURPOSE

Pentoxifylline exhibits rheological properties that improve microvascular flow and it is widely used in vascular perfusion disorders. It also exhibits marked anti-inflammatory properties by inhibiting tumour necrosis factor alpha production. Thiopental is one of the most widely used drugs for rapid induction of anaesthesia. During experimental studies on the treatment of acute pancreatitis, we observed that when pentoxifylline was administered after anaesthesia with thiopental, most of the rats exhibited dyspnea, signs of pulmonary oedema and died. The aim of the work described here was to investigate the cause of the unexpected toxic effect of the combined treatment with thiopental and pentoxifylline.

EXPERIMENTAL APPROACH

Pulmonary vascular permeability and arterial blood gases were measured, and a histological analysis was performed. The possible role of haemodynamic changes in the formation of pulmonary oedema was also assessed.

KEY RESULTS

Co-administration of pentoxifylline and thiopental increased pulmonary vascular permeability and markedly decreased arterial pO2, with one third of rats suffering from hypoxemia. This combined treatment caused death by acute pulmonary oedema in 27% of normal rats and aggravated the respiratory insufficiency associated with acute pancreatitis in which the mortality rate increased to 60%. This pulmonary oedema was not mediated by cardiac failure or by pulmonary hypertension.

CONCLUSIONS AND IMPLICATIONS

Co-administration of pharmacological doses of pentoxifylline and thiopental caused pulmonary oedema and death in rats. Consequently, pentoxifylline should not be administered when anaesthesia is induced with thiopental to avoid any possible risk of acute pulmonary oedema and death in humans.

Intrinsic changes on automatism, conduction, and refractoriness by exercise in isolated rabbit heart

We have studied the intrinsic modifications on myocardial automatism, conduction, and refractoriness produced by chronic exercise. Experiments were performed on isolated rabbit hearts. Trained animals were submitted to exercise on a treadmill. The parameters investigated were 1) R-R interval, noncorrected and corrected sinus node recovery time (SNRT) as automatism index; 2) sinoatrial conduction time; 3) Wenckebach cycle length (WCL) and retrograde WCL, as atrioventricular (A-V) and ventriculoatrial conduction index; and 4) effective and functional refractory periods of left ventricle, A-V node, and ventriculoatrial retrograde conduction system. Measurements were also performed on coronary flow, weight of the hearts, and thiobarbituric acid reagent substances and glutathione in myocardium, quadriceps femoris muscle, liver, and kidney, to analyze whether these substances related to oxidative stress were modified by training. The following parameters were larger (P < 0.05) in trained vs. untrained animals: R-R interval (365 +/- 49 vs. 286 +/- 60 ms), WCL (177 +/- 20 vs. 146 +/- 32 ms), and functional refractory period of the left ventricle (172 +/- 27 vs. 141 +/- 5 ms). Corrected SNRT was not different between groups despite the larger noncorrected SNRT obtained in trained animals. Thus training depresses sinus chronotropism, A-V nodal conduction, and increases ventricular refractoriness by intrinsic mechanisms, which do not involve changes in myocardial mass and/or coronary flow.

Flow cytometric analysis of peroxidative activity in granulocytes from coronary and peripheral blood in acute myocardial ischemia and reperfusion in dogs: protective effect of methionine

BACKGROUND

Methionine has shown protective effects in experimental models of myocardial infarction and is highly reactive to oxidative compounds produced by polymorphonuclear leukocytes (PMN), which in turn have been associated with myocardial damage. We have investigated the effect of methionine administration on spontaneous leukocyte peroxidative activity in myocardial ischemia and reperfusion.

METHODS

In anesthetized dogs, with coronary occlusion (90 min) and reperfusion (90 min), PMN activation was measured by flow cytometric determination of H(2)O(2) with dihydrorhodamine 123, and correlated to hemodynamic parameters and infarct presence. To assess a possible direct effect of methionine, H(2)O(2) and superoxide were measured by flow cytometry in dog leukocyte suspensions following in vitro stimulation with f-MLP.

RESULTS

PMN peroxidative activity in saline-treated dogs increased significantly after coronary occlusion and after reperfusion. These changes were greater in coronary venous blood than in femoral blood. Methionine administration (150 mg/kg, i.v.) before occlusion totally suppressed PMN activation, both after occlusion and reperfusion.

