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Biomedical subjects

G Heusch

Publications and source records attributed to G Heusch.

At least 181 records · Page 10Linked to original sources
PubMed1990

No impairment of sympathetic neurotransmission in stunned myocardium.

Reversibly injured myocardium after short periods of ischemia is characterized by a prolonged depression of contractile function which can, however, be enhanced by inotropic interventions. Thus, a lack of inotropic stimulation due to ischemic damage of cardiac sympathetic nerves has been suggested as a mechanism underlying postischemic myocardial dysfunction. We tested this hypothesis in nine anesthetized, vagotomized dogs with left cardiac sympathetic nerve stimulation (CSNS) at 1, 2, 5, 10, and 20 Hz and compared this response to that of intravenous norepinephrine infusion (NE, 0.5-1 microgram/kg.min). Regional myocardial wall thickness was measured using sonomicrometry, and mean systolic wall thickening velocity (MSTV) was determined. CSNS was performed before and at 0, 1, 2, 3, 4, 8, 12, 16, 20, and 24 h after release of a 15 min occlusion of a left circumflex coronary artery branch. Before coronary artery occlusion MSTV was increased in a frequency-dependent way from 7.5 +/- 2.7 (S.D.) (rest) to 8.1 +/- 3.1 (1 Hz), 9.4 +/- 3.2 (2 Hz), 11.4 +/- 2.7 (5 Hz), 13.4 +/- 2.4 (10 Hz), and 16.8 +/- 2.1 (20 Hz) by CSNS, and to 12.6 +/- 3.4 mm/s by NE. Immediately upon reperfusion CSNS increased MSTV from 2.9 +/- 2.0 to 2.9 +/- 2.8, 4.1 +/- 3.0, 5.4 +/- 4.6, 6.9 +/- 4.5 and 9.4 +/- 5.9, and NE increased MSTV to 7.8 +/- 1.9 mm/s. Baseline function recovered over 24 h, as did the response to CSNS and NE. Since the recovery of baseline function paralleled the increases in regional contractile function achieved by CSNS or NE, we conclude that there is no impairment of sympathetic neurotransmission in the stunned myocardium.

Animals↗
PubMed1990

Xamoterol recruits an inotropic reserve in the acutely failing, reperfused canine myocardium without detrimental effects on its subsequent recovery.

The present study tested (1) whether xamoterol recruits an inotropic reserve in reperfused myocardium and (2) whether acute inotropic stimulation by xamoterol has deleterious consequences on the long-term recovery of the reperfused myocardium. Sixteen anaesthetized, open-chest dogs were bilaterally vagotomized and heart rate kept constant by left atrial pacing. The distal left circumflex coronary artery was occluded for 15 min and then reperfused for 8 h. The coronary occlusion resulted in regional myocardial dyskinesia and myocardial function remained severely depressed after release of the occlusion. At 10 min reperfusion, 8 dogs received xamoterol (100 micrograms/kg i.v.), whereas the remaining 8 dogs served as controls and received saline. Xamoterol increased mean systolic wall thickening velocity (from 1.47 +/- 2.34 (SD) mm/s at 10 min reperfusion to 7.13 +/- 3.55 mm/s at 30 min reperfusion and 7.64 +/- 2.48 mm/s at 1 h reperfusion, respectively, both P less than 0.05). In the control group, only a slow recovery of mean systolic wall thickening velocity was observed (from 3.14 +/- 3.30 mm/s to 2.96 +/- 3.74 mm/s and 4.03 +/- 3.00 mm/s at 10 min, 30 min, and 1 h reperfusion, respectively). At 8 h reperfusion, mean systolic wall thickening velocity was similar in both groups (7.97 +/- 4.23 mm/s in the xamoterol-group and 6.87 +/- 4.00 mm/s in the placebo-group). Histological examination revealed no difference in the extent of necrosis between the two groups after 8 h reperfusion. We conclude that (1) xamoterol recruits an inotropic reserve in reperfused myocardium, and (2) this recruitment of an inotropic reserve does not compromise functional recovery and structural integrity of the reperfused myocardium.

