Age-related differences in the dynamics of the skin blood flow oscillations during postocclusive reactive hyperemia

Age-related changes in peripheral microcirculation were studied using laser Doppler flowmetry in 60 apparently healthy subjects. The response of microcirculation to short-term ischemia was studied using the occlusion test. Changes in the amplitude of the peripheral blood flow oscillations were determined using time-amplitude analysis based on continuous adaptive wavelet filtration. The oscillation amplitude in the frequency range of the heart rate was found to reach the maximum with a delay after the removal of the occlusion, whereas in the range of the respiratory rhythm, no delay was observed. The hyperemic response to short-term ischemia is assumed to develop under the predominant influence of the arterial-arteriolar component, whereas the dynamics of amplitude oscillations in the range of the respiratory rhythm is a result of the devastation of the venular component after removal of occlusion. In response to short-term ischemia, the maximum oscillation amplitudes of myogenic, neurogenic, and endothelial rhythms decreased with age, which demonstrates the restriction of the regulatory control of the peripheral blood flow by the corresponding systems.     

Hyaluronidase treatment of coronary glycocalyx increases reactive hyperemia but not adenosine hyperemia in dog hearts

Because adenosine is commonly used for inducing maximal coronary hyperemia in the clinic, it is imperative that adenosine-induced hyperemia (AH) resembles coronary hyperemia that can be attained by endogenous stimuli. In the present study we hypothesized that coronary reactive hyperemia (RH) is limited compared with AH due to the presence of the glycocalyx and that the AH response is therefore unable to detect glycocalyx modifications. In anesthetized open-chest dogs, blood flow and pressure were measured in the left circumflex artery. RH after 15-s occlusion was compared with an intracoronary infusion of adenosine (650 microg; AH) during control conditions and after intracoronary treatment of the glycocalyx with hyaluronidase (20.000 U, 2 x 20 min; n = 6) or heat-inactivated hyaluronidase (n = 5). During control, coronary conductance during RH was 1.49 +/- 0.15 ml.mmHg(-1).min(-1) and 76 +/- 7% of coronary conductance during AH (P < 0.05). After hyaluronidase, RH conductance increased (P < 0.01) by 43 +/- 13% and became 93 +/- 4% of AH conductance (P = NS). Heat-inactivated hyaluronidase had no effect on RH and AH conductance. Our results demonstrate that adenosine-induced coronary hyperemia profoundly exceeds RH and that the difference is virtually abolished on selective removal of the glycocalyx. It is concluded that, compared with RH, adenosine-induced coronary hyperemia is not affected by modification of the glycocalyx. This glycocalyx insensitivity should be taken into account when using adenosine-induced coronary hyperemia as a marker for vasodilating capacity to an ischemic stimulus.     

Mechanisms involving the endothelium in reaction of reactive hyperemia

The experiments on anesthetized dogs and on test-preparations of isolated vascular rings of femoral artery used for detection of appearance of vasoactive substances in venous blood demonstrated that the response of reactive hyperemia is accompanied by the appearance of vasodilation substances in the blood, the concentration of which taking into account the reaction of relaxation of vascular preparation, increases with the occlusion duration. Chemical inhibition of endothelium of a studied bed by saponin essentially decreases the reactive hyperemia and relaxation of test-preparation. The rise of pressure in an overlapped part of a bed and the decrease in the deformation of endothelium with the help of dimerized glutaraldehyde treatment affected the hyperemia and vascular preparation reaction in the similar way. We concluded that the reaction of reactive hyperemia is the result of the vasoactive substances secretion by endothelium in response to a decrease in intravascular pressure.     

