A pharmacological analysis of the possible role of vasoactive mediators in compensatory coronary blood flow.

BACKGROUND: Coronary blood flow in one (circumflex) branch of the left coronary artery increases when an adjacent (left anterior descending [LAD]) branch is occluded for periods of between 1 min and 25 min. OBJECTIVE: To examine the possible role of the myocardial release of vasoactive substances in such 'compensatory blood flow' increase by the classical pharmacological approach of inhibition of synthesis, or blockade at the receptor level, of the most likely mediators. METHODS: In pentobarbitone anesthetized, thoracotomized dogs, coronary blood flow changes were measured in both the LAD (using a Doppler flow probe) and the left circumflex (using an electromagnetic flow probe) coronary arteries. RESULTS: The flow increase during 5 min occlusions of the LAD coronary artery was unaffected by blockade of adenosine receptors by 8-sulfophenyltheophylline, inhibition of prostanoid synthesis by sodium meclofenamate or celecoxib, blockade of bradykinin B(1) receptors by icatibant, inhibition of nitric oxide synthesis by N(omega)-nitro-L-arginine methyl ester (L-NAME), inhibition of guanylyl cyclase by methylene blue, or opening (using diazoxide) and closing (using glibenclamide or 5-hydroxydecanote) of ATP-dependent K(+) channels. Neither dual blockade with L-NAME and glibenclamide, or meclofenamate and 5-hydroxydecanote, nor triple blockade with L-NAME, glibenclamide and 8-sulfophenyltheophylline, modified the blood flow response. However, it was greatly reduced (60%) by metoprolol. CONCLUSIONS: These results suggest that coronary vascular beta(1)-adrenoceptors are involved in 'compensatory' vasodilation, whereas bradykinin, nitric oxide, prostanoids and ATP-dependent K(+) channels are seemingly not required for this flow increase.

Nitric oxide involvement in the delayed antiarrhythmic effect of treadmill exercise in dogs.

We have shown previously that a single period of treadmill exercise in dogs protects the heart against the severe ventricular arrhythmias that arise when a major (anterior descending) branch of the left coronary artery is occluded following anaesthesia 24 h later. This protection is aminoguanidine sensitive, suggesting a role for nitric oxide (NO) in this exercise-induced delayed antiarrhythmic effect. The present study has further examined the possible role of NO as a mediator and/or as a trigger using the selective induced (iNOS) inhibitor S-(2-aminoethyl)-methyl-isothiourea (AEST) and the specific but not selective nitric oxide synthase inhibitor N(omega)-nitro-L-arginine-methyl-ester (L-NAME). Exercise markedly reduced the severity of ischaemia and reperfusion-induced ventricular arrhythmias 24 h later. Thus, only one of the dogs (8%) so exercised fibrillated on occlusion (contrast 46% in the control, non-exercised dogs; P<0.05) and the marked changes in the inhomogeneity of electrical activation that occur in the ischaemic region following occlusion were much reduced (P<0.05 compared to controls). This delayed exercise-induced cardioprotection was significantly attenuated by the nitric oxide synthase (NOS) inhibitors L-NAME, given prior to the exercise protocol and by AEST given prior to the coronary artery occlusion. For example, survival from the ischaemia-reperfusion insult was 54% in the exercise dogs, 0% in the controls and 14% in those dogs given a NOS inhibitor. We conclude that nitric oxide (NO) is both the trigger and the mediator of this delayed protection against ischaemia and reperfusion-induced arrhythmias.

A common mechanism in the protective effects of preconditioning, cardiac pacing and physical exercise against ischemia and reperfusion-induced arrhythmias.

Ischemic preconditioning results not only in a reduction in myocardial ischemic damage, but also in a marked suppression of those ventricular arrhythmias that result from a more prolonged period of ischemia and reperfusion insult. This protection is time-dependent and occurs in two distinct phases. There is an 'early phase' which is apparent immediately after the preconditioning stimulus but fades quickly (within 1 h to 2 h), and a 'delayed protection phase' in which the antiarrhythmic protection reappears 20 h to 24 h later. In both phases, the intensity of protection largely depends on the nature of the preconditioning stimulus. This can be ischemia resulting from brief coronary artery occlusions, cardiac pacing or vigorous physical exercise. Both cardiac pacing and exercise results in a marked reduction in the incidence and severity of ischemia and reperfusion-induced ventricular arrhythmias 24 h later. Although the precise mechanisms of the delayed protection that results from cardiac pacing and exercise are not yet fully understood, there is some evidence that similar endogenous protective substances (such as bradykinin, prostanoids and nitric oxide), as with ischemic preconditioning, play a pivotal trigger and mediator role in this anti-arrhythmic protection.