Animals↗
PubMed1990

Minimal alpha 1- and alpha 2-adrenoceptor-mediated coronary vasoconstriction in the anaesthetized swine.

alpha-Adrenoceptor-mediated coronary vasoconstriction contributes to the initiation and aggravation of experimental and clinical myocardial ischaemia. However, the extent of alpha 1- and alpha 2-adrenoceptor-mediated constriction has not been characterized in the porcine coronary circulation despite the frequent use of this experimental model. Fifteen swine were anaesthetized with either alpha-chloralose, enflurane or isoflurane to determine the amount of alpha-adrenoceptor-mediated coronary constriction elicited by either the selective alpha 1-adrenoceptor agonist methoxamine or the selective alpha 2-adrenoceptor agonist azepexole. The left anterior descending coronary artery was cannulated and perfused by an external pump delivering constant blood flow from the carotid artery. Following bilateral cervical vagotomy and beta-adrenoceptor blockade with propranolol (2 mg kg-1), graded dosages of either one of the alpha-adrenoceptor agonists (9-45 micrograms kg-1 min-1) were infused into the coronary perfusion line while coronary arterial pressure (CAP) was measured through a distal side arm of the cannula to detect changes in coronary vascular resistance. Infusion of the alpha-adrenoceptor agonists was terminated when systemic arterial pressure increased. Sonomicrometers were used to measure anterior left ventricular wall thickening for the assessment of regional contractile function. During methoxamine infusion, no increase in vascular resistance was observed during alpha-chloralose, enflurane or isoflurane anaesthesia, whereas the infusion of azepexole increased CAP from 103 +/- 31 mmHg to 120 +/- 35 mmHg (alpha-chloralose), from 101 +/- 16 mmHg to 122 +/- 11 mmHg (enflurane) and from 84 +/- 20 mmHg to 94 +/- 19 mmHg (isoflurane), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic alpha-Agonists↗
PubMed1990

Felodipine prevents the poststenotic myocardial ischemia induced by alpha 2-adrenergic coronary constriction.

Alpha 2-adrenoceptor-mediated coronary constriction contributes to the precipitation of myocardial ischemia during sympathetic activation. Felodipine is a novel dihydropyridine calcium-channel antagonist with vascular selectivity. In this study, the effect of felodipine on alpha 2-adrenoceptor-mediated poststenotic coronary constriction was investigated. In ten open-chest dogs, the selective alpha 2-adrenoceptor agonist BHT 933 (200 micrograms IC) was infused before and after production of a severe stenosis on the left circumflex coronary artery. BHT 933 increased calculated resistance of the intact left circumflex coronary artery from 1.16 +/- 0.30 (SD) to 2.00 +/- 0.70 mmHg*min*100 g/ml (p less than 0.05) without changing posterior systolic wall thickening (sonomicrometry) (14.2 +/- 2.8% vs. 14.1 +/- 2.7%). In the presence of a severe stenosis, BHT 933 increased poststenotic coronary resistance from 1.59 +/- 0.54 to 2.88 +/- 1.16 mmHg*min*100 g/ml (p less than 0.05) and decreased posterior systolic wall thickening from 11.9 +/- 2.7% to 8.2 +/- 3.1% (p less than 0.05). In contrast, after intravenous pretreatment with felodipine (4 micrograms/kg), intracoronary infusion of BHT 933 did not change coronary resistance (1.69 +/- 0.61 vs. 1.61 +/- 0.64 mmHg*min*100 g/ml) and posterior systolic wall thickening (12.1 +/- 3.0% vs. 12.6 +/- 2.9%). In conclusion, felodipine prevents alpha 2-adrenoceptor-mediated coronary constriction and ischemic regional myocardial dysfunction distal to a severe coronary stenosis.

Adrenergic alpha-Agonists↗
PubMed1990

ACE inhibitors for the treatment of myocardial ischemia?

Apart from their established use in the treatment of hypertension and heart failure, ACE inhibitors have been suggested to exert anti-ischemic effects. This article reviews the mechanisms of systemic and intracardiac angiotensin formation, as well as its interaction with the bradykinin, the prostaglandin, and the sympathetic nervous system. While high doses of angiotensin can precipitate myocardial ischemia. experimental data on a potential beneficial effect of ACE inhibitors on ischemic myocardial blood flow and function are inconsistent and controversial. Pooling the few available clinical data, several ACE inhibitors may attenuate myocardial ischemia at rest and during exercise. However, a significant fraction of patients does not benefit or even deteriorates. Recent experimental studies suggest a beneficial role of ACE inhibitors in attenuating reperfusion arrhythmias and postinfarction left ventricular remodeling. Unless the mechanisms and determinants of potential anti-ischemic actions of ACE inhibitors can be better defined, their use for treatment of myocardial ischemia cannot be recommended at present.