CONCLUSIONS

PMN are promptly activated in myocardial ischemia, and methionine administration prevents such activation. However, methionine has no direct effect on spontaneous peroxidative activity, and f-MLP induced peroxidative activity. These in vivo effects of methionine, may additionally contribute to explain its protective role in experimental -788-877-7QQ8-8-7-88-8-8778--8Q78-----8--8-Q-7-Q7----- --------------8888 888888-7777777777777777777777777777777----------------888888888888888888 8877777--87--------8-----------------7-8888-887-----------8----8-8-87777 7777777------------------------------------------------------T7OW

[Thymoma. A retrospective study]

We review cases of thymic cell tumor treated between January 1991 and March 1998. Nineteen of the 23 cases studied involved thymoma. Eight (42%) were asymptomatic, 4 (21%) were associated with myasthenia gravis and 7 (37%) were symptomatic. The most common symptom was non-specific chest pain, reported by 4 (47%) patients with symptoms. Classifying the cases of thymoma by Masaoka's system, we found that 12 were cases of thymoma in stage I (63.2%), 4 in stage II (21.1%) and 3 in stage III (15.8%). No stage IV patients were treated. Treatment consisted of full exeresis of the tumor in 17 (89.5%) cases, partial resection in one case (5.2%) and biopsy of the tumor in one non-resectable, case. Adjuvant radiotherapy was applied in seven cases. Chemotherapy was not prescribed. With follow-up ranging from 9 to 96 months, half the patients survived 21 months after surgery. Among the surviving patients, mortality was nil at the end of the study. The results of microscopic, cytologic and blood analyses were of scarce value in differentiating between benign and malignant tumors, even though p53 and bcl2 antigen positivity and clinical stage have been related to poor prognosis in recent years.

Systemic hemodynamics and renal function during long-term pathophysiological increases in circulating endothelin

Although recent studies have reported endogenous plasma endothelin levels to be elevated two- to fivefold in chronic pathophysiological states, whether such an increase in circulating endothelin levels alone can lead to significant long-term alterations in cardiovascular and renal function is not known. The purpose of this study was to examine the long-term systemic hemodynamic and renal effects of a pathophysiological increase in plasma endothelin concentration in chronically instrumented, conscious dogs (n = 7). Infusion of endothelin-1 (2.5 ng.kg-1.min-1) for 8 days increased plasma concentration of immunoreactive endothelin approximately two- to threefold from 6.7 +/- 0.4 to 16.0 +/- 2.2 pg/ml. Mean arterial pressure increased 21% from a control value of 86.7 +/- 2.1 to 105.0 +/- 2.5 mmHg during the endothelin infusion period. Cardiac output averaged 2,200 +/- 205 ml/min during control and fell by 33% on day 4 of endothelin infusion (1,484 +/- 146 ml/min) and was still 14% below control after day 8 of endothelin infusion (1,885 +/- 154 ml/min). Endothelin increased total peripheral resistance from 42.0 +/- 3.1 to 80.3 +/- 9.1 mmHg.l-1.min. Increasing plasma endothelin two- to threefold was associated with an increase in renal vascular resistance and decreases in glomerular filtration rate and renal plasma flow. Endothelin-1 had no long-term effect on plasma renin activity or aldosterone concentration. These data indicate the importance of pathophysiological levels of endothelin in controlling renal and cardiovascular function in chronic conditions. Furthermore, the results indicate that endothelin may play a role as a mediator of chronic hypertension in pathophysiological states associated with endothelial dysfunction.

Role of nitric oxide in the renal hemodynamic response to a meat meal

Ingestion of a high-protein meat meal results in significant increases in renal plasma flow (RPF) and glomerular filtration rate (GFR). The mechanism involved in this hemodynamic response to the meat meal has not yet been fully elucidated. The present study was designed to test the hypothesis that nitric oxide (NO) is involved in the renal hyperemic responses to a meat meal. To test this hypothesis, renal hemodynamic response to a meat meal (10 g/kg) was determined in conscious, chronically instrumented dogs with (n = 9) and without (n = 7) an intrarenal NO synthesis inhibition with NG-nitro-L-arginine methyl ester (L-NAME, 3 micrograms.kg-1.min-1 intrarenally). Under control conditions, the meat meal resulted in significant renal hyperemia. Three hours after ingestion of the meat meal, GFR (43 +/- 3 to 59 +/- 6 ml/min) and RPF (128 +/- 10 to 160 +/- 17 ml/min) progressively increased by approximately 40 and 25%, respectively. In contrast, pretreatment with intrarenal infusion of L-NAME abolished the GFR (48 +/- 6 to 52 +/- 6 ml/min) and RPF (129 +/- 20 to 121 +/- 17 ml/min) increases induced by the meat meal. Pretreatment with L-arginine (0.5 mg.kg-1.min-1) plus L-NAME (3 micrograms.kg-1.min-1) did not modify the meat meal-induced changes in GFR (41 +/- 4 to 66 +/- 6 ml/min) and RPF (127 +/- 9 to 182 +/- 14 ml/min). In summary, a meat meal in dogs results in marked increases in RPF and GFR. Intrarenal NO synthesis inhibition abolished the RPF and GFR responses to the meat meal.(ABSTRACT TRUNCATED AT 250 WORDS)

