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Objective: The aim of this research was to investigate if dielectric spectroscopy between 100 Hz and 1 MHz provides reliable information about water distribution in ischaemic heart tissue and to investigate the influence of temperature on oedema formation., Methods: We examined hearts of landrace piglets (n = 13) during ischaemia at 35 °C, 25 °C, and 15 °C. The dielectric permittivity ε'(f) and conductivity σ'(f) were calculated from impedance spectra measured between 100Hz and 1MHz. Gap junction uncoupling (GJU) was identified in the sigmoidal time course of ε'(13 kHz). The extracellular space index (ECSI) was estimated by the ratio σ'(100 Hz)/σ'(1 MHz). Intercalated water was analysed in electron microscopy images of the myocardial samples and was used to calculate the extracellular space index ECSI histo . The ECSI and ECSI histo were compared during ischaemia. GJU and oedema formation were simulated with an electrical heart model., Results: At the onset of ischaemia, the ECSI was significantly higher than the ECSI histo (p < .01). GJU during ischaemia was temperature-dependent. After GJU, the values of the ECSI and ECSI histo matched very well. The simulations confirmed the influence of GJU on the ECSI., Significance: The estimation of cell oedema with the ECSI is reliable only after GJU. The development of oedema estimated by the ECSI was delayed at cooler temperatures., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Only few data are available concerning the biochemical and functional state of the beta-adrenergic system in hypertrophied human myocardium. The present study was to investigate the myocardial beta-adrenergic signal transduction system in hypertrophic obstructive cardiomyopathy (HOCM). Thin myocardial strips were prepared from surgically excised, septal myocardium from 7 patients with HOCM and their force of contraction was measured in vitro. The positive inotropic effects of calcium and dihydro-ouabain, both acting independently of beta-adrenoceptors and cAMP, were similar in these preparations to those, previously published, seen with nonfailing myocardium. In contrast, the beta-adrenoceptor agonist isoprenaline and the phosphodiesterase inhibitor 3-isobutyl-1-methylxanthine (IBMX) had reduced positive inotropic effects. Their EC50-values were about 10 fold higher than the respective EC50-values published for nonfailing myocardium. The positive inotropic potencies of isoprenaline and IBMX were reduced in HOCM by as much as they were in the additionally investigated myocardium from 6 patients with severe mitral regurgitation (MR, NYHA III). In order to clarify whether the functional alterations are related to changes in the beta-adrenoceptors, beta-adrenoceptor density and beta 1: beta 2-adrenoceptor subtype distribution were determined in the same myocardium using 125I-Iodocyanopindolol saturation binding. Myocardial beta-adrenoceptor density was reduced to 68% in HOCM and to 56% in MR compared to nonfailing myocardium controls (NF: 64.8 +/- 6.5 fmol/mg protein). In HOCM, this reduction was due to a selective down regulation of beta 1-adrenoceptors (24.9 +/- 3.7 fmol/mg protein vs NF: 46.4 +/- 6.8 fmol/mg protein, P < 0.05), whereas beta 2-adrenoceptor density was unchanged (19.0 +/- 1.9 fmol/mg protein vs NF: 18.4 +/- 3.3 fmol/mg protein, n.s.). In MR both beta-adrenoceptor subtypes were reduced (beta 1: 26.9 +/- 1.4 fmol/mg protein, beta 2: 9.6 +/- 1.7 fmol/mg protein; both P < 0.05 vs NF). Electrochemically determined plasma catecholamine levels were elevated in MR. However, plasma catecholamine levels were normal or slightly below normal in HOCM. In summary, myocardial beta-adrenoceptors are downregulated and their function is impaired in HOCM. This desensitization is not caused by a negative feedback regulation due to increased plasma catecholamines. The present results show that the desensitizations of the beta-adrenergic system associated with HOCM has characteristics that indicate a major deviation in its development from that of the beta-adrenergic desensitization previously described to occur in congestive heart failure.

