Arrhythmia and sudden death associated with elevated cardiac chloride channel activity.

The identification and analysis of several cationic ion channels and their associated genes have greatly improved our understanding of the molecular and cellular mechanisms of cardiac arrhythmia. Our objective in this study was to examine the involvement of anionic ion channels in cardiac arrhythmia. We used a transgenic mouse model to overexpress the human cystic fibrosis transmembrane conductance regulator (CFTR) gene, which encodes a cAMP-regulated chloride channel. We used RNase protection and in situ hybridization assays to determine the level of CFTR expression, and radiotelemetry and in vivo electrophysiological study in combination with pharmacological intervention to analyse the cardiac function. Cardiac CFTR overexpression leads to stress-related sudden death in this model. In vivo intracardiac electrophysiological studies performed in anaesthetized mice showed no significant differences in baseline conduction parameters including atrial-His bundle (AH) or His bundle-ventricular (HV) conduction intervals, atrioventricular (AV) Wenckebach or 2:1 AV block cycle length and AV nodal functional refractory period. However, following isoproterenol administration, there was marked slowing of conduction parameters, including high-grade AV block in transgenic mice, with non-sustained ventricular tachycardia easily inducible using programmed stimulation or burst pacing. Our sudden death mouse model can be a valuable tool for investigation of the role of chloride channels in arrhythmogenesis and, potentially, for future evaluation of novel anti-arrhythmic therapeutic strategies and pharmacological agents.

The neonatal but not the mature heart adapts to acute tachycardia by beneficial modification of the force-frequency relationship.

The force-frequency relationship (FFR) reflects alterations in intracellular calcium cycling during changing heart rate (HR). Tachycardia-induced heart failure is associated with depletion of intracellular calcium. We hypothesized (1) that the relative resistance to tachycardia-induced heart failure seen in neonatal pigs is related to differences in calcium cycling, resulting in different FFR responses and (2) that pretreatment with digoxin to increase intracellular calcium would modifies these changes. LV +dP/dt was measured during incremental right atrial pacing in 16 neonatal and 14 adult pigs. FFR was measured as the change in +dP/dt as HR was increased. Animals were randomized to control or intravenous bolus digoxin (n = 8 neonate pigs in the 0.05 mg/kg group and n = 7 adult pigs in the 0.025 mg/kg group) and paced for 90 min at 25 bpm greater than the rate of peak +dP/dt. Repeat FFR was then obtained. The postpacing FFR in neonatal control pigs shifted rightward, with peak force occurring 30 bpm greater than baseline (P < 0.03). There was no vertical shift; thus, force at 150 bpm decreased (P < 0.03) and force at 300 beats/min increased (P < 0.08). In adult control pigs, FFR shifted downward (P < 0.01), with decreased force generation at all HRs. In both neonates and adult pigs, digoxin increased +dP/dt at all HRs; however, in neonate pigs digoxin decreased the contractile reserve by abrogation of the rightward shift of FFR. An adaptive response to tachycardia in the neonate pig leads to improved force generation at greater HRs. Conversely, the response of the mature pig heart is maladaptive with decreased force generation. Pretreatment with digoxin modifies these responses.

The effect of weight training on bone mineral density and bone turnover in postmenopausal breast cancer survivors with bone loss: a 24-month randomized controlled trial.