Role of prostaglandins on the renal effects of angiotensin and interstitial pressure during volume expansion

This study was undertaken to determine, in anesthetized dogs, the role of renal prostaglandins (PG) in mediating the natriuretic response to increased renal interstitial hydrostatic pressure (RIHP) during extracellular volume expansion (ECVE) with isotonic saline. It was also determined if the intrarenal angiotensin II (ANG II) effects during ECVE are potentiated by the inhibition of PG synthesis. ECVE induced similar elevations of RIHP, natriuresis, and fractional lithium excretion in dogs treated (n = 7) and not treated with a PG synthesis inhibitor (n = 5). In other experimental groups, the effects of the intrarenal maintenance of ANG II levels (n = 6) by infusing captopril and ANG II into the right renal artery were compared with those induced by the simultaneous infusion of captopril, ANG II, and a PG synthesis inhibitor (n = 6). In response to ECVE, renal blood flow and glomerular filtration rate were similar in both kidneys when ANG II levels were maintained constant and were significantly higher in the left kidney when ANG II levels were maintained constant and PG synthesis was inhibited in the right kidney. However, when compared with the left kidney, the ECVE-induced increments of natriuresis and RIHP in the right kidney were reduced by the same magnitude when intrarenal ANG II was maintained constant with (36 and 53%, respectively) and without (40 and 54%, respectively) the simultaneous PG synthesis inhibition. Our results indicate that during ECVE, renal PGs do not play an important role in mediating the RIHP-induced increments in natriuresis and decrements in proximal sodium reabsorption. (ABSTRACT TRUNCATED AT 250 WORDS)

Salt-induced increase in arterial pressure during nitric oxide synthesis inhibition

The objective of this study was to determine in conscious dogs the role of endothelium-derived nitric oxide in mediating the arterial pressure and renal response to a prolonged increment of sodium intake. After a control period of 3 days, an inhibitor of nitric oxide synthesis, NG-nitro-L-arginine-methyl ester, was infused intravenously during 5 consecutive days (0.1 micrograms/kg per minute). Sodium intake (80 mmol/d) did not change throughout the experiment in one group (n = 4). In another group (n = 6), 1 day after infusion of this inhibitor was started, sodium intake increased from 80 to 300 mmol/d during 4 consecutive days. Inhibition of nitric oxide synthesis in dogs with normal sodium intake induced a significant decrease in natriuresis and diuresis (P < .05) without changes in arterial pressure. However, in dogs treated with the nitric oxide synthesis inhibitor, mean arterial pressure increased from 95.2 +/- 3.3 to 106.2 +/- 4.0 mm Hg (P < .01) the first day that sodium intake was elevated and remained increased the following 3 days. In a different group of dogs (n = 5), the increment of sodium intake during 4 days did not induce changes in arterial pressure when nitric oxide synthesis was not inhibited. Cumulative sodium balance was higher (P < .01) in dogs treated simultaneously with the nitric oxide synthesis inhibitor and high sodium intake (158 +/- 21 mmol sodium) than in those treated only with the nitric oxide synthesis inhibitor (82 +/- 19 mmol sodium) or with high sodium intake (36 +/- 13 mmol sodium).(ABSTRACT TRUNCATED AT 250 WORDS)

Changes in canine ventricular fibrillation threshold induced by verapamil, flecainide and bretylium