Angiotensin II↗
PubMed1990

Left ventricular asynchrony: an indicator of regional myocardial dysfunction.

There is a marked heterogeneity of myocardial wall thickening within the left ventricle and among different individuals. It is therefore difficult to detect regional myocardial dysfunction from absolute values of systolic wall thickening. We tested whether the extent of left ventricular asynchrony during ischemia and reperfusion can be used to quantify the severity of regional myocardial dysfunction when nonischemic baseline function is not known. In six anesthetized, open-chest dogs regional myocardial wall thickness was measured by means of sonomicrometry under control conditions, at three degrees of ischemic dysfunction (mild, moderate, and severe), and after release of a 15-minute occlusion of the left circumflex coronary artery, when degrees of moderate and mild reperfusion dysfunction similar to the preceding ischemic dysfunction were present. Two indexes of left ventricular asynchrony were calculated: (1) postejection thickening (PET) and (2) the phase difference of the first Fourier harmonic of posterior versus anterior myocardial wall motion (PD). Systolic myocardial wall thickening was decreased from 15.3 +/- 3.1 (standard deviation) % (control value) to 9.7 +/- 1.4% (mild ischemia), 4.2 +/- 1.6% (moderate ischemia), and -3.7 +/- 3.1% (severe ischemia). Conversely PET increased from 0.02 +/- 0.04 mm (control value) to 0.15 +/- 0.22 mm (mild ischemia), 0.19 +/- 0.15 mm (moderate ischemia), and 0.50 +/- 0.26 mm (severe ischemia). PD increased from 9 +/- 28 degrees (control value) to 22 +/- 19 degrees (mild ischemia), 54 +/- 18 degrees (moderate ischemia), and 107 +/- 21 degrees (severe ischemia). After release of the 15-minute left circumflex coronary artery occlusion, PET and PD recovered to 0.34 +/- 0.19 mm and 36 +/- 24 degrees (moderate dysfunction) and 0.25 +/- 0.31 mm and 29 +/- 8 degrees (mild dysfunction), respectively. There were inverse linear relationships between systolic wall thickening and PET (r = -0.86, p less than 0.001) and between systolic wall thickening and PD (r = -0.87, p less than 0.001). Inotropic stimulation by postextrasystolic potentiation increased regional systolic myocardial posterior and anterior wall thickening but did not alter the extent of left ventricular asynchrony. Thus, when normal baseline function is not known, the severity of regional myocardial dysfunction at a given inotropic state can be determined by analysis of left ventricular asynchrony. There was no significant correlation between the extent of PET and PD during ischemia and at early reperfusion and the recovery of contractile function at late reperfusion. Thus PET does not provide a prospective marker for the functional outcome of reperfusion.

Animals↗
PubMed1990

Alpha-adrenergic mechanisms in myocardial ischemia.

alpha-Adrenoceptor-mediated effects of sympathetic activation on the heart and coronary circulation are reviewed with emphasis on the pathophysiology of myocardial ischemia. A classification of alpha-adrenoceptor subtypes is presented, and the effects of alpha-adrenoceptor activation on presynaptic sympathetic nerve terminals, cardiomyocytes, endothelium, platelets, and coronary smooth muscle cells are discussed. alpha-Adrenergic coronary vasoconstriction at rest and during situations of sympathetic activation such as exercise and excitement is analyzed for the segmental, transmural, and regional distribution of coronary blood flow. Evidence for a significant contribution of alpha-adrenergic coronary vasoconstriction to experimental and clinical myocardial ischemia is provided. Cardiomyocyte alpha-adrenoceptor activation may be involved in ischemic and reperfusion arrhythmias. The participation of presynaptic and postsynaptic alpha-adrenoceptors, as well as of alpha 1- and alpha 2-adrenoceptors, in experimental and clinical myocardial ischemia will require further investigation.

Adrenergic alpha-Agonists↗
PubMed1990

Myocardial lactate release during ischemia in swine. Relation to regional blood flow.

