Ultrastructural and biochemical alterations induced by propranolol treatment in experimental myocardial ischaemia

The effect of propranolol within the first ten days after a transient experimental myocardial ischaemia was investigated. As compared to the untreated control lot, the ultrastructural and biochemical lesions appeared to be much reduced and within reversible limits. Worthy of note was the slight affection of mitochondria revealed by the level of mitochondrial enzymes, the presence of lysosomal and phagolysosomal structures and capillaries of normal aspect, and the absence of cytolysis. The favourable effect of this beta-blocking drug might be attributed to its protective action on the cellular and capillary membrane systems.     

Experimental studies in transient myocardial ischaemia

The biology of the myocardium was studied under experimental conditions similar to angina pectoris. In some dogs the myocardium was adapted to ischaemia by progressive coronary occlusion of 1-5 min followed by restoration of circulation during 5 min. In other dogs adaption was followed by 20 to 35 min ischaemia. The animals were sacrificed immediately or after 2-10 days. Transient ischaemia produced less severe alterations then abrupt coronary obstruction. Adaptation followed by 20 and 35 min ischaemia induced foci that undergo cytolysis and scarring of maximum intensity on the 8th day. Activity of enzymes in the mitochondrial suspension, especially of cytochromoxidase, decreases and lysosomal hydrolases increase with focal necroses.     

Effects of L-carnitine in acute myocardial ischaemia

Data in the literature suggest that exogenous L-carnitine improves the metabolic function of ischaemic heart cells: it enhances the transport of long-chain fatty acids into the mitochondria, stimulates the slowed beta-oxidation, and moderates the accumulation of amphiphilic acyl esters. A study has therefore been made of the cardiac effects of L-carnitine in dog experiments (n = 8). The left anterior descending coronary artery (LAD) was isolated in anaesthetized, thoracotomized animals in situ. After a control occlusion and equilibration period, the LAD was again ligated at the time of L-carnitine infusion (100 mg/kg iv. during 10 min). The agent diminished the maximal conduction delay and the degree of epicardial ST-segment elevation in the ischaemic myocardial region, and the free fatty acid concentration of the arterial blood, but it did not influence the frequency of ventricular extrasystoles. The anti-ischaemic effect of L-carnitine was manifest only during the infusion, and its discontinuation was immediately followed by an enhanced ST-segment elevation. In the dose applied, the substance did not affect the heart rate, systemic mean arterial pressure, left ventricular end-diastolic pressure (LVEDP), or left ventricular contractility (LV dP/dtmax). In the canine myocardial infarction model employed it was observed that the duration of the anti-ischaemic effect of L-carnitine (100 mg/kg iv.) is very short, and it has no significant antiarrhythmic action.     

Changes of regional myocardial blood flow during and after acute focal experimental ischaemia.

The regional blood flow through the myocardium of the left ventricle was measured in 11 dogs after ligation of the left anterior descending coronary artery, by means of a local injection of 133Xe depot and precordial detection of its washout 2 hours after ligation. Immediately after ligation the blood flow in the ischaemic area declined considerably but at the same time there was a significant increase of blood flow in the non-ischaemic left ventricular myocardium. The regional flow in the ischaemic and non-ischaemic area increased insignificantly for 2 hrs. These changes were not due to alterations in coronary artery pressure, as the mean arterial pressure declined significantly during the first hour. After temporary ischaemia by ligation of the left anterior descending coronary artery for 2--4 minutes, an intensive reactive hyperaemia developed in the ischaemic region (the blood flow reached 221% of control values on the average) which was the more intensive, the greater the drop of blood flow in the ischaemic area after ligation.     

Experimental investigations in prolonged myocardial ischaemia. Note I. Biology of the myocardial fiber after transient myocardial fiber after transient myocardial ischaemia

The first ten days' evolution of post-ischaemic lesions of the premonitory or angina pectoris syndrome type was experimentally studied by the challenge of a short-term (10 and 15 min) ischaemia, of an adaptation to ischaemia and an adaptation followed by prolonged ischaemia (20 and 35 min). Worthy of note was the persistence of reversible lesions after short-term ischaemia and adaptation, and the progressive evolution towards cytolysis and cicatrization of some pancicellular foci after adaptation followed by prolonged ischaemia. The role of mitochondrial lesions, of lysosomal hydrolases, the inefficiency of renewed circulation, as well as problems of diagnosis are discussed.     