Delayed exercise-induced protection against arrhythmias in dogs--effect of celecoxib.

A 20-min period of treadmill exercise in dogs, sufficient to increase heart rate by 90-100 beats min(-1), markedly decreases the severity of the life-threatening ventricular arrhythmias that result when, following anaesthesia 24 h later, the left coronary artery is occluded. This protection was unaffected by the administration of the selective cyclooxygenase-2 inhibitor celecoxib (two times 3 mg kg(-1) given intravenously). These results show that prostacyclin, derived from cyclooxygenase-2, plays no role in this pronounced delayed cardioprotection.

Sildenafil (Viagra) reduces arrhythmia severity during ischaemia 24 h after oral administration in dogs.

Sildenafil (Viagra) prolongs repolarisation in cardiac muscle, an effect that could lead to ventricular fibrillation (VF). Sildenafil (2 mg kg(-1)) was given by mouth to 12 mongrel dogs and, 24 h later, these dogs were anaesthetised, thoracotomised and subjected to a 25 min occlusion of the anterior descending coronary artery. Haemodynamic parameters were similar in this and the control group, but there were fewer and less serious ventricular arrhythmias during occlusion in the sildenafil group (VF 17 vs 60%; ventricular premature beats 140+/-52 vs 437+/-127% and episodes of ventricular tachycardia 4.0+/-3.2 vs 19.3+/-7.7%, all P<0.05). However, reperfusion VF and indices of ischaemia severity (epicardial ST-segment mapping, inhomogeneity) were not modified by the drug. Sildenafil increased the QT interval, especially during ischaemia. Our conclusion is that ischaemia-induced ventricular arrhythmias are reduced by sildenafil, but this protection is less pronounced than that following cardiac pacing or exercise.

N-2-mercaptopropionylglycine, a scavanger of reactive oxygen species, does not modify the early antiarrhythmic effect of ischaemic preconditioning in anaesthetised dogs.

OBJECTIVE: The possible involvement of reactive oxygen species (ROS) in the protective effects of ischaemic preconditioning (PC) against arrhythmias was examined in anaesthetised dogs using the ROS scavenger N-2-mercaptopropionylglycine (MPG). METHODS: PC was induced in 20 chloralose-urethane anaesthetised dogs by two 5 min occlusions of the left anterior descending (LAD) coronary artery 20 min prior to the prolonged (25 min) ischaemia/reperfusion (I/R) insult. In 10 of these dogs MPG was infused locally into a small side branch of the LAD in a dose of 0.15 mg kg(-1) min(-1), starting 10 min prior to and continuing throughout the entire PC procedure. In another four dogs subjected to preconditioning in the absence and then 2h later in the presence of MPG free radical formation was evaluated by the chemiluminescence method. Eleven dogs, infused with saline and subjected to a 25 min I/R insult, served as controls. A further 9 dogs, which were not preconditioned, were given MPG over a period of 60 min prior to occlusion. RESULTS: Preconditioning markedly reduced the number of ventricular premature beats (VPBs; 86 +/- 34 v. 377 +/- 78; P < 0.05), the episodes of ventricular tachycardia (VT; 2.0 +/- 0.7 v. 13.6 +/- 4.5; P < 0.05) and the incidences of both VT (60% v. 91%) and ventricular fibrillation (0% v. 82%; P < 0.05) during the prolonged occlusion. Survival (from the combined ischaemia and reperfusion insult) was significantly increased (40% v. 0%; P < 0.05) by PC. MPG did not modify the protective effects of PC, although free radical (mostly superoxide) formation that occurred following PC was abrogated in the presence of MPG. Thus, the number of VPBs (111 +/- 39), VT episodes (1.2 +/- 0.9) and the incidences of VT (20%) and VF (0%) during occlusion were similar to the PC dogs. MPG itself did not significantly modify arrhythmia severity in non-PC dogs. CONCLUSIONS: We conclude that in our canine model of ischaemia/reperfusion the generation of ROS does not play a trigger role in the early PC-induced antiarrhythmic protection.