The changes produced by verapamil, bretylium and flecainide in both ventricular fibrillation threshold (VFT) and ventricular repetitive response threshold (VRRT) were studied in 20 closed-chest dogs anaesthetized with pentobarbital. Right ventricle endocardium thresholds were determined using bipolar electrode catheters. Increasing intensity stimulus trains (200 ms, 4 ms, 100 Hz, 1 mA steps) were delivered 50 ms after QRS; VRRT and VFT were calculated before and after drug administration. Three study groups were considered according to the drug assayed: (1) verapamil 0.15 mg.kg-1 n = 6; (2) flecainide 2.0 mg.kg-1 n = 7, and (3) bretylium 10.0 mg.kg-1 n = 7. Flecainide significantly increased VRRT (4.8 +/- 1.4 vs 9.4 +/- 1.5 mA, P < 0.05), but the latter failed to change in the other two groups. VFT remained unchanged with verapamil, increased slightly post-flecainide (10.3 +/- 4.6 vs 12.4 +/- 4.1, P < 0.05 mA) and markedly post-bretylium (10.3 +/- 4.6 vs 17.3 +/- 7.5, P < 0.05). VFT changes were significantly correlated (r = 0.77, P < 0.05) with the effective refractory period changes in the bretylium group. Thus, of the three drugs tested, bretylium induced the greatest VFT increases without modifying VRRT, whereas flecainide affected both parameters. Only in the bretylium series were ERP changes significantly correlated to the corresponding VFT changes. This suggests that ventricular fibrillation threshold increase is not a non-specific property of antiarrhythmic drugs. Changes in ventricular repetitive response threshold may provide additional information.

Effect of glutathione on canine myocardial ischaemia without reperfusion

The present study was to evaluate the effect of exogenous glutathione on myocardial damage resulting from permanent (no reperfusion) coronary ligation (3 or 6 h) in anaesthetized dogs. Haemodynamics, infarct size and myocardial glutathione content were determined. Erythrocyte superoxide dismutase (SOD) activity was also determined in coronary venous blood samples. Glutathione was administered by the intraperitoneal route, 100 mg kg-1 as initial dose given 5 min before coronary ligation, and successive doses of 25 mg kg-1 every 40 min throughout the study period. Saline-treated dogs showed myocardial infarction, a decrease in myocardial glutathione content, and a transient increase in SOD activity. Three hours occlusion in glutathione-treated dogs resulted in a small reduction of infarct size, and no changes in myocardial glutathione content and SOD activity. By contrast, administration of glutathione failed to reduce infarct size and failed to prevent myocardial glutathione decrease in dogs subjected to 6 h occlusion. These results indicate that exogenous glutathione is of minor beneficial effect for myocardial damage resulting from permanent coronary occlusion and suggest that endogenous glutathione has a limited role in protecting against myocardial ischaemia without reperfusion.

Chronic pathophysiologic circulating endothelin levels produce hypertension in conscious dogs

Although recent studies have reported endogenous plasma endothelin (ET) levels to be elevated two- to fivefold in chronic pathophysiologic states, whether such an increase in circulating ET levels alone can lead to significant long-term alterations in cardiovascular function is not known. The purpose of this study was to examine the long-term systemic hemodynamic effects of a pathophysiologic increase in circulating ET concentration in chronically instrumented, conscious dogs (n = 4). Infusion of endothelin (2.5 ng/kg/min) for 8 days increased plasma concentration of endothelin two- to threefold. ET increased mean arterial pressure from 85 +/- 3 to 103 +/- 3 mm Hg, which was sustained throughout the period of infusion. Total peripheral resistance was increased by approximately 70%. Cardiac output decreased transiently by 25% and remained below control levels at the termination of ET infusion. These data indicate the importance of pathophysiologic levels of ET in controlling systemic hemodynamics in chronic conditions. Furthermore, ET may play a role as a mediator of chronic hypertension in pathophysiologic states associated with endothelial dysfunction.

The effects of selective stellate ganglion manipulation on ventricular refractoriness and excitability