Effect of noradrenaline on reactive myocardial hyperemia in dogs

The effect of norepinephrine (NE) on reactive myocardial hyperemia (RH) after a brief (20 sec) flow arrest was studied in 9 closed-chest anesthetized dogs. NE infusion into the left ventricle resulted in the increase of RH peak during coronary flow and the elevation of the left ventricular pressure and its first derivative. The increased coronary dilatation may be explained by the activation of beta 1-adrenergic myocardial receptors. RH peak decreased later, with the coronary flow, left ventricular pressure and its first derivative returning to the control level. This RH decrease can be explained by the activation of alpha-adrenergic receptors of the coronary vessels and the competition between alpha-receptors for vasoconstriction and metabolic vasodilatation.     

Capsaicin-sensitive nerves modulate reactive hyperemia in rat gut.

Reactive hyperemia (RH) is a local, vascular response that occurs following release from mechanical occlusion of an artery, with restoration of intra-arterial pressure. The mechanism of this postocclusion hyperemia in the gut has not been identified, although metabolic, myogenic, and neurogenic mediators of this response have been proposed. The present study was conducted to evaluate a possible modulatory role for sensory innervation of the intestinal vasculature in RH, using acute and chronic treatment with capsaicin applied in different ways. In anesthetized rats, the velocity of flowing blood in the gut was determined continuously with a pulsed Doppler velocimeter, and arterial pressure was determined with a transducer. The increase in calculated intestinal vascular conductance at the height of RH (Ch), the excess volume of blood accumulating during RH, and the duration of the hyperemia were also used to quantify RH after occluding the anterior mesenteric artery for 30, 60, and 120 sec. In the initial control group of rats, the maximal increases in the velocity of flowing blood during RH were 61 +/- 4%, 90 +/- 7%, and 129 +/- 10% of control, conductances were increased to 192 +/- 5%, 222 +/- 12%, and 267 +/- 15% of control, volumes were 3.5 +/- 0.6 ml, 7.2 +/- 0.4 ml, and 16.2 +/- 1.8 ml, and durations of hyperemia were 78 +/- 5 sec, 93 +/- 6 sec, and 178 +/- 7 sec, respectively, after each elapsed period of occlusion. Acute treatment with periarterial capsaicin significantly decreased peak conductances in RH by 15-35% for all occlusions tested and reduced both volume and duration values. Rats treated with capsaicin in neonatal life exhibited reduced Ch values, as did adult rats treated chronically with capsaicin. Both periarterial and intrajejunal treatment with capsaicin decreased the duration of RH. Hexamethonium increased both Ch and the duration of RH and tended to reverse reductions in these parameters caused by capsaicin. These results suggest that sensory innervation of the intestinal vasculature exerts a modulatory influence in the regulation of intestinal RH.     

Role of the endothelium in the development of reactive hyperemia

The experiments on anesthetized dogs demonstrated that reaction of the femoral vessels reactive hyperemia essentially decreased after chemical inhibition of endothelium by saponin, inhibition of lipoxygenase by quercetin and guanylate cyclase by methylene blue. Reaction was increased after cyclooxygenase inhibition by indomethacin. We concluded that the endothelium plays an important role in reaction of reactive hyperemia by endothelium-derived relaxing factor release.     

Contribution of anaerobic metabolism to reactive hyperemia in skeletal muscle

Elevated blood flow (reactive hyperemia) is seen in many organs after a period of blood flow stoppage. This hyperemia is often considered to be due in part to a shift to anaerobic metabolism during tissue hypoxia. The aim of our study was to test this hypothesis in skeletal muscle. For this purpose we measured NADH fluorescence at localized tissue areas in cat sartorius muscle during and after arterial occlusions of 5-300 s. In parallel studies, red blood cell (RBC) velocity was measured in venules. Tissue NADH fluorescence rose significantly with occlusions of 45 s or greater, reaching a maximum of 44% above control at 180 s. Peak RBC velocity rose to four times control as occlusion duration was increased from 5 to 45 s, but hyperemia duration was stable at approximately 70 s. With occlusions of 45-240 s, hyperemia duration increased progressively to 210 s while peak flow was unchanged. However, after 300-s occlusions, peak flow rose to six times above control and hyperemia duration fell to 140 s. With occlusions of 45-300 s the time integral both of increased NADH fluorescence and of reduced fluorescence following occlusion release showed a high degree of correlation with the additional hyperemia. We conclude that in this muscle anaerobic vasodilator metabolites are responsible for the increase in reactive hyperemia with arterial occlusions longer than 45 s. Since the durations of reactive hyperemia and reduced fluorescence are substantially different, vasodilator metabolite removal may be due to washout by the bloodstream rather than metabolic uptake.     