Effects of delayed preconditioning on myocardial regional contractility during repeated episodes of low-flow ischaemia in anaesthetized dogs: possible role of nitric oxide.

The effect of cardiac pacing on repeated low-flow ischaemia-induced changes in regional myocardial segmental contractility, and the role in these changes of nitric oxide, were investigated in anaesthetized dogs. Dogs were instrumented for cardiac pacing (pacing electrode in the right ventricle). Dogs were paced (four times for 5 min; pacing rate 220 beats.min(-1)) 24 h prior to the repeated ischaemic insults. Controls were instrumented, but not paced. After 24 h, the dogs were re-anaesthetized with pentobarbitone and subjected to four 20 min low-flow ischaemia and reperfusion cycles, by constricting the left anterior descending coronary artery (LAD) to achieve an approx. 50% reduction in resting coronary blood flow. In some dogs (both control and paced), N (G)-nitro-L-arginine methyl ester (L-NAME; a non-selective inhibitor of nitric oxide synthase) was infused into a side-branch of the LAD 10 min prior to the first ischaemia/reperfusion cycle. Regional contractile function was measured by ultrasonic microcrystals in the ischaemic and normal regions of the left ventricular wall supplied from the LAD and left circumflex coronary artery respectively, and expressed as percentage changes in segmental shortening (%SS). In some dogs, myocardial tissue blood flow (coloured microspheres) and lactate production (local coronary venous sampling) were measured; samples were also taken for histological analysis. In control dogs, the regional %SS was progressively reduced within the ischaemic segment during the four repeated occlusions (by 40+/-6, 59+/-6, 68+/-6, 70+/-6% during occlusions 1-4 respectively). These reductions were more pronounced, especially during the first two cycles (68+/-6, 68+/-6, 67+/-6, 67+/-6%, respectively), when the dogs had been previously subjected to cardiac pacing. In both paced and control dogs, these changes in contractile function were L-NAME-sensitive. Thus, in the presence of L-NAME, changes in regional segmental shortening in control dogs were 37+/-8, 40+/-8, 37+/-8, 42+/-11% and in the paced dogs 46+/-6, 45+/-7, 45+/-8, 45+/-7% respectively, during the four consecutive occlusions. There were no significant differences in tissue blood flow or in lactate production between the groups, and no structural changes indicative of infarction. These results show that the myocardium rapidly adapts to re-occurring acute ischaemia by reducing contractility within the ischaemic segment and, thereby, metabolic demand. Furthermore, cardiac pacing 24 h prior to these ischaemic challenges induces a similar adaptive response, a form of 'delayed preconditioning'. Since both the acute and delayed adaptation were L-NAME-sensitive, we suggest that this adaptation involves nitric oxide.

The role of mitochondrial K(ATP) channels in antiarrhythmic effects of ischaemic preconditioning in dogs.

1. In the canine a single brief (5 min) coronary artery occlusion protects the myocardium against the severe ventricular arrhythmias and reduces the ischaemic changes that result from a subsequent, more prolonged (25 min) occlusion. The main purpose of the present study was to examine whether mitochondrial K(ATP) channels are involved in this protection. 2. In chloralose-urethane anaesthetized dogs, preconditioning (PC) was induced by a single 5 min period occlusion of the left anterior descending (LAD) coronary artery, 20 min prior to a 25 min occlusion of the same artery. In some of these PC dogs 5-hydroxydecanoate (5-HD; 150 micro g kg(-1) min(-1) by intracoronary infusion) was given over a period of 30 min either before, or after PC. In other dogs the mitochondrial K(ATP) channel opener diazoxide (1 mg kg(-1); i.c.) was given, either alone or in the presence of 5-HD. Control dogs (infused with saline) were simply subjected to a 25 min occlusion and reperfusion. 3. Compared to controls, both PC and diazoxide significantly reduced the number of ventricular premature beats (VPBs; 295+/-67 to 89+/-28 and 19+/-11, respectively; P<0.05), the number of episodes of ventricular tachycardia (VT; 8.3+/-4.2 to 1.6+/-0.9 and 0.2+/-0.1; P<0.05) and the incidences of VT (100 to 43 and 33%; P<0.05) and ventricular fibrilation (VF; 60 to 0 and 17%; P<0.05) during the 25 min occlusion of the LAD. Further, 43% of the PC dogs and 58% of the diazoxide treated dogs survived the combined ischaemia-reperfusion insult (cp. 0% in the controls; P<0.05). The protection afforded by PC and diazoxide was abolished by 5-HD, especially when it was given prior to the PC occlusion. In the presence of 5-HD, three out of 10 dogs fibrillated during the PC occlusion and another three dogs died following reperfusion. Furthermore, there were no survivors in this group from the prolonged ischaemia/reperfusion insult. 5-HD given after PC only attenuated the antiarrhythmic protection. 4. Opening of mitoK(ATP) channels prior to ischaemia by preconditioning and diazoxide protects the myocardium against ischaemia and reperfusion-induced arrhythmias. This protection is abolished if the opening of these channels is prevented by the prior administration of 5-HD but only attenuated if 5-HD is given after preconditioning. The results indicate that opening of mitoK(ATP) channels prior to ischaemia is mandatory for protection against ischaemia and reperfusion-induced arrhythmias.