To determine the relation between regional myocardial blood flow, contractile function, and myocardial lactate release during mild-to-moderate regional myocardial ischemia, nine open-chest swine were instrumented for measurement of regional myocardial blood flow (microsphere method), contractile function (sonomicrometry), and hemodynamics. L-[1-14C]Lactate or L-[U-13C]lactate was infused intravenously using a primed continuous infusion technique to quantify regional myocardial lactate release. D-[U-13C]glucose or D-[6-14C]glucose was simultaneously infused to determine the contribution of exogenous glucose to lactate release. Graded coronary ischemia (two to three levels) was created in the left anterior descending coronary arterial distribution by mechanically constricting the artery in five animals or by decreasing flow through a cannulated left anterior descending artery in four animals. In all nine animals, subendocardial blood flow was 0.99 +/- 0.21 (ml/min)/g during control and 0.34 +/- 0.14 (ml/min)/g during the most severe grade of underperfusion (p less than 0.001) in the left anterior descending coronary arterial distribution. Regional myocardial lactate release was 0.15 +/- 0.09 and 1.19 +/- 0.75 mumols/ml, respectively (p less than 0.003). A highly significant inverse correlation was observed between subendocardial blood flow and myocardial lactate release during the graded reductions in blood flow (r = -0.71, p less than 0.001). Results from sonomicrometry showed a significant reduction in contractile ventricular function in the anterior wall during the graded reductions in blood flow. The regional arterial-venous glucose difference increased significantly with underperfusion in the left anterior descending coronary arterial distribution, from 0.14 +/- 0.15 to 0.56 +/- 0.37 mumols/ml (p less than 0.003). The contribution of exogenous glucose to lactate release also increased significantly; 0.04 +/- 0.03 mumols/ml of the lactate came from exogenous glucose during control compared with 0.64 +/- 0.59 mumols/ml during the most severe underperfusion (p less than 0.02). A significant positive correlation exists between lactate release and lactate from exogenous glucose during graded underperfusion (r = 0.96, p less than 0.001). In summary, these data demonstrate a close inverse relation between regional myocardial lactate release and regional subendocardial blood flow during graded ischemia.

Animals↗
PubMed1990

Myocardial effects of selective alpha-adrenoceptor blockade during exercise in dogs.

To study the effect of selective alpha 1- or alpha 2-adrenergic blockade on the myocardial contractile and chronotropic response to exercise, 29 dogs were chronically instrumented with a sonomicrometer for measuring myocardial wall thickness and a micromanometer for measuring left ventricular pressure. During treadmill exercise, either the selective alpha 1-blocker prazosin (80 micrograms/kg, n = 12) or the alpha 2-blocker idazoxan (80 micrograms/kg, n = 8) was infused into the left atrium beginning 2-3 minutes after the onset of exercise. alpha 1-Adrenoceptor blockade, like alpha 2-adrenoceptor blockade, was found to cause significant increases in systolic wall thickening, thickening velocity, heart rate, and left ventricular contractility, indicating an increase in inotropic state that was comparable to that with alpha 2-adrenoceptor blockade. Preventing the decrease in aortic blood pressure after selective alpha 1-blockade by using either systemic angiotensin II infusion (n = 6) or inflation of an intra-aortic balloon (n = 6) did not prevent the observed increases in wall thickening, heart rate, and left ventricular contractility. In four of the dogs treated with prazosin, the norepinephrine concentration in the coronary sinus was found to more than double after alpha 1-blockade. beta-Adrenergic blockade (propranolol, 1.0 mg/kg) prevented the increased contractile and chronotropic state caused by alpha 1- or alpha 2-blockade. Selective alpha-adrenergic blockade during adrenergic activation by intravenous norepinephrine infusion, in contrast to exercise, had no effect on wall thickening, heart rate, or left ventricular contractility. These data indicate that selective alpha 1-adrenergic blockade, like selective alpha 2-adrenergic blockade, causes a significant augmentation of heart rate and left ventricular contractility in the dog during dynamic exercise. These data are consistent with the hypothesis that this occurs through a presynaptic disinhibition of neural norepinephrine release mediated by a prejunctional alpha 1-adrenoceptor.

Adrenergic alpha-Antagonists↗
PubMed1989

Pharmacological mechanisms to attenuate sympathetically induced myocardial ischemia.