SUMMARY: This study examined whether 24 months of weight training exercises enhanced the effectiveness of risedronate, calcium, and vitamin D in maintaining or improving bone mineral density (BMD) in 223 postmenopausal breast cancer survivors. Subjects who were > or =50% adherent to exercise had no improvement in BMD but were less likely to lose BMD. INTRODUCTION: This study examined whether (1) postmenopausal breast cancer survivors (BCS) with bone loss taking 24 months of risedronate, calcium, and vitamin D had increased bone mineral density (BMD) at the total hip, femoral neck, L1-L4 spine, total radius and 33% radius, and decreased bone turnover; (2) subjects who also participated in strength/weight training (ST) exercises had greater increases in BMD and greater decreases in bone turnover; and (3) subjects who also exercised were more likely to preserve (at least maintain) BMD. METHODS: Postmenopausal BCS (223) were randomly assigned to exercise plus medication or medication only groups. Both groups received 24 months of 1,200 mg of calcium and 400 IU of vitamin D daily and 35 mg of risedronate weekly, and the exercise group additionally had ST exercises twice weekly. RESULTS: After 24 months, women who took medications without exercising had significant improvements in BMD at the total hip (+1.81%) and spine (+2.85%) and significant decreases in Alkphase B (-8.7%) and serum NTx (-16.7%). Women who also exercised had additional increases in BMD at the femoral neck (+0.29%), total hip (+0.34%), spine (+0.23%), total radius (+0.30%), and additional decreases in Alkphase B (-2.4%) and Serum NTx (-6.5%). Additional changes in BMD and bone turnover with exercise were not significant. Subjects who were > or =50% adherent to exercise were less likely to lose BMD at the total hip (chi-square [1] = 4.66, p = 0.03) and femoral neck (chi-square [1] = 4.63, p = 0.03). CONCLUSION: Strength/weight training exercises may prevent loss of BMD in postmenopausal BCS at risk for bone loss.

Opioids and myocardial reperfusion injury.

It is well-established that reperfusion is the major method of salvaging ischemic myocardium following prolonged coronary artery occlusion, although the idea of reperfusion injury remains controversial. Moreover, more recent evidence strongly suggests that reperfusion per se is thought to result in further damage to the myocardium and blood vessel endothelium by various biochemical and physical factors including a burst of oxygen-derived free radicals (ROS), cellular or mitochondrial calcium overload and shear stress, to name a few. This has been termed lethal reperfusion injury. It has become increasingly evident that strategies in which interventions are administered during the early stages of reperfusion produce a reduction in reperfusion-mediated damage primarily by reducing massive calcium overload or by altering the intracellular milieu (pH, osmotic stress, etc.) and ROS release upon reperfusion. Furthermore, it is apparent that activation of blood borne elements such as neutrophils and macrophages and factors released by these cells such as cytokines may be responsible for a continuing expansion of infarction in the hours or even days following timely reflow and that inhibiting these factors may attenuate reperfusion injury. The present review will focus on the effect of endogenous and exogenous opioids on ischemic and reperfusion injury since these compounds are routinely used in the surgical arena and may have unappreciated cardioprotective effects in this subset of patients. Particular emphasis will be on the role of opioids in reperfusion injury and their relationship to the newly discovered phenomenon of postconditioning.

Increased mitochondrial K(ATP) channel activity during chronic myocardial hypoxia: is cardioprotection mediated by improved bioenergetics?

Increased resistance to myocardial ischemia in chronically hypoxic immature rabbit hearts is associated with activation of ATP-sensitive K(+) (K(ATP)) channels. We determined whether chronic hypoxia from birth alters the function of the mitochondrial K(ATP) channel. The K(ATP) channel opener bimakalim (1 micromol/L) increased postischemic recovery of left ventricular developed pressure in isolated normoxic (FIO(2)=0.21) hearts to values (42+/-4% to 67+/-5% ) not different from those of hypoxic controls but did not alter postischemic recovery of developed pressure in isolated chronically hypoxic (FIO(2)=0.12) hearts (69+/-5% to 72+/-5%). Conversely, the K(ATP) channel blockers glibenclamide (1 micromol/L) and 5-hydroxydecanoate (5-HD, 300 micromol/L) attenuated the cardioprotective effect of hypoxia but had no effect on postischemic recovery of function in normoxic hearts. ATP synthesis rates in hypoxic heart mitochondria (3.92+/-0.23 micromol ATP. min(-1). mg mitochondrial protein(-1)) were significantly greater than rates in normoxic hearts (2.95+/-0.08 micromol ATP. min(-1). mg mitochondrial protein(-1)). Bimakalim (1 micromol/L) decreased the rate of ATP synthesis in normoxic heart mitochondria consistent with mitochondrial K(ATP) channel activation and mitochondrial depolarization. The effect of bimakalim on ATP synthesis was antagonized by the K(ATP) channel blockers glibenclamide (1 micromol/L) and 5-HD (300 micromol/L) in normoxic heart mitochondria, whereas glibenclamide and 5-HD alone had no effect. In hypoxic heart mitochondria, the rate of ATP synthesis was not affected by bimakalim but was attenuated by glibenclamide and 5-HD. We conclude that mitochondrial K(ATP) channels are activated in chronically hypoxic rabbit hearts and implicate activation of this channel in the improved mitochondrial bioenergetics and cardioprotection observed.