Thyroid hormone and myocardial ischaemia

Thyroid hormone has various effects on the cardiovascular system and its effects on cardiac contractility, heart rhythm and vascular function has long been recognized. However, new evidence is emerged on the importance of thyroid hormone in the response of the myocardium to ischaemic stress and cardiac remodelling following myocardial infarction. Based on this new information, this review highlights the role of thyroid hormone in myocardial ischaemia and cardiac remodelling, the possible underlying mechanisms and the potential therapeutic implications. Thyroid hormone or analogs may prove new therapeutic agents for treating ischaemic heart disease.     

Signal transduction in myocardial ischaemia and reperfusion

Recent studies in the non-ischaemic myocardium indicated that drugs stimulating cAMP formation inhibit ₁-mediated inositol phosphate generation, while ₁-adrenergic stimulation lowered tissue CAMP levels, implicating cross-talk between ₁,- and -adrenergic signalling pathways in normal physiological conditions. Massive amounts of endogenous catecholamines, predominantly noradrenaline, are released during myocardial ischaemia and reperfusion, causing stimulation of both ₁- and -adrenergic receptors which, in turn, may contribute to intracellular Ca²⁺ overload and subsequent cell damage. Since no information is available regarding cross-talk in pathophysiological conditions, the aim of this study was to evaluate the interactions between ₁- and -adrenergic signalling pathways during different periods of ischaemia and reperfusion.Isolated rat hearts were perfused retrogradely for 30 min before being subjected to (i) 5–25 min global ischaemia and (ii) 1–5 min of reperfusion after 20 min global ischaemia. Drugs (prazosin, 10^–7 M; propranolol, 10^–6 M; phenylephrine 3 × 10^–5 M; isoproterenol 10^–9 M) were added 10 min before the onset of ischaemia and were present during reperfusion.Increasing periods of ischaemia caused an immediate rise and progressive lowering in tissue cAMP and Ins(1,4,5)P₃ levels respectively. In contrast, reperfusion caused an elevation in Ins(1,4,5)P₃ levels and reduced cAMP. Prazosin elevated cAMP levels during both ischaemia and reperfusion, while propranolol had no effects on tissue Ins(1,4,5)P_3–. The activity of the ₁-adrenergic signal transduction pathway appears to have an inhibitory effect on the activity of the -adrenergic system during ischaemia and reperfusion.     

Right ventricular function in acute myocardial ischaemia

A haemodynamic examination of 10 dogs was carried out at rest, during volume loading and after ligation of the right coronary artery in the presence of a closed pericardium. Ligation of the right coronary artery led to haemodynamic signs of depression of right ventricular function--a drop in systolic pressure and an increase in end diastolic pressure, together with a shift of the functional curve to the right and downwards. Overall performance of the heart (cardiac output and the mean systemic pressure, also fell. Our results show that the depression of the systolic function of the myocardium in the presence of right ventricular infarction can be an important factor in the genesis of low cardiac output syndrome observed in clinical situations. Its pathophysiological mechanisms and some of the clinical consequences are discussed.     

Elevation of plasma fibrinogen in silent myocardial ischaemia

High plasma levels of fibrinogen and plasminogen activator inhibitor (PAI-1) are reported to be correlated with coronary heart disease. Therefore the level of fibrinogen concentration in plasma was examined and verified for the possible correlation with the previously explored PAI-1 antigen and PAI-1 activity in the pathogenesis of premature atherosclerosis (Grzywacz et al., 1998, Blood Coagul Fibrinol. 9, 245-249). Examination included only men, aged 33-46 years, who were in a stable condition for at least six months after the acute event. They were divided into two subgroups: group A (n = 14) with and group B (n = 15) without ischaemic changes in 24 h Holter electrocardiogram. The number of involved vessels visible on the coronarography picture was similar in both groups. In the patients of group A the mean level of fibrinogen (3.92 vs 3.23 g/l, P < 0.05) was higher than in the controls (n = 15). No statistically differences were found between group B and control healthy subjects in any of the parameters measured. There were no correlation between fibrinogen concentration and PAI-1 antigen and activity levels, which were elevated in both groups of patients according to our previous study. Our results indicate that elevated levels of plasma fibrinogen and PAI-1 appeared in the group of patients with more severe disease, as revealed by silent myocardial ischaemia.     

Rat alpha-fetoprotein in experimental utero-placental ischaemia.

Retardation of growth and death of fetal rats were produced after uteroplacental ischaemia was induced by surgical ligation of the uterine arteries. Changes in maternal plasma levels of alpha-fetoprotein (AFP) were measured by radioimmunoassay. In rats in which the uterine blood supply was totally occluded, the resultant increase in maternal plasma AFP was due to resorption of fetal elements, because AFP levels in maternal rat plasma did not increase following hysterectomy in a control group. Maternal plasma AFP levels in rats with a partly occluded blood supply (and therefore some dead and some live fetuses) paralleled those of sham-operated rats, suggesting that increased placental transfer of AFP to maternal plasma may have offset the anticipated decline of AFP due to a decreased number of live fetuses.     