Effect of sildenafil on coronary active and reactive hyperemia

Sildenafil, a selective inhibitor of phosphodiesterase type 5, produces relaxation of isolated epicardial coronary artery segments by causing accumulation of cGMP. Because shear-induced nitric oxide-dependent vasodilation is mediated by cGMP, this study was performed to determine whether sildenafil would augment the coronary resistance vessel dilation that occurs during the high-flow states of exercise or reactive hyperemia. In chronically instrumented dogs, sildenafil (2 mg/kg per os) augmented the vasodilator response to acetylcholine, with a leftward shift of the dose-response curve relating coronary flow to acetylcholine dose. Sildenafil caused a 6. 7 +/- 2.1 mmHg decrease of mean aortic pressure, which was similar at rest and during treadmill exercise (P < 0.05), with no change of heart rate, left ventricular (LV) systolic pressure, or LV maximal first time derivative of LV pressure. Sildenafil tended to increase myocardial blood flow at rest and during exercise (mean increase = 14 +/- 3%; P < 0.05 by ANOVA), but this was associated with a significant decrease in hemoglobin, so that the relationship between myocardial oxygen consumption and oxygen delivery to the myocardium (myocardial blood flow x arterial O(2) content) was unchanged. Furthermore, sildenafil did not alter coronary venous PO(2), indicating that the coupling between myocardial blood flow and myocardial oxygen demands was not altered. In addition, sildenafil did not alter the peak coronary flow rate, debt repayment, or duration of reactive hyperemia that followed a 10-s coronary occlusion. The findings suggest that cGMP-mediated resistance vessel dilation contributes little to the increase in myocardial flow that occurs during exercise or reactive hyperemia.     

On the role of mechanosensitive mechanisms eliciting reactive hyperemia

We hypothesized that changes in hemodynamic forces such as pressure (P) and flow (F) contribute importantly to the development of reactive hyperemia. To exclude the effects of vivo factors, isolated rat skeletal muscle arterioles ( approximately 130 microm) were utilized. We found that changes in P or P + F following occlusions elicited reactive dilations (RD). The peak of RD (up to approximately 45 microm), but not the duration of RD, increased to changes in P (80 to 10, then back to 80 mmHg) as a function of the length of occlusions (30, 60, and 120 s). However, changes in P + F (80-10 -80 mmHg + 25-0-25 microl/min) increased both the peak and duration of RD (from approximately 25 to 90 s) with longer occlusions. When only P changed, inhibition of nitric oxide synthesis or endothelium removal (E-) reduced only the peak of RD, whereas when P + F were changed, both the peak and duration of RD became reduced. Inhibition of stretch-activated cation channels by gadolinium reduced the peak but enhanced the duration of RD (both to P or P + F) that was unaffected by N(G)-nitro-l-arginine methyl ester (l-NAME) or by E-. When only P changed, inhibition of tyrosine kinases by genistein reduced peak RD but did not affect the RD duration. However, when P + F changed, genistein reduced both the peak and the duration of RD, additional l-NAME reduced the peak RD, but did not affect the duration of RD. Thus in isolated arterioles an RD resembling the characteristics of reactive hyperemia can be generated that is elicited by deformation, stretch, pressure, and flow/shear stress-sensitive mechanisms and is, in part, mediated by nitric oxide.     

Effect of sympathetic nerve stimulation on myocardial reactive hyperemia

It has been established in experiments on 25 dogs that the peak of reactive hyperemia (RH) of the myocardium cannot be regarded as an absolute criterion of the coronary dilatory reserves. Stimulation of the stellate ganglion under the conditions of arterial blood pressure stabilization increased the peak of RH. After-effect of the sympathetic nerve stimulation also led to a rise in the peak of RH as compared with control.     