Characteristics and superoxide-induced activation of reconstituted myocardial mitochondrial ATP-sensitive potassium channels.

Mitochondrial ATP-sensitive potassium (mitoK(ATP)) channels have been suggested as triggers and end effectors in myocardial ischemic preconditioning. However, the intracellular mechanism regulating mitoK(ATP) channels remains unclear. In the present study, mitoK(ATP) channels from bovine ventricular myocardium were reconstituted using planar lipid bilayers, and the effect of superoxide (O(2-.)) on the activity of these reconstituted channels was examined. After incorporation, a potassium-selective current was recorded. The mean conductance of this current was 56 pS at 150 mmol/L KCl, which was substantially inhibited by 1 mmol/L MgATP. 5-Hydroxydecanoate (5-HD, 10 to 100 micromol/L), a selective mitoK(ATP) antagonist, reduced the open state probability (NPo) of these channels in a concentration-dependent manner, whereas diazoxide (10 micromol/L), a selective mitoK(ATP) agonist, significantly increased channel activity. HMR-1098 (100 micromol/L), a selective sarcolemmal K(ATP) antagonist, had no effect on the activity of reconstituted channels. Addition of xanthine/xanthine oxidase (100 micromol/L per 0.038 U/mL), an O(2-.)-generating system, resulted in a marked activation of mitoK(ATP) channels; the NPo of the channels was increased from 0.60+/-0.10 to 1.94+/-0.02. This O(2)(-.)-induced channel activation was completely abolished by pretreatment with 5-HD (100 micromol/L) or a sulfhydryl alkylating compound, N-ethylmaleimide (2 mmol/L). It is concluded that myocardial mitoK(ATP) channels can be reconstituted into lipid bilayers and that O(2-.) activates these channels. The effect of O(2-.) may be associated with its direct action on the sulfhydryl groups of the channel protein.

Opioids and cardioprotection.

Opioid peptides and exogenous opioids such as morphine are known to exert important cardiovascular effects. However, until recently, it was not appreciated that activation of specific receptors results in a potent cardioprotective effect to reduce infarct size in experimental animals and to reduce cell death in isolated cardiomyocytes. In intact rat and rabbit hearts, nonselective opioid receptor antagonists such as naloxone and a selective delta1-opioid receptor antagonist, 7-benzylidenenaltrexone, have been shown to inhibit the cardioprotective effect of ischemic preconditioning, a phenomenon in which brief periods of ischemia protect the heart against a more prolonged period of ischemia. Selective delta(1) specific agonists such as 2-methyl-4a-alpha-(3-hydroxyphenyl)-1,2,3,4,4a,5,12,12a-alpha-octahydroquinolino[2,3,3-g]isoquinoline have been shown to exert potent cardioprotective effects in intact animals and cardiac myocytes via activation of Gi/o proteins, protein kinase C, and ultimately, the mitochondrial KATP channel. These protective effects occur immediately following drug administration, and reappear 24-48 hr post treatment. Although further studies are needed to more clearly define the mechanisms by which opioids exert their cardioprotective effects, the data accumulated and summarized in this review suggest that this class of drugs may not only be useful in alleviating the pain associated with a myocardial infarction, but may also be simultaneously reducing the size of the ultimate infarct. Since many of these drugs are already clinically available, a long period of drug development may not be necessary before the use of these drugs reaches the patient with signs of myocardial ischemia.

