The Influence of Temperature on Metabolic and Cellular Protection of the Heart during Long-Term Ischemia: A Study Using P-31 Magnetic Resonance Spectroscopy and Biochemical Analyses

We have compared the influence of two different cold temperatures (below 10°C) for cardiac ischemia by measuring a large variety of hemodynamic and metabolic parameters during ischemia and reflow. Isolated isovolumic rat hearts were arrested with a preservation solution which was developed in our laboratory and then submitted to 5 h of cold storage (4°C, group I; and 7.5°C, group II) in the same solution. After an additional period of 50 min of ischemia at 15°C with intermittent cardioplegic infusion, hearts were reperfused for 60 min at 37°C. Function was assessed during the control period and reflow. High-energy phosphates and intracellular pH were followed by³¹P magnetic resonance spectroscopy. Analyses of metabolites and enzymes were performed by biochemical assays and HPLC in coronary effluents and in freeze-clamped hearts to assess cellular integrity. The energetic pool was better preserved at 4°C during ischemia (ATP at the end of 4°C ischemia, 59 ± 7% in group I vs 31 ± 5% in group II,P< 0.01) and reflow (P< 0.05) but membrane protection was higher when increasing the temperature to 7.5°C (reduction of creatine kinase leakage, 89 ± 16 IU/min in group I vs 51 ± 5 IU/min in group II,P< 0.05). As a result, functional recovery, represented by the rate pressure product, was higher in hearts preserved at 7.5°C (52 ± 6% recovery in group I vs 77 ± 7% in group II at the end of reflow,P< 0.05). Altogether, cold storage at 7.5°C provides a better protection than storage at 4°C.