Distal to a coronary stenosis, resting myocardial blood flow and function can be maintained by a compensatory dilation of the poststenotic vascular bed and an increased collateral blood flow from adjacent coronary vessels. Under this condition, electrical stimulation of cardiac sympathetic nerves, as well as their activation during sympathoexcitatory reflexes and exercise, induces a poststenotic alpha 2-adrenoceptor-mediated coronary constriction and a beta-adrenoceptor-mediated, tachycardia-related redistribution of blood flow away from the ischemia myocardium. Thus, activation of cardiac sympathetic nerves can precipitate poststenotic myocardial ischemia. In experimental studies in anesthetized, vagotomized dogs, as well as in conscious, chronically instrumented dogs, selective alpha 2-adrenoceptor antagonists and calcium-channel blockade with nifedipine were able to attenuate the sympathetically induced poststenotic myocardial ischemia. Beta-adrenoceptor blockade with atenolol was only proven beneficial as long as there was a heart-rate reduction. Conversely, a specific bradycardic agent (ULFS-49) also exerted beneficial effects. Myocardial ischemia can activate cardiac sympathetic afferents and then, by a spinal reflex, can in turn activate sympathetic efferents and aggravate the severity of myocardial ischemia. This vicious cycle could be interrupted by segmental epidural anesthesia with procaine as well as by blockade of sympathoexcitation at the central nervous level with clonidine in anesthetized dogs.

Animals↗
PubMed1989

Poststenotic ischaemic myocardial dysfunction induced by peripheral nociceptive stimulation.

UNLABELLED: Sympathetic activation increases cardiac performance, and the increased myocardial oxygen demand is adequately met by an increase in coronary blood flow after metabolic coronary dilation under normal conditions. Distal to a severe coronary stenosis, however, activation of cardiac sympathetic nerves induces myocardial ischaemia by alpha 2-adrenergic coronary constriction. Activation of cardiac sympathetic nerves is one of the autonomous reactions associated with acute somatic pain. Therefore we investigated the effects of acute somatic pain on regional myocardial function distal to a severe coronary stenosis. In 5 anaesthetized, vagotomized dogs activation of cardiac sympathetic nerves was achieved by electrical stimulation of the nervus peronaeus superficialis. To analyse regional myocardial function, myocardial wall thickness was continuously measured by sonomicrometry in the circumflex-perfused posterior and in the anterior (control) myocardium. Under control conditions, nociceptive stimulation increased systolic wall thickening of the posterior myocardium from 10.9 +/- 3.9% to 13.6 +/- 5.0%. With a severe stenosis on the left circumflex coronary artery, systolic wall thickening was reduced to 7.0 +/- 2.5% and further decreased to 4.6 +/- 2.3% during nociceptive stimulation. Intravenous injection of 27 micrograms/kg fentanyl prevented the deterioration of poststenotic myocardial function during nociceptive stimulation. CONCLUSION: Acute somatic pain can induce ischaemic myocardial dysfunction distal to a severe coronary stenosis by activation of cardiac sympathetic nerves. Fentanyl not only prevents the pain sensation but also poststenotic ischaemic myocardial dysfunction.

Animals↗
PubMed1989

Neurogenic regulation of coronary vasomotor tone.

Controversies on acetylcholine-induced increases or decreases in coronary blood flow arise from obvious species differences, the role of endothelium in mediating vascular smooth muscle responses and the marked negative chronotropic and inotropic effects of acetylcholine. In man, there appears to be a predominant dilation of intact epicardial coronary arteries and a constriction of atherosclerotic segments. However, at present there is no evidence for a vagal initiation of myocardial ischaemia. Coronary vascular beta-receptors mediate dilation, but appear to be functionally insignificant during sympathetic activation. The beta-adrenergic mechanisms contributing to myocardial ischaemia are indirect, mediated by a tachycardia-related redistribution of blood flow away from the ischaemic myocardium. alpha-receptors mediating epicardial coronary artery constriction in experimental studies appear not to be responsible for the initiation of ischaemia in patients with angina at rest. However, alpha-adrenergic constriction of coronary resistance vessels resulting in the precipitation of poststenotic myocardial ischaemia was demonstrated in experimental studies and recently confirmed in patients with effort angina.

Animals↗
PubMed1989

Characteristics of regional myocardial stunning after exercise in dogs with chronic coronary stenosis.