[Contribution of the endogenous opioid system to regulation of heart resistance to the arrhythmogenic effect of short-term ischemia and reperfusio].

Preliminary selective blockade of micro, delta1, delta2, kappa1, and kappa2 opioid receptors proved to have no effect on the incidence of ventricular arrhythmias during a 10-min coronary occlusion and subsequent reperfusion in ketamine-anesthetized rats. We propose that the endogenous opioid system has no considerable role in regulation of heart resistance to the arrhythmogenic effect of short-term local ischemia and subsequent reperfusion.

Role of ATP dependent potassium channels in myocardial ischaemia.

Recently, a class of potassium (K) channels has been discovered which are regulated by the intracellular level of ATP. These channels have been termed ATP dependent K channels (KATP) and have been found to exist in the heart, skeletal muscle, pancreatic beta cells, brain, and smooth muscle. In this article, we discuss the function of the KATP channel in the ischaemic myocardium and present evidence to suggest that activation of these channels may, on the one hand, result in a marked cardioprotective effect from reversible or irreversible electrical, functional or biochemical damage or, on the other hand, have the potential to produce electrical instability and a proarrhythmic effect. The therapeutic potential of potassium channel modulators is also discussed.

Evidence for the involvement of the ATP-sensitive potassium channel in a novel model of hypoxic preconditioning in dogs.

OBJECTIVES: The major aims of the present study were to determine if a 5 min period of hypoxic (pO2 = 30-40 mmHg) buffer perfusion of the left anterior descending (LAD) coronary artery 10 min prior to a 60-min LAD occlusion produces myocardial preconditioning (PC) and to determine if hypoxic PC is mediated via activation of ATP-sensitive potassium channels (KATP). Normoxic (pO2 = 500-600 mmHg) buffer perfusion served as a control. METHODS: Barbital-anesthetized dogs were subjected to 60 min of LAD occlusion followed by 3 h of reperfusion. Hypoxic PC was produced by 5 min of LAD perfusion with hypoxic buffer followed by 10 min of blood reperfusion prior to a 60-min occlusion. A sham PC group, elicited by 5 min of LAD perfusion with normoxic buffer, served as a control. A final group of animals was treated with glibenclamide (0.3 mg/kg i.v.), a specific KATP channel antagonist, 15 min prior to hypoxic PC and 3 microM of glibenclamide was also added to the hypoxic buffer. Transmural myocardial blood flow (TMBF, ml/min/100 g) was determined by radioactive microspheres 30 min after the initiation of the prolonged 60-min occlusion and infarct size (IF/AAR) as a percent of the area at risk (AAR) was determined by triphenyltetrazolium staining. RESULTS: There were no significant differences between groups in hemodynamics, AAR, or TMBF. Five minutes of perfusion with hypoxic buffer prior to the 60-min occlusion produced a marked reduction in myocardial infarct size as compared to control animals (control, 30 +/- 7 to 9 +/- 2%, hypoxic PC, P < 0.05). Five minutes of perfusion with normoxic buffer had no effect on infarct size (30 +/- 6%) and pretreatment with glibenclamide completely blocked the protective effect of hypoxic PC (31 +/- 7%). CONCLUSIONS: These results support the hypothesis that a brief period of hypoxic buffer perfusion can precondition the heart and that this cardioprotective effect is dependent on the opening of myocardial KATP channels.

Intracoronary versus intravenous nitroglycerin on the transmural distribution of coronary blood flow.

