Coronary artery disease causes an increase in glutamate uptake and alanine output by the heart. We assessed the effects of acute myocardial ischemia on alanine and glutamate exchange and ammonia production in 10 anesthetized open-chest domestic swine (46.9±0.7 kg). Coronary blood flow was controlled through an extracorporal perfusion circuit. After a nonischemic control period (aerobic) the blood flow in the left anterior descending coronary artery was reduced by 60%. Arterial and anterior interventricular venous samples where drawn before and during 35 min of ischemia. Subendocardial blood flow, measured using radiolabeled microspheres, decreased from 1.27±0.16 to 0.25±0.09 (ml/g)/min, and left-ventricular wall-thickening fell to 47% of aerobic values. Ischemia resulted in a significant increase in the rate of glucose uptake (p<0.05) and a switch to net lactate production (p<0.01). Ischemia did not affect the rates of alanine output (−0.9±1.0 vs. −0.3±0.3 μmol/min) or glutamate uptake (−0.4±1.1 vs. 0.3±0.6 μmol/min), but did increase the venous-arterial difference for ammonia (−4.1±4.1 to 52.7±5.5 μM, p<0.0001) and the ammonia output (−0.33±0.24 to 1.34±0.14 μmol/min, p<0.0001). In conclusion, acute ischemia did not stimulate greater alanine output or glutamate uptake. However, acute ischemia did cause an increase in anaerobic glycolysis rate and ammonia output, which reflects a profound disruption in myocardial energy metabolism.

We assessed the relationship between myocardial glucose metabolism and blood flow during ischemia in eight open-chest swine. Coronary flow was controlled by an extracorporeal perfusion circuit. Left anterior descending coronary arterial (LAD) flow was reduced by 60%, while left circumflex flow was normally perfused. The rate of glucose uptake (Rg) was measured with a coronary infusion of 2-deoxy-D-[14C]glucose and myocardial blood flow with radiolabeled microspheres. Myocardial biopsies were taken after 50 min of ischemia. Regional arterial-venous glucose difference was calculated as Rg per myocardial blood flow. Subendocardial blood flow decreased from 1.27 +/- 0.19 to 0.25 +/- 0.11 ml.g-1.min-1 (P less than 0.0001). The subendocardial arterial-venous glucose difference was greater in the LAD bed (1.38 +/- 0.35 mumol/ml) than the left circumflex coronary arterial perfusion bed (0.10 +/- 03; P less than 0.01); however, there was no statistically significant difference in the rate of glucose uptake between the two beds. Subendocardial glycogen concentration in the LAD perfusion bed was reduced to 26% of circumflex bed values. In conclusion, acute ischemia stimulated a dramatic increase in glucose extraction; however, this did not compensate for the decrease in blood flow, and thus the rate of glucose uptake did not increase significantly. The high rate of glycolysis is primarily supported by accelerated net glycogen breakdown rather than increased glucose uptake.

The purpose of this report was to test the effects of systemic treatment with propionyl-L-carnitine in a new model of chronically hypoperfused ("hibernating") myocardium. Adolescent swine were instrumented to undergo a period of mild partial coronary constriction for 1 week (50% reduction of the maximum phasic flow velocity in the anterior descending coronary artery). This reduced regional mechanical function by 56%. The system satisfied criteria defining "hibernating" myocardium, in that the chronic hypoperfusion did not produce massive tissue necrosis and that the reduction in regional contraction remained responsive to inotropic stimulation. Treatment with 50 mg/kg propionyl-L-carnitine by mouth twice daily for 1 week significantly (p less than 0.0005) increased concentrations of free and total carnitine in the myocardial tissue by 39% and 31%, respectively. Treatment with propionyl-L-carnitine did not alter regional systolic shortening in either hibernation or reperfusion for 2 hours, but enhanced one estimate of contractility reserve based on the rate of left ventricular emptying with occlusion of the inferior vena cava. Propionyl-L-carnitine did not reverse the observed impairments in mitochondrial respiration (diminutions in state 3 respiration and the respiratory control ratio), but limited the number of lesions seen on histological examination. Six out of eight placebo hearts showed one or more changes of ischemia, infarction or reperfusion injury, while the same was true in only two out of eight hearts treated with propionyl-L-carnitine (p less than 0.003). Carnitine and various analogues have been proposed to benefit ischemic myocardium. The present data suggest that this general sparing effect may also occur with the propionyl derivative in chronically underperfused myocardium.

The study of flow dynamics on the coronary microcirculation of the intact beating heart has been greatly hampered by the thickness of the tissue and its continual movement. Using fluorescent microspheres and video-image processing, we have devised a means to measure an index of blood velocities. Measurements were made on open-chest anesthetized cats without any artificial restraints to the heart motion. However, advantages exist for minimizing mechanical motion, therefore, a heart holder based on a vacuum concept, along with modified versions of previously demonstrated methods, were tested. Results showed that the vacuum holder provided more restraint to epicardial motion than the pericardium alone, and despite large differences in epicardial motion between the two, overall flow measurements of the microspheres were comparable. Other methods of immobilizing the heart usually did not yield normal flow velocities. This video analysis method allows for the reproducible measurement of particle velocities at time points throughout the cardiac cycle. In keeping the normal heart dynamics intact, more realistic results from the study of coronary blood flows can be obtained.