Persistent impairment of regional contraction of the left ventricle after restoration of blood flow following transient coronary occlusion has been termed "stunning," and reversible regional dysfunction has also been observed during recovery from exercise-induced regional ischemia. To determine whether limitation of subendocardial blood flow after exercise is a determinant of such dysfunction in the presence of chronic coronary stenosis, nine conscious chronically instrumented dogs having an Ameroid constrictor were studied before, during, and after treadmill runs that induced regional ischemia. During exercise, systolic wall thickening (%WTh, sonomicrometers) in the ischemic region decreased from a normal level of 22.1 +/- 9.1% at rest to 8.8 +/- 5.2% (+/- SD, P less than 0.01), whereas subendocardial blood flow (microspheres) in the ischemic region decreased from 0.75 +/- 0.25 to 0.45 +/- 0.27 ml.min-1.g-1 (P less than 0.05). %WTh in the ischemic region gradually improved after exercise but remained depressed (75% of control) at 30 min after the run (P less than 0.05). Postexercise dysfunction was not related to simultaneous regional hypoperfusion, since at 5 and 10 min after running there was a tendency toward subendocardial hyperemia (control 0.75 vs. 1.33 and 1.30 ml.min-1.g-1, NS) with a return to control by 30 min. Thus persistent regional dysfunction after exercise-induced regional ischemia in the conscious dog is not due to sustained subendocardial ischemia in the presence of chronic coronary stenosis and represents an example of myocardial stunning.

Animals↗
PubMed1989

Consequences of regional inotropic stimulation of ischemic myocardium on regional myocardial blood flow and function in anesthetized swine.

Determination of the effect of inotropic stimulation on regionally ischemic and hypokinetic myocardium is complicated when intravenous administration of the inotropic agent also causes stimulation of nonischemic adjacent and distant regions, thereby altering global ventricular hemodynamics. To obviate such events, 16 anesthetized swine were studied during regional inotropic stimulation by infusion of dobutamine hydrochloride (2.5 +/- 1 microgram/min) into the cannulated left anterior descending coronary artery. Coronary inflow was controlled by a pump in an extracorporeal circuit. Two groups of swine with different degrees of ischemia were studied. In the first group of animals (n = 8), reduction in coronary inflow to produce a fall in coronary artery pressure (CAP) from 114 +/- 7 mm Hg to 62 +/- 2 mm Hg caused a decrease in percent systolic wall thickening (%WTh) from 34.6 +/- 8.1% to 25.4 +/- 5.8% (p less than 0.005). In the second group of animals (n = 8), CAP was decreased to 46 +/- 5 mm Hg (control: 115 +/- 8 mm Hg) and % WTh decreased from 34.1 +/- 16.4% to 10.4 +/- 6.9% (p less than 0.001). Subendocardial blood flow was reduced from 1.41 +/- 0.38 ml/min/g to 0.65 +/- 0.13 ml/min/g (group 1, p less than 0.001) and from 1.08 +/- 0.22 ml/min/g to 0.24 +/- 0.08 ml/min/g (group 2, p less than 0.001). Regional infusion of dobutamine caused asynchronous ventricular contraction with early systolic augmentation in wall thickening followed by late systolic thinning. Therefore, during hypoperfusion regional myocardial function assessed by %WTh remained unchanged (26.2 +/- 5.8%, p = NS) in group 1 and decreased significantly to 1.6 +/- 5.1% (p less than 0.041) in group 2. Subendocardial blood flow decreased to 0.44 +/- 0.15 ml/min/g in group 1 (p less than 0.005) and to 0.15 +/- 0.07 ml/min/g in group 2 (p less than 0.012). To account for the augmented early systolic thickening that occurred during asynchronous contraction, a myocardial work index was developed in which the sum of the instantaneous left ventricular pressure-wall thickness product was calculated for estimation of regional myocardial work. Increases in this work index were apparent with the addition of dobutamine at both levels of hypoperfusion. This significant enhancement in regional myocardial function in group 2 caused a significant increase of 16% (p less than 0.009) in overall left ventricular power during ejection. Thus, regional inotropic stimulation with dobutamine caused enhancement of maximum work of the ischemic myocardium in the steady state despite a further decrease in subendocardial blood flow.

Animals↗
PubMed1989

[Coronary vasomotion in myocardial ischemia].