The effect of intracoronary versus intravenous administration of nitroglycerin (GTN) on the transmural distribution of coronary blood flow (epi/endo) was studied in an isolated canine heart preparation and intact dogs. The distribution of blood flow between epicardium and endocardium of the left ventricle was determined by use of radioactive microspheres (15 micrometer diameter). Intracoronary infusion of GTN in the isolated heart significantly increased epi/endo during a constant coronary blood flow, whereas no change in epi/endo was observed during a constant coronary perfusion pressure. When maximal coronary vasodilatation was produced by chromonar, the epi/endo increased significantly, however intracoronary GTN produced no further vasodilatation and did not improve epi/endo. In contrast, intravenous infusion of GTN in intact hearts significantly decreased epi/endo. These results suggest that intracoronary GTN does not enhance endocardial perfusion and may even produce a coronary steal, whereas intravenous GTN may improve endocardial perfusion via indirect haemodynamic actions.

Effects of nicorandil and glyceryl trinitrate on infarct size, adenosine release, and neutrophil infiltration in the dog.

OBJECTIVE: The major aim of this study was to determine if nicorandil, a potassium channel opener nitrate, produces a reduction in myocardial infarct size at a non-hypotensive dose in dogs and to determine if this effect is the result of an increase in adenosine release or reduction in neutrophil infiltration into the ischaemic area. Glyceryl trinitrate was used for purposes of comparison. METHODS: Barbitone anaesthetised dogs were subjected to 60 min of left anterior descending coronary artery occlusion followed by 3 h of reperfusion. Nicorandil (100 microgram.kg-1 bolus followed by a 10 microgram.kg-1.min-1 infusion; NC/pre group), glyceryl trinitrate (10 microgram.kg-1 bolus followed by a 1 microgram.kg-1.min-1 infusion; GTN/pre group), or an equivalent volume of saline (control group) were given intravenously 15 min before occlusion and continued to the time of reperfusion. In two other groups, nicorandil (NC/post group) or glyceryl trinitrate (GTN/post group) were given 10 min before reperfusion and continued until the end of the experiment. To measure the release of adenosine from the ischaemic region, coronary venous blood samples were collected before occlusion, during occlusion, and at various times following reperfusion. Myocardial infarct size was determined by triphenyltetrazolium chloride and transmural myocardial blood flow by radioactive microspheres. Transmural myeloperoxidase activity, an index of neutrophil infiltration, was measured in biopsies obtained from the area at risk. RESULTS: Pretreatment with nicorandil and glyceryl trinitrate caused a marked reduction in myocardial infarct size expressed as percent of the area at risk [NC/pre group, 7.8(SEM 1.6)%; GTN/pre group, 11.9(2.3)%; control group, 31.0(5.6)%]. When nicorandil and glyceryl trinitrate were given before reperfusion, both drugs still produced a significant reduction in infarct size [NC/post group, 13.8(2.0)%; GTN/post group, 18.9(4.3)%]. Coronary venous adenosine concentrations during reperfusion were significantly lower in both nicorandil and glyceryl trinitrate pretreated groups, but not in the post-treated groups. Transmural myeloperoxidase activity was significantly lower in both nicorandil treated groups. CONCLUSIONS: Pretreatment with a non-hypotensive dose of nicorandil or glyceryl trinitrate markedly reduces myocardial infarct size and adenosine release from the ischaemic-reperfused area. These agents were also effective, but to a lesser degree, when given just before reperfusion. The cardioprotective actions of nicorandil appear to be related not only to its potassium channel opening activity but also in part to its nitrate activity.

Infarct size-reducing effect of nicorandil is mediated by the KATP channel but not by its nitrate-like properties in dogs.