The objective of this study was to augment myocardial tissue levels of amphiphiles using a treatment protocol of pantothenic acid, cysteine and dithiothreitol (DTT) in 24 hr fasted pigs and to test their influence on mechanical recovery in reperfusion. Eighteen pig hearts were extracorporeally perfused aerobically, subjected to regionally reversible ischemia in the left anterior descending perfusion system and reperfused. Nine hearts served as a placebo group; nine hearts were treated. All hearts received trace-labeled palmitate to measure fatty acid oxidation and were perfused with an infusion of 20% Intralipid to augment perfusate levels of fatty acids. Fasting alone in the presence of carbon substrates in the coronary perfusate was not sufficient to de-inhibit pantothenic acid kinase such that CoA synthesis was not enhanced. Tissue contents of triacylglycerols and phospholipids in reperfused myocardium were no different than in aerobic heart muscle but free CoA and free and total carnitine were reduced, suggesting a leakage of cytosolic contents across injured sarcolemma. Treatment significantly impaired mechanical recovery during reflow, presumable due to the noxious properties of DTT whose reported effects in heart muscle are wide ranging, difficult to predict in intact hearts and may be harmful.

The purpose of this study was to apply step-wise multiple linear regression analysis retrospectively to an array of mechanical and metabolic measurements chosen because they had the potential to predict the extent of contractile recovery from a prescribed duration of myocardial ischemia. Data were acquired from the extracorporeally perfused, intact, working pig heart which was rendered regionally ischemic (60% reduction in anterior descending coronary flow) for 45 minutes and reperfused to aerobic levels for a final 30-50 minutes. Mechanical recovery was defined by the percentage systolic shortening and the area circumscribed by left ventricular pressure-segment length loops. Data were taken from 39 control hearts and from 16 hearts treated with oxfenicine, an agent which we have previously used to alter mechanical function by its interference with fatty acid metabolism. Despite the fixed nature of the protocol in affecting ischemic hypoperfusion, a wide range of mechanical responses encompassing hypo- and dyskinesis was produced during ischemia, followed by mechanical stunning during reflow. Of the parameters surveyed, regional indices of mechanical performance, together with perfusate pH and PCO2, best predicted recovery. Along with the heart rate, these predictors gave correlations of 0.875 for percentage systolic shortening and 0.766 for the length-pressure loop in control hearts. The analyses were also sensitive to the influence of pharmacological intervention with oxfenicine in that several parameters lost statistical significance for percentage systolic shortening and two were added (heart rate and end-diastolic length) for the length-pressure loop. Separate statistical models for oxfenicine-treated hearts gave correlations of 0.905 for percentage systolic shortening and 0.915 for the length-pressure loop. The data suggest that step-wise multiple linear regression analysis provides new insights toward our understanding of the mechanisms of mechanical stunning in myocardial reperfusion.

We previously reported in working swine hearts a preferred use of fatty acids during early myocardial reperfusion. The purpose of these studies was to test whether this pattern of substrate oxidation was the result of excess energy demands during mechanical recovery. Two groups of pig hearts (n = 15) were compared. Both received Intralipid with heparin (serum fatty acids, 1.02 +/- 0.05 mumol/ml) to ensure preferred substrate availability and both received [2-14C]pyruvate to monitor myocardial use of a carbohydrate substrate. In one group (n = 8) oxfenicine was administered to suppress fatty acid utilization. Left anterior descending (LAD) coronary flow was maintained at aerobic levels for 30 min, reduced by 60% for 45 min, and restored to aerobic levels for a final 50 min. Ischemia caused the expected decreased in global and regional mechanical performance. Recovery in motion during reflow was less in oxfenicine-treated hearts (73 vs. 32% decrease in systolic shortening from aerobic values in treated and control hearts, P less than or equal to 0.01 and P less than or equal to 0.05, respectively). Pyruvate oxidation declined dramatically in both groups during ischemia but recovered disparately. In control hearts CO2 production remained depressed during reperfusion (NS from ischemic values), whereas in treated hearts it increased 5.5-fold (but did not exceed aerobic values). Tissue levels of acetyl CoA and acetylcarnitine were not statistically different between perfusion beds (aerobic vs. reperfusion) within groups. Oxfenicine reduced levels of acetyl carnitine in both perfusion beds.(ABSTRACT TRUNCATED AT 250 WORDS)

The purpose of these studies was to characterize the rates of fatty acid oxidation in reperfused myocardium and test the influence of excess fatty acids (FA) on mechanical function in the extracorporeally perfused, working swine heart model. Seventeen animals were prepared. Eight were untreated (LOW FA group; serum FA averaged 0.55 +/- 0.07 mumol/ml) and nine received a constant infusion of 10% Intralipid with heparin to raise serum FA to about 1.4 +/- 0.21 mumol/ml (HIGH FA group). Coronary flow in both groups was held at aerobic levels for an equilibrium period of 40 minutes, acutely reduced regionally in the anterior descending circulation by 60% for 45 minutes, and acutely restored to aerobic levels for 60-minute reflow. Appreciable mechanical depression (-47 delta% from aerobic values; p less than 0.01) during reperfusion was noted in both groups. This was associated with modest reductions in myocardial oxygen consumption (p less than 0.05) and losses of total tissue carnitine stores (p at least less than 0.02). Reperfused myocardium showed a strong preference for and aerobic use of FA during reflow such that 14CO2 production from labeled palmitate exceeded preischemic levels (+89 delta% in LOW FA hearts; +111 delta% in HIGH FA hearts). This suggested relative preservation of restoration of certain elements in mitochondrial function during reflow. The findings argue for uncoupling between substrate metabolism and energy production, accelerated but useless energy drainage, or some impairment between energy transfer and function of contractile proteins as possible explanations for the persistent depression of mechanical function (stunning) during reperfusion.(ABSTRACT TRUNCATED AT 250 WORDS)