Noradrenaline, infused locally, reduces arrhythmia severity during coronary artery occlusion in anaesthetised dogs.

OBJECTIVE: To contribute to the debate, discussed in an earlier issue, regarding the role of adrenoceptors in the genesis of early, coronary artery occlusion-induced ventricular arrhythmias. METHODS: Mongrel dogs anaesthetised with chloralose and urethane were given either noradrenaline (NA, 100 ng kg(-1) min(-1)), phenylephrine (PHE, 200 ng kg(-1) min(-1)) or isoprenaline (ISO 12.5 ng kg(-1) min(-1)) by intracoronary infusion into a side branch of the left anterior descending coronary artery (LAD), commencing 10 min prior to the occlusion and then throughout the 25-min occlusion period. Control dogs were infused for the same period with saline. In another group of dogs noradrenaline was infused intravenously in a dose of 1 and then 2 microg kg(-1) min(-1) over a period of 60 min, 24 h prior to coronary artery occlusion. Haemodynamic and coronary blood flow changes, as well as changes in the epicardial ST-segment and in the degree of inhomogeneity were continuously recorded. Ventricular arrhythmias were evaluated as ventricular premature beats (VPBs), tachycardiac (VT) episodes and the incidences of VT and ventricular fibrillation (VF) during occlusion and following reperfusion. RESULTS: Compared to the controls, NA markedly reduced the severity of ventricular arrhythmias resulted from coronary artery occlusion and increased survival (to 40%) following reperfusion; there were no survivors in the control group. Noradrenaline released endogenously following guanethidine administration was also protective. Protection was also seen, although to a lesser extent with intracoronary PHE (occlusion VF 20% cp 80% in controls; survival 42%). In contrast, ISO enhanced arrhythmia severity; five out of seven dogs infused with ISO fibrillated within 10 min of the commencement of occlusion and no dog survived reperfusion. Other indices of ischaemia severity (epicardial ST-segment and inhomogeneity) were also reduced by NA and by PHE. NA, infused 24 h prior to occlusion was also protective against ischaemia and reperfusion-induced arrhythmias and ischaemia-induced changes in inhomogeneity. CONCLUSION: We conclude that exogenously administered NA, or released endogenously by chemical means, reduces the severity of ischaemia and reperfusion-induced ventricular arrhythmias and that this is mediated by alpha-adrenoceptors, perhaps through presynaptic inhibition of local NA release or by a 'preconditioning' effect presumably mediated by PKC.

Delayed cardioprotective effects of exercise in dogs are aminoguanidine sensitive: possible involvement of nitric oxide.