The effects of selective stellate ganglion stimulation or stellectomy on ventricular excitability were studied in 30 open chest mongrel dogs anesthetized with alpha-chloralose. The effective refractory period (ERP) and strength interval curves (stimulus intensity [S2] = twice the diastolic threshold [ERP], and 2, 3, 5, 7, and 14 mA) were determined using bipolar epicardial electrodes placed in the mid-anterior wall of the right ventricle (RV) and the mid-posterolateral wall of the left ventricle (LV) during left stellate ganglion stimulation (LSGSt, n = 8) or right stellate ganglion stimulation (RSGSt, n = 8), or after left stellectomy (LSGEx, n = 7) or right stellectomy (RSGEx, n = 7). LSGEx prolonged ERP-LV (172 +/- 9 vs 167 +/- 8 msec, P < 0.05) and ERP-RV (163 +/- 10 vs 158 +/- 14 msec, P < 0.05). RSGEx prolonged ERP-LV (168 +/- 17 vs 162 +/- 15 msec, P < 0.01) and ERP-RV (166 +/- 14 vs 160 +/- 13 msec, P < 0.01), and the times of the strength interval curves obtained for each S2 intensity in both ventricles. LSGSt decreased ERP-LV (157 +/- 11 vs 163 +/- 12 msec, P < 0.01) and ERP-RV (147 +/- 18 vs 157 +/- 17 msec, P < 0.05), and the times of the strength interval curves obtained for each S2 intensity in both ventricles. RSGSt did not significantly decreased ERP-LV (152 +/- 11 vs 156 +/- 9 msec); however, it significantly shortened the times of the strength interval curves obtained for S2 intensities of 2 and 7 mA in the LV, and shortened ERP-RV (139 +/- 10 vs 145 +/- 7 msec, P < 0.01) and the times of the strength interval curve for S2 intensities of 2, 3, and 5 mA in the RV. A significant interaction (MANOVA test) was observed between the ventricle studied and the ganglion stimulated for S2 intensities of 2 and 3 mA, and between the effect of stimulation and the ganglion stimulated for S2 intensities of 3 and 14 mA. To conclude, selective stellectomy prolonged epicardial ventricular refractoriness in both the mid-anterior wall of the RV and the mid-posterolateral wall of the LV; the magnitude of the epicardial excitability variations in both areas was different during selective stellate ganglion stimulation.

Role of nitric oxide in mediating renal response to volume expansion

The objective of the present study was to determine the role of endothelium-derived nitric oxide in mediating the renal response to extracellular volume expansion with isotonic saline (5% body weight). In anesthetized dogs (n = 7) and before volume expansion, nitric oxide synthesis was inhibited in the right kidney by continuous intrarenal infusion of NG-nitro-L-arginine-methyl ester (1 microgram/kg/min). Arterial pressure and renal hemodynamics of both kidneys did not change significantly either during nitric oxide synthesis inhibition or during 5% volume expansion. However, in response to extracellular volume expansion, increases in natriuresis, diuresis, and fractional excretion of lithium (an index of proximal sodium reabsorption) were inhibited in the right kidney by 27%, 28%, and 41%, respectively, when compared with the contralateral kidney. Increases of renal interstitial hydrostatic pressure during 5% volume expansion were not statistically different between both kidneys. In another group of dogs (n = 4), the administration of L-arginine (0.5 mg/kg/min) into the right renal artery prevented the renal effects induced by the nitric oxide synthesis inhibitor during volume expansion. The findings in this study suggest that nitric oxide production plays an important role in regulating the renal response to extracellular volume expansion. The proximal tubule seems to be involved in the reduced renal excretory response to volume expansion during nitric oxide synthesis inhibition.

Protective effect of N-acetylcysteine on ischaemia-induced myocardial damage in canine heart

The glutathione redox pathway is an important antioxidant system in the myocardium. N-Acetylcysteine is a low molecular weight glutathione precursor that has been used clinically to replenish glutathione stores. The present study was aimed at evaluating the protective effect of N-acetylcysteine on myocardial damage resulting from permanent coronary occlusion (without reperfusion) in anaesthetized dogs. N-Acetylcysteine (150 mg kg-1 i.v.) administered 2 min before occlusion reduced infarct size in dogs subjected to 24 h ischemia. The infarct size as a percentage of the area at risk was 86.8 +/- 3.6% (n = 11) in control (saline-treated) dogs and 68.2 +/- 2.4% (n = 7; P less than 0.05 vs control) in N-acetylcysteine-treated animals. Haemodynamic variables (heart rate, mean arterial pressure and rate-pressure product) were similar in the control and the treated group. Regional myocardial blood flow was determined with radioactive microspheres in ischaemic and non-ischaemic zones before occlusion and 3 h post-occlusion. N-Acetylcysteine did not influence the regional distribution of myocardial blood flow. The myocardial content of reduced glutathione was significantly (P less than 0.05) decreased 3 h post-occlusion (0.53 +/- 0.19 mumol/g-1; n = 5) compared to either pre-occlusion values (0.94 +/- 0.03 mumol/g-1; n = 8) or values 3 h post-occlusion in sham-operated animals (0.93 +/- 0.15 mumol/g-1; n = 5). Depletion of myocardial glutathione 3 h post-occlusion was not observed in dogs treated with N-acetylcysteine (0.87 +/- 0.11 mumol/g-1; n = 5).(ABSTRACT TRUNCATED AT 250 WORDS)