OBJECTIVES: We wished to determine whether the cardioprotective effect of nicorandil to reduce infarct size is blocked by glibenclamide, a selective KATP channel antagonist, or methylene blue, a nitric oxide (NO)/guanylate cyclase inhibitor, in dogs. The second aim was to determine if glyceryl trinitrate produces a cardioprotective effect in the same model and to test if this effect is blocked by methylene blue and not by glibenclamide. We also determined whether adenosine release from the ischemic-reperfused area is an accurate index of ischemic severity in the presence of these drugs. METHODS: Barbiturate-anesthetized dogs were subjected to 60 min of left anterior descending coronary artery (LAD) occlusion followed by 3 h of reperfusion. In the first three groups, either nicorandil (100 micrograms/kg bolus + 10 micrograms/kg/min), glyceryl trinitrate (10 micrograms/kg bolus + 1 microgram/kg/min) or an equivalent volume of saline was given intravenously 15 min before LAD occlusion and continued to the time of reperfusion. In the next three groups, glibenclamide (0.3 mg/kg) was administered 15 min before drug infusion. In the final three groups, methylene blue (80 microM) was given intracoronarily 5 min before nicorandil or glyceryl trinitrate and continued until 15 min following reperfusion. Coronary venous blood samples were collected at various times during ischemia and following reperfusion and the concentration of adenosine measured. RESULTS: Nicorandil produced a marked reduction in infarct size expressed as a percent of the area at risk (NC group, 12.2 +/- 3.2% vs. Control group, 25.7 +/- 4.1%, P < 0.05) and this effect was completely abolished by pretreatment with glibenclamide. However, intracoronary administration of methylene blue did not block the cardioprotective effect of nicorandil. On the other hand, glyceryl trinitrate also produced a significant reduction in infarct size (GTN group, 13.0 +/- 3.1%) and this effect was reversed by methylene blue but not by glibenclamide. Adenosine concentrations in coronary venous blood were significantly reduced after reperfusion in the groups with small infarctions as compared with the Control group. CONCLUSIONS: These results suggest that at equieffective cardioprotective doses the infarct size-reducing effect of nicorandil in dogs is mediated via opening of myocardial KATP channels and that the cardioprotective effect of glyceryl trinitrate is most likely to be mediated via activation of guanylate cyclase at a site yet to be determined.

Characterisation of transient outward current in young human atrial myocytes.

OBJECTIVE: The aim was to characterise the development of the transient outward current (Ito) in atrial myocytes of infants and children. METHODS: Whole cell voltage clamp was used to study outward currents in enzymatically isolated atrial myocytes from infants and children ranging in age from 3 days to 13.2 years. RESULTS: A transient inactivating current characteristic of Ito was observed in 71 myocytes from 22 patients aged 3 days to 13.2 years, including a 10 day old infant born prematurely at 33 weeks gestation. There was no discernible developmental trend in Ito current density [10.74(SEM 0.65) pA.pF-1 at +40 mV, n = 71 cells from 22 patients] or voltage dependence of inactivation, newborn values being similar to those in older children, and in adults reported elsewhere. A developmental reduction in total outward current density was attributable entirely to diminution of the non-inactivating steady state current component. The Ito time course of inactivation showed an apparent maturational evolution, with the youngest infants having slightly but significantly slower inactivation kinetics. The kinetics of Ito recovery from inactivation were well described by a single exponential model with no appreciable developmental trend in time course. CONCLUSIONS: Ito is expressed in human atrial myocytes from early infancy and does not show significant developmental changes in current density. The relative contribution of Ito to myocyte repolarisation might increase with age as a result of diminution in the non-inactivating current component. There is an apparent slight maturational acceleration in the time course of Ito inactivation but not in recovery from inactivation, perhaps excluding the latter as a mechanism for the previously reported functional unavailability of Ito in young human atrial muscle.

Blockade of ischaemic preconditioning in dogs by the novel ATP dependent potassium channel antagonist sodium 5-hydroxydecanoate.