Relationship between coronary flow and adenosine release in reactive hyperemia

A linear relationship was found between coronary flow and adenosine release during the course of reactive hyperemia. Isolated guinea pig heart was perfused with a modified Krebs Ringer bicarbonate buffer containing 2.0 mM pyruvate. Hyperemia was induced with 30, 60 and 90-second coronary occlusions. The hyperemic response was divided into three consecutive 13-second intervals (I, II and III), and perfusate efflux from coronary circulation was collected during the last 10 seconds of each interval for adenosine assay using the HPLC. The data show a control flow of 3.13 +/- 0.4 ml/min/g and adenosine release of 66 +/- 4 pmoles/min/g. Flow increased by 99, 38 and 23% at I, II and III, respectively following 30-second occlusion, whereas adenosine release increased by 241, 132 and 91% for I, II and III. A 60-second occlusion increased the flow by 125, 64 and 34% with a simultaneous increase in the release of adenosine by 464, 155 and 133%, respectively, for I, II and III. Marked elevations in flow (165, 92 and 59%) and in adenosine release (659, 194 and 176%) for I, II and III were observed following 90-second occlusion. The linear relationship between coronary flow and adenosine release had r values of 0.84, 0.74 and 0.88 for 30, 60 and 90-second occlusions, respectively. This study quantifies the relationship between coronary flow and adenosine release during the course of reactive hyperemia. It also suggests that on a percent basis, adenosine contributes equally to the hyperemia at I, II and III.     

Time course of forearm arterial compliance changes during reactive hyperemia

Ultrasonic studies have shown that arterial compliance increases after prolonged ischemia. The objective of the present study was to develop an alternative plethysmographic method to investigate compliance, exploring validity and clinical applicability. Forearm pulse volume (FPV) and blood pressure (BP) were used to establish the FPV-BP relationship. Forearm arterial compliance (FAC) was measured, and the area under the FAC-BP curve (FAC(AUC)) was determined. The time course curve of compliance changes during reactive hyperemia was obtained by continuous measurements of FAC(AUC) for 20 s before and for 300 s after arterial occlusion. This technique allows us to effectively assess compliance changes during reactive hyperemia. Furthermore, the selected measurement protocol indicated the necessity for continuous measurements to detect "true" maximal FAC(AUC) changes. On multivariate analysis, preischemic FAC(AUC) was mainly affected by sex, peak FAC(AUC) was affected by sex and systolic BP, percent changes were affected by plasma high-density and low-density lipoprotein cholesterol, peak time was affected by age and body mass index, and descent time was affected by plasma triglyceride levels. The proposed technique is highly sensitive and well comparable with the generally accepted echotracking system. It may thus be considered as an alternative tool to detect and monitor compliance changes induced by arterial occlusion.     

Histamine H3 receptors modulate reactive hyperemia in rat gut.

Reactive hyperemia (RH) is an abrupt blood flow increase following release from mechanical occlusion of an artery, with restoration of intra-arterial pressure. The mechanism of this postocclusion increase in blood flow in the gut is multifactorial. Relaxation of intestinal resistance vessels, observed during RH, may involve myogenic, metabolic, hormonal and neurogenic factors. Evidence exists that histamine is an important endogenous mediator of various functions of the gut, including blood flow. The vascular effects of histamine in the intestinal circulation are due its agonistic action on histamine H1, H2 and H3 receptors. In the present study the hypothesis was tested that peripheral histamine H3 receptors are involved in the mediation of RH in the intestinal circulation. In anesthetized rats, anterior mesenteric artery blood flow (MBF) was determined with ultrasonic Doppler flowmeter, and arterial pressure (AP) was determined with a transducer. The increase in the volume of blood accumulating during RH (RH-volume), the peak increase of arterial blood flow (RH-peak response) and the duration of the hyperemia (RH-duration) were used to quantify RH after occluding the anterior mesenteric artery for 30, 60 and 120 s. Hyperemia parameters were determined before and after administration of the selective histamine H3 receptor antagonist clobenpropit. Pretreatment with clobenpropit was without any effect on control MBF and AP but significantly reduced most of RH responses. These findings support the hypothesis that histamine H3 receptors do not play any role in the control of intestinal vasculature at basal conditions but these receptors participate in the intestinal hyperemic reaction in response to complete temporal intestinal ischemia.     