Changes in canine ventricular refractoriness induced by trains of subthreshold high-frequency stimuli

Epicardial electrodes were applied to 12 thoractomized dogs to determine the effects of trains of subthreshold conditioning stimuli (TSc) on ventricular refractoriness when delivered preceding a premature suprathreshold stimulus (S2). Several factors were analyzed: (1) the influence of TSc pulse frequency (100-900 Hz); (2) the delay between TSc and S2 (1 or 10 ms); (3) the distance between the electrodes for the emission of TSc and S2 (same electrodes or different electrodes at 3 mm); and (4) S2 current intensity (two- or fourfold diastolic threshold). The TSc (mean current intensity 0.33 mA, range 0.1-0.7) were found to significantly prolong the effective ventricular refractory period (EVRP) at all train pulse frequencies. The EVRP increment was progressively greater as pulse frequency was increased, the maximum EVRP increment being at 900 Hz (mean 50.8 +/- 32.3 ms; maximum increment 130 ms). On increasing S2 current intensity, the EVRP increment was less (maximum value 35 ms) and less consistent (in four of six dogs); in two cases the EVRP was shortened. The increase in delay between TSc and S2 attenuated the EVRP prolongation, which was present in only three of six dogs tested, and the EVRP was shortened in two dogs. There was no EVRP prolongation at any TSc pulse frequency when TSc and S2 were delivered at different electrodes. Thus TSc decreases myocardial ventricular excitability, prolonging EVRP in direct proportion to TSc pulse frequency. However, this property is limited by S2 current intensity as well as the time and distance between TSc and S2.

[Experimental study of the effects of ATP on sinus automatism and atrioventricular node conduction]

A study was made of 14 thoracotomized dogs under i.v. sodium thiopental anesthesia; the effects of 1.5 mg/kg intravenous ATP on sinus node automatism and atrio-ventricular conduction were investigated. In 7 dogs (group A) ATP was administered under control conditions and following successive intravenous administrations of atropine (1 mg/kg), aminophylline (5 mg/kg) and propranolol (0.6 mg/kg). The remaining 7 dogs (group B) received ATP following atropine (1 mg/kg), isoproterenol (0.4 microgram/kg/min.), and aminophylline (5 mg/kg). An analysis was made of the percentage variations in cardiac cycle length during spontaneous rhythm and of the AH interval during atrial pacing at a fixed rate. In group A the negative dromotropic and chronotropic effects of ATP under control conditions decreased in 5 cases following atropine, although the average decrease was not statistically significant. On adding aminophylline, a statistically significant decrease was observed in the effects of ATP, and following propranolol the drop in negative chronotropic effect of ATP provoked by aminophylline was maintained. In group B, and following prior atropinization, the negative chronotropic and dromotropic effects of ATP were maintained in the presence of isoproterenol. As in group A, aminophylline significantly reduced the effects of ATP. To conclude: in the thoracotomized dog under sodium thiopental anesthesia, 1) atropine does not prevent the negative chronotropic and dromotropic actions of ATP, although the effect of the latter is decreased in a large percentage of cases; 2) sympathetic beta stimulation following prior atropinization does not prevent ATP action; 3) aminophylline in the atropinized dog noticeably reduces the effects of ATP, and 4) this action of aminophylline is effective in the presence of sympathetic beta stimulation.

Myocardial glutathione alterations in acute coronary occlusion in the dog

Glutathione (GSH) decreases in dog myocardium upon acute coronary occlusion when compared with sham-operated dogs. Total glutathione content (GSHeq = GSH + 2GSSG) remains unchanged throughout the experiment (6 h after surgery) in both sham- and acute coronary occlusion-operated dogs. GSSG and GSH/GSSG ratio increases and decreases respectively in all animals but tends to reach the normal value after 6 h in sham-operated dogs. Both parameters (GSSG and GSH/GSSG ratio) remain altered in acute coronary occlusion-operated ones. This alteration of glutathione status in ischemic myocardium is discussed.