OBJECTIVE: The aims were: (1) to determine if a new ischaemia selective ATP dependent potassium (KATP) channel antagonist, sodium 5-hydroxydecanoate (5-HD), blocks ischaemic preconditioning in dogs; (2) to determine whether a small intracoronary dose of glibenclamide, a classical sulphonylurea KATP channel antagonist, could block ischaemic preconditioning independent of systemic metabolic effects. METHODS: Barbitone anaesthetised dogs were subjected to 60 min of left circumflex coronary artery occlusion followed by 5 h of reperfusion. Preconditioning was produced by a single 5 min left circumflex occlusion followed by 10 min of reperfusion prior to the 60 min occlusion period. 5-HD (150 micrograms.kg-1 x min-1) or vehicle was given by intracoronary infusion into the ischaemic region over 20 min, beginning 15 min prior to the 60 min occlusion period in the presence or absence of preconditioning. Glibenclamide (3 micrograms.kg-1 x min-1) was given by intracoronary infusion into the left circumflex artery during the 5 min preconditioning period or during the first 5 min of occlusion in preconditioned or non-preconditioned dogs. Transmural myocardial blood flow was measured by radioactive microspheres and infarct size determined by triphenyltetrazolium staining and expressed as a percent of the area at risk. RESULTS: There were no differences in haemodynamic variables, myocardial blood flow, area at risk, or blood glucose between groups. Infarct size was markedly reduced in preconditioned dogs compared to control animals, at 7(SEM 2)% v 29(4)%, p < 0.05 The reduction in infarct size by preconditioning was blocked completely by intracoronary 5-HD, or by intracoronary glibenclamide given during preconditioning or during the first 5 min of the prolonged occlusion period. Neither 5-HD nor glibenclamide affected infarct size in the absence of preconditioning at the doses studied. CONCLUSIONS: These results further strengthen the hypothesis that activation of myocardial KATP channels is involved in the mechanism of ischaemic preconditioning in dogs.

Changes in regional myocardial perfusion by muscarinic receptor subtypes in dogs.

To determine the muscarinic receptor subtype (M1 or M2 or both) responsible for cholinergic coronary vasodilatation and alterations in the transmural distribution (endocardial to epicardial blood flow ratio) of coronary blood flow, systemic and coronary haemodynamic indices and regional myocardial blood flow (radioactive microspheres) were measured in anaesthetised dogs. Submaximal vasodilative doses of the mixed muscarinic agonist acetylcholine were given by intracoronary infusion to avoid peripheral haemodynamic effects. Acetylcholine produced significant increases in myocardial perfusion and selectively redistributed flow to the subendocardium (increased endocardial to epicardial blood flow ratio). Pirenzepine (160 nmol X kg-1 iv), a selective M1 antagonist, produced no change in endocardial to epicardial blood flow ratio or myocardial blood flow but blocked the increase in endocardial to epicardial blood flow ratio and attenuated the transmural increase in myocardial perfusion during acetylcholine infusion. 4-Diphenylacetoxy-N-methylpiperidine methyl bromide (4-DAMP) (17 nmol X kg-1 iv), a selective M2 antagonist, also attenuated the transmural increase in myocardial blood flow but had little effect on the increase in endocardial to epicardial blood flow ratio produced by acetylcholine. These results support the hypothesis that M1 muscarinic coronary receptors are responsible for the redistribution of blood flow to the subendocardium (increased endocardial to epicardial blood flow ratio) during cholinergic coronary vasodilatation, whereas both M1 and M2 receptors are involved in increasing myocardial perfusion.

Cardioprotective effects of monophosphoryl lipid A, a novel endotoxin analogue, in the dog.