A comparative study of reactive hyperemia in human forearm skin and muscle

Reactive hyperemia (RH) in forearm muscle or skin microcirculation has been considered as a surrogate endpoint in clinical studies of cardiovascular disease. We evaluated two potential confounders that might limit such use of RH, namely laterality of measurement and intake of non-steroidal anti-inflammatory drugs (NSAIDS). Twenty-three young non-smoking healthy adults were enrolled. In Experiment 1 (n=16), the RH elicited by 3 min of ischemia was recorded in the muscle (strain gauge plethysmography, hand excluded) and skin (laser Doppler imaging) of both forearms. In Experiment 2 (n=7), RH was determined in the dominant forearm only, one hour following oral acetylsalicylic acid (1 g) or placebo. In Experiment 1, peak RH was identical in both forearms, and so were the corresponding durations of responses. RH lasted significantly less in muscle than in skin (p=0.003), a hitherto unrecognized fact. In the skin, acetylsalicylate reduced duration (43 vs. 57.4 s for placebo, p=0.03), without affecting the peak response. In muscle, duration tended to decrease with acetylsalicylate (21.4 vs. 26.0 s with placebo, p=0.06) and the peak increase in blood flow was blunted (27.2 vs. 32.4 ml/min/100 ml tissue with placebo, p=0.003). We conclude that, when using RH as a surrogate endpoint in studies of cardiovascular disease, a confounding by laterality of measurement need not be feared, but NSAIDS may have an influence, although perhaps not on the peak response in the skin.     

Cyclooxygenase and nitric oxide synthase dependence of cutaneous reactive hyperemia in humans

We tested the hypothesis that cyclooxygenases (COXs) or COX products inhibit nitric oxide (NO) synthesis and thereby mask potential effects of NO on reactive hyperemia in the cutaneous circulation. We performed laser-Doppler flowmetry (LDF) with intradermal microdialysis in 12 healthy volunteers aged 19-25 yr. LDF was expressed as the percent cutaneous vascular conduction (%CVC) or as the maximum %CVC (%CVC(max)) where CVC is LDF/mean arterial pressure. We tested the effects of the nonisoform-specific NO synthase inhibitor nitro-L-arginine (NLA, 10 mM), the nonspecific COX inhibitor ketorolac (Keto, 10 mM), combined NLA + Keto, and NLA + sodium nitroprusside (SNP, 28 mM) on baseline and reactive hyperemia flow parameters. We also examined the effects of isoproterenol, a beta-adrenergic agonist that causes prostaglandin-independent vasodilation to correct for the increase in baseline flow caused by Keto. When delivered directly into the intradermal space, Keto greatly augments all aspects of the laser-Doppler flow response to reactive hyperemia: peak reactive hyperemic flow increased from 41 +/- 5 to 77 +/- 7%CVC(max), time to peak flow increased from 17 +/- 3 to 56 +/- 24 s, the area under the reactive hyperemic curve increased from 1,417 +/- 326 to 3,376 +/- 876%CVC(max).s, and the time constant for the decay of peak flow increased from 100 +/- 23 to 821 +/- 311 s. NLA greatly attenuates the Keto response despite exerting no effects on baseline LDF or on reactive hyperemia when given alone. Low-dose NLA + SNP duplicates the Keto response. Isoproterenol increased baseline and peak reactive flow. These results suggest that COX inhibition unmasks NO dependence of reactive hyperemia in human cutaneous circulation.