Mitochondrial phospholipid composition and microviscosity in myocardial ischaemia

Normothermic ischaemic arrest of the isolated perfused rat heart causes profound changes in mitochondrial ultrastructure. Since the mitochondrial membranes contain a high percentage of phospholipids, an evaluation of the effect of different periods of ischaemia on mitochondrial phospholipid content and fatty acid composition was made. The results showed that ischaemia had no effect on the content of the different phospholipid classes and no correlation was observed between ultrastructural changes and mitochondrial phospholipid content. However, the phospholipid fatty acid composition of several phospholipids showed marked changes. For example, with lysophosphatidylcholine a progressive increase in the percentage saturated fatty acids was observed with increasing periods of ischaemia, while a reduction occurred in lysophosphatidylethanolamine. To determine whether the ischaemia-induced changes in mitochondrial phospholipid fatty acid composition had an effect on the physical properties of the membrane, the microviscosity of mitochondrial preparations was studied, using the lipophilic probe, 1,6-diphenyl-1,3,5-hexatrine. Mitochondria isolated from ischaemic hearts showed a progressive increase in fluorescence polarization with longer periods of ischaemia, indicating an overall increase in microviscosity. This phenomenon may be responsible for the increased mitochondrial fragility which is characteristic of ischaemic damage.     

Prevalence of asymptomatic myocardial ischaemia in diabetic subjects.

OBJECTIVE--To compare the prevalence of silent myocardial ischaemia associated with coronary artery disease in diabetic subjects with that in controls of similar age and sex. DESIGN--A controlled study in which subjects with positive findings on exercise electrocardiography, 24 hour electrocardiographic recording, or dynamic thallium scintigraphy (diabetics only) underwent coronary angiography. SETTING--Academic medical centre; referral based cardiology clinic. SUBJECTS--136 Diabetic subjects, of whom 72 (33 women, 39 men (mean age 46.0] were insulin dependent and 64 (19 women, 45 men (mean age 49.3] non-insulin dependent. 80 Controls matched for age and sex; all were clients of the Occupational Health Service of Oulu University Central Hospital or the State Occupational Health Service Station in Oulu in whom diabetes had been excluded by a glucose tolerance test. INTERVENTIONS--Any subject showing signs of myocardial ischaemia was referred for cardiac catheterization. MAIN OUTCOME MEASURES--Exercise electrocardiography and 24 hour electrocardiographic recording were regarded as positive if there were ST depressions of greater than or equal to 1 mm that were planar or downsloping and persisted for 0.08 seconds after the J point. Thallium tomographic imaging. With cardiac catheterisation, coronary artery lesions were classified as significant in half or more of the vessel lumen was narrowed, or insignificant if such narrowing was less than half. RESULTS--40 (29%) diabetes and four (5%) controls had positive results in one or more of the non-invasive tests. Coronary angiography was performed on 34 of the diabetics (six refused); 12 had significant coronary artery narrowing; seven had unimportant atherosclerosis; 15 had patent coronary arteries. Among the controls only one had unimportant atherosclerosis; the other three had patent arteries. CONCLUSIONS--These results confirm the high prevalence of asymptomatic myocardial ischaemia in diabetics. Non-invasive screening of diabetic subjects, however, does not seem justified because of the low preset probability of the presence of the disease and the inaccuracy of the available test methods.     

Arrhythmias associated with myocardial ischaemia and infarction

The intention of this review has been to summarise the current state of knowledge regarding the arrhythmias induced by myocardial ischaemia and infarction. Both clinical and experimental aspects were considered. There has been some progress toward understanding the electrophysiological mechanisms responsible for the genesis of such arrhythmias but understanding is far from complete. We are still unable to trace the sequence of events which begin with the electrophysiological changes induced in cells by ischaemia and progress through macromechanisms such as re-entry, automaticity, etc., to the final arrhythmia. Exactly how the changes in individual cells translate into the macromechanisms is not known. Similarly, which macromechanism actually operate, and to what extent, is not known.We have very little information regarding the biochemical events responsible for the changes in intracellular potential seen with ischaemia. Similarly, we do not know whether arrhythmogenic mediators are involved in such a process. We have a fairly complete catalogue of the changes in biochemistry induced by ischaemia, but at the moment it is difficult to find causal relationships between such changes and ischaemia-induced disturbances in electrophysiology.Finally, we are in possession of a catalogue of drugs which may reduce the arrhythmias induced by ischaemia and infarction (both clinically and experimentally), but have no clear direction as how to develop the ideal antiarrhythmic (antifibrillatory) drugs.