Dogs were subjected to exercise on a treadmill, using a protocol in which the speed and slope were increased every 3 min, and which elevated both heart rate (to a mean of 198+/-14 beats.min(-1)) and mean arterial blood pressure (to 150+/-4 mmHg). Then, 24 or 48 h later, the dogs were anaesthetized with a mixture of alpha-chloralose and urethane and subjected to a 25 min occlusion of the left anterior descending coronary artery. The control dogs (instrumented but not exercised) were subjected to the same procedure. In some dogs the nitric oxide synthase inhibitor aminoguanidine (50 mg.kg(-1); intravenous) was administered 30 min before occlusion. Baroreflex sensitivity (BRS) was determined by the rapid bolus injection of phenylephrine 60 min before, and again 3 min after, the onset of occlusion. Exercise markedly reduced the consequences of coronary artery occlusion 24 h (but not 48 h) later, without modifying myocardial tissue blood flow. In the exercised dogs there were reductions in arrhythmia severity [ventricular fibrillation (VF) during occlusion, 0%; survival from the combined ischaemia/reperfusion insult, 70%] compared with controls (VF during occlusion, 36%; survival, 9%). BRS was preserved during occlusion in the exercised dogs (before occlusion, 1.60+/-0.54 ms.mmHg(-1); 3 min after occlusion, 1.37+/-0.4 ms.mmHg(-1)), but not in controls (before occlusion, 1.28+/-0.29 ms.mmHg(-1); 3 min after occlusion, 0.45+/-0.12 ms.mmHg(-1); P<0.05), and other ischaemic changes (inhomogeneity of electrical activation and changes in the ST-segment, recorded over the ischaemic region) were also less marked in the exercised dogs. Exercise-induced cardioprotection was abolished by aminoguanidine (VF during occlusion, 25%; survival, 0%). The results show that even a single period of exercise affords delayed protection against ischaemia/reperfusion-induced VF and other ischaemic changes. Since this protection is abolished by aminoguanidine, and since (inducible) NO synthase activity was elevated 3-fold in left ventricular samples 24 h after exercise, we suggest that this protection is mediated by nitric oxide.

Streptozotocin diabetes protects against arrhythmias in rat isolated hearts: role of hypothyroidism.

We examined the contribution of hypothyroidism to streptozotocin diabetes-induced alterations in the arrhythmia susceptibility of ex vivo hearts to regional zero-flow ischaemia. Diabetic rats received either protamine zinc insulin (10 IU/kg/day, s.c.) or triiodothyronine (10 microg/kg/day, s.c.) for 8 weeks commencing 72 h after injection of streptozotocin (60 mg/kg, i.p.). Arrhythmias were determined in ex vivo Langendorff-perfused hearts, subjected to a 30-min main left coronary artery occlusion, followed by 30-min reperfusion. Serum free thyroxine concentrations, rectal temperature and ex vivo heart rate were significantly decreased in the 8-week diabetic group (P<0.001). These changes were prevented by administration of triiodothyronine or insulin. Ventricular fibrillation during reperfusion was abolished in hearts from diabetic rats. This protection was prevented by treatment with either triiodothyronine or insulin. Hearts from methimazole-hypothyroid rats also showed no ventricular fibrillation during reperfusion. The protection against ischaemia-reperfusion-arrhythmias observed in hearts from streptozotocin-diabetic rats may be due to diabetes-induced hypothyroidism.

The antiarrhythmic effects of ischaemic preconditioning in anaesthetized dogs are prevented by atropine; role of changes in baroreceptor reflex sensitivity.

1. Dogs, anaesthetized with chloralose and urethane, were subjected to a 25 min occlusion of the left anterior descending coronary artery. This resulted in ventricular ectopic activity, a reduction in baroreflex sensitivity (BRS, measured following the intravenous administration of phenylephrine), elevations in the epicardial ST-segment and increases in the degree of inhomogeneity of electrical activation, both measured from the ischaemic region of the left ventricular wall. 2. These changes were markedly reduced when the 25 min occlusion was preceded, 20 min earlier, by a 5 min (preconditioning) occlusion of the same coronary artery (e.g. VF during ischaemia reduced from 40% in the controls to 0%; P<0.05; BRS increased from 1.22+/-0.23 pre-occlusion to 1.61+/-0.25 mmHg ms(-1) post-occlusion in preconditioned dogs; cf. 1.28+/-0.29 to 0.45+/-0.12 mmHg ms(-1) respectively in the controls, P<0.05). 3. These beneficial effects of preconditioning were prevented by the administration, 10 min prior to the 25 min coronary artery occlusion, of atropine (1 mg kg(-1) i.v. followed by a continuous infusion of 0.04 mg kg(-1) h(-1)). For example, VF during occlusion was increased from 0% in the preconditioned dogs to 40% (P<0.05) in the presence of atropine and BRS was again reduced during occlusion (from 1.75+/-0.29 to 0.30+/-0.08 mmHg ms(-1); P<0.05). 4. We conclude that preconditioning reduces arrhythmia severity during ischaemia by favourably modifying cardiac autonomic receptor mechanism through enhancing vagal influences.