OBJECTIVE: The major objective of the present study was to determine the effects of a new endotoxin analogue, monophosphoryl lipid A (MLA), on myocardial infarct size in dogs. A second aim was to determine if potential cardioprotective effects of MLA might be mediated via an enhancement of antioxidant defence mechanisms. METHODS: Barbiturate anaesthetised dogs were subjected to 60 min left circumflex coronary artery occlusion followed by 5 h reperfusion. Either of two different doses of MLA (30 and 100 micrograms.kg-1) or an equivalent volume of vehicle were given intravenously 24 h prior to the infarct experiments. Transmural myocardial blood flow was measured at 30 min of occlusion by the radioactive microsphere technique and infarct size was determined at the end of 5 h of reperfusion by triphenyltetrazolium staining. Tissue catalase and myeloperoxidase activities were measured at 5 h of reperfusion as indices of antioxidant activity and neutrophil infiltration, respectively. RESULTS: There were no significant differences between groups in systemic haemodynamic variables, myocardial oxygen demand, ischaemic bed size, or coronary and collateral blood flow to the ischaemic region. However, administration of MLA produced a marked dose dependent reduction in myocardial infarct size: 19.8(SEM 3.7)% and 14.1(2.5)%, respectively, v 32.7(2.9)% in the vehicle control group, p < 0.05. Pretreatment with either 30 or 100 micrograms.kg-1 of MLA resulted in small increases in tissue catalase activity in the non-ischaemic region of the heart: 0.169(0.033) and 0.197(0.013) K.g-1, respectively, v 0.136(0.013) K.g-1 tissue in the control; however, the increases were not statistically significant by ANOVA. Myeloperoxidase activity in the border zone immediately adjacent to the infarct was markedly decreased in both MLA treated groups: MLA 30 micrograms.kg-1, 2.69(0.82); MLA 100 micrograms.kg-1, 2.49(0.47), v control group, 5.81(1.20) units.g-1 tissue; p < 0.05. CONCLUSIONS: These data are the first to show a marked cardioprotective effect of a lipid A derivative of endotoxin in an in vivo model of myocardial infarction. Although the mechanism responsible for the reduction in infarct size by MLA is unknown, a reduction in neutrophil migration at the site of ongoing tissue injury, the border zone, may be partially responsible.

Recovery of contractile function in post-ischaemic reperfused myocardium of conscious dogs: influence of nicorandil, a new antianginal agent.

The effects of intravenous administration of nicorandil, a new antianginal agent, on the recovery of regional myocardial contractile function after a 10 minute coronary artery occlusion were studied in chronically instrumented conscious dogs. Compared with the control group nicorandil administration resulted in an increase in heart rate and a decrease in blood pressure with an overall increase in the double product during the preocclusion period, no significant difference in double product during ischaemia, and a significant decrease in double product during reperfusion. After reperfusion the return of regional contractile function was appreciably enhanced in the nicorandil treated group. These effects were seen immediately after coronary reflow and persisted throughout the reperfusion period. These data suggest that nicorandil protects ischaemic cardiac tissue, and that the beneficial actions may be mediated through a reduction in left ventricular afterload.

Transmural triglycerides in acute myocardial ischaemia.

The effect of coronary artery occlusion on endogenous triglycerides of left ventricular subepicardium and subendocardium was studied in the open-chest anaesthetised dog. Under control conditions, the subepicardium was found to have a greater concentration of triglycerides than the subendocardium. Thirty minutes after acute coronary artery occlusion there was a decrease followed by a steady increase at 60, 120, and 240 min in subepicardial triglycerides of the ischaemic region. No change in triglycerides in the subendocardium of normal or ischaemic regions was observed. The initial decrease of subepicardial triglycerides in the ischaemic region was blocked by administration of propranolol or bevantolol (CI-775; a specific beta 1 antagonist) given 30 min before occlusion. It is concluded that the effect of coronary artery ligation on transmural endogenous triglycerides is biphasic with an initial period of increased mobilisation followed by a period of increased deposition.

Myocardial distribution of coronary blood flow in the isolated supported heart preparation.

The regional distribution of myocardial blood flow was studied by use of radioactive microspheres (15 micro-meters [mum]) under control conditions and during an intracoronary infusion of norepinephrine (2mug/min). In control experiments endocardial blood flow was generally greater than epicardial flow; during administration of norepinephrine the endocardium received significantly less blood flow. It is proposed that normally the endocardium is well perfused, but under conditions of stress, eg, norepinephrine infusion in the presence of a constant coronary blood flow, decreased endocardial blood flow results.