Coronary vasomotion can be characterized with respect to its localization in the coronary vascular tree as segmental (epicardial, collateral, resistive), with respect to its localization in the myocardium as transmural (subendocardial vs subepicardial), or with respect to its mediators (myogenic, metabolic, endothelial, neuronal, humoral). Coronary vessels exhibit a marked coronary dilator reserve which can be recruited to maintain regional myocardial blood flow and contractile function distal to coronary stenoses. Even in the presence of myocardial ischemia, coronary vessels retain a significant dilator reserve which can only be recruited pharmacologically. A critical reduction in blood flow at the level of epicardial coronary arteries is the underlying cause for a range of pathophysiological processes that extends from changes in the hemodynamic severity of a fixed stenosis to dynamic coronary stenosis, and finally to true spasm. These pathophysiological processes differ in the quantitative contribution of active coronary vasoconstriction and fixed mechanical obstruction to the initiation of myocardial ischemia; the mediators of epicardial coronary constriction are largely unclear. Significant alpha 2-adrenergic coronary constriction of the resistive vessels, predominantly in the subendocardium, contributes to the initiation of poststenotic myocardial ischemia during sympathetic activation and exercise in experimental studies. Intracoronary alpha-blockade with phentolamine also attenuates exercise-induced myocardial ischemia in patients with stable angina. Experimental analyses of regional myocardial blood flow and contractile function in ischemic myocardium reveal that a discrepancy between O2-supply (flow) and O2-demand (function) does not exist on a hemodynamic level. Regional myocardial blood flow and function are instead adequately reduced in ischemic myocardium. Thus, absolute regional myocardial blood flow--as a result of coronary vasomotion and blood flow redistribution--is the significant determination of myocardial ischemia.

Animals↗
PubMed1988

Intracoronary alpha 2-adrenergic receptor blockade attenuates ischemia in conscious dogs during exercise.

Studies on the role of alpha-adrenergic constrictor tone in the coronary vascular bed during ischemia were performed in dogs running on a treadmill. The animals were instrumented with a left ventricular pressure transducer, and regional systolic wall thickening (%WTh) was assessed by sonomicrometry in the anterior and posterior walls of the left ventricle. An intracoronary catheter was implanted chronically in the circumflex coronary artery, and a hydraulic cuff was placed proximally around the artery. After beta-adrenergic blockade with propranolol (0.8 mg/kg i.v.), acute stenosis of the coronary artery was performed during running in five dogs to induce severe regional myocardial dysfunction in the posterior wall. Intracoronary infusion of the selective alpha 2-adrenergic blocking agent idazoxan (80 micrograms/kg) improved %WTh in the ischemic region from 5.1 +/- 1.6 to 10.8 +/- 2.8% (p less than 0.05), without any significant effect on the anterior wall. Blood flow to the subendocardium of the posterior wall (radioactive microspheres) increased from 0.17 +/- 0.05 to 0.45 +/- 0.30 (ml/min)/g (p less than 0.05). It is concluded that in exercising dogs subjected to beta-adrenergic blockade, significant postjunctional alpha 2-adrenergic receptor-mediated coronary vasoconstriction exists, even during severe ischemia. Regional alpha 2-adrenergic receptor blockade can reduce regional ischemia and improve contractile function by attenuating exercise-induced sympathetic vasoconstriction in this conscious animal model.

Adrenergic alpha-Antagonists↗
PubMed1987

Ischemic myocardial dysfunction assessed by temporal Fourier transform of regional myocardial wall thickening.

A Fourier analysis including the first 20 harmonics was performed on sonomicrometric measurements of regional myocardial wall thickness in eight conscious dogs under control conditions and at four levels of ischemia produced by a hydraulic occluder on the left circumflex coronary artery. Systolic wall thickening was reduced from 26.47 +/- 6.20% (S.D.) (control) to 22.05 +/- 5.73% (mild stenosis), 17.00 +/- 5.86% (moderate stenosis), 11.46 +/- 3.56% (severe stenosis), and 3.69 +/- 2.57% (30-second occlusion), values significantly different from each other (p less than 0.01). The amplitude of the first harmonic decreased stepwise from 1.35 +/- 0.31 to 1.08 +/- 0.29 mm, 0.90 +/- 0.27 mm, 0.69 +/- 0.24 mm, and 0.43 +/- 0.12 mm, all significantly different from each other (p less than 0.05). These amplitude values correlated to percent systolic wall thickening (r = 0.894, p = 0.001). A phase shift of the first harmonic from 137 +/- 11 to 139 +/- 14 degrees, 150 +/- 15 degrees (p less than 0.05 vs control), 161 +/- 21 degrees (p less than 0.01 vs control), and 191 +/- 21 degrees (p less than 0.01 vs control and severe stenosis) correlated with the increase in time from end diastole to the point of maximum wall excursion (r = 0.662, p less than 0.001). These data indicate that the extent of ischemic regional myocardial hypokinesis can be adequately described by the amplitude of the first harmonic, and that the asynchrony of ventricular contraction and relaxation can be detected from the phase of the first harmonic.

Animals↗