Clinically applied methods of cardioplegia show very different effects on the rapidity of decay of energy-rich phosphates as well as on kind and progression of ultrastructural alterations of the ischemic myocardium. Comparing the methods of cardioplegia according to Kirklin, St. Thomas's Hospital and Bretschneider (solution HTK) with pure ischemia at 25 degrees C (model A) and Kirklin's or St. Thomas's cardioplegia and subsequent 210 min or HTK cardioplegia and 300 min ischemia at 22 degrees C plus 20 min subsequent reperfusion (model B) leads to the following results: Model A: Compared with pure ischemia cardioplegia according to Kirklin and the St. Thomas's Hospital slows down the decay of the left ventricular ATP-concentration by a mean factor of 3 and the progression of structural alterations of the left ventricular subendocardium by a factor of 2. HTK retards the ATP-decay by a factor of 6, the alterations of ultrastructure by a factor of 6.5. St. Thomas's solution, in contrast to all other methods of cardioplegia, at the onset of ischemia already causes a cellular edema of myocytes; the edema increases during ischemia, and at the ATP-concentration of 4 mumol per gram myocardium is more pronounced than with pure ischemia, Kirklin or HTK. After application of Kirklin's solution, in contrast, a cellular edema of capillary endothelia develops during ischemia, which at 4 mumol ATP is more pronounced than with each of the other methods. Model B: After global ischemia until the ATP-concentration of left ventricular myocardium is 4 mumol/g and a subsequent 20 minutes post-ischemic recovery the ultrastructural alterations in principle resemble those occurring during ischemia (model A).(ABSTRACT TRUNCATED AT 250 WORDS)

The influence of pre-ischemic treatment with propranolol (0.8 mg/kg bw) or with verapamil (0.1 mg/kg bw) on myocardial O2 consumption and on coronary resistance after cardioplegic arrest (300 minutes at 22 degrees - 24 degrees C) was investigated, using a Langendorff technique in open chest experiments (canine hearts). For myocardial protection histidine buffered Bretschneider solution was used, while for standardization all hearts were postischemically reperfused with a modified Tyrode solution at 35 degrees C. Both drugs were given intravenously in two fractions, 60 and 30 minutes before the onset of cardioplegic perfusion; a third group was not pretreated. Although the verapamil group had the lowest O2 consumption post-ischemically, the most impressive results were found in coronary resistance. Propranolol significantly diminished coronary resistance (p less than 0.05), while verapamil distinctly enhanced it compared to the non treated group. The "membrane labilizing" effect of verapamil combined with calcium-free cardioplegic solution was confirmed by a massive postischemic myocardial sodium uptake.

The functional behaviour of membrane systems of the cardiac cell during oxygen deficiency was analyzed and the alterations were related to the metabolic state of the tissue as an index of injury. 1. The retention function of the cell membrane for proteins. With increasing energy deficiency the cardiac sarcolemma loses its ability to retain macromolecules (myoglobin, enzymes) within the cell. Close correlations exist between protein release and oxygen supply as well as ATP content of the tissue. 2. Function of isolated mitochondria after ischemia. In parallel with a strong impairment of oxidative phosphorylation (decrease of QO2, RCI values, phosphorylation rates) the Ca++-transporting activity of mitochondria is continuously depressed with decreasing myocardial ATP. 3. Function of isolated sarcoplasmic reticulum after ischemia. With breakdown of high energy phosphates during ischemia rate and extent of Ca++ binding with decrease markedly.

In canine hearts the myocardial equilibration processes (temperature, pO2, pCO2, Na+, K+) and the myocardial energy turnover were analyzed at the beginning of a cardioplegically induced cardiac arrest during a coronary perfusion of 10 minutes. The investigated hearts (n = 10) were perfused with the Bretschneider histidine-buffered cardioplegic solution according to the recommendations worked out for clinical use. The results show that during the cardioplegic coronary perfusion of 10 minutes the cooling and temperature equilibration of the myocardium occur considerably faster than the establishment of a new energy steady-state at a very low level. The minimalization of the coronary resistance and of the myocardial O2 consumption are only reached after an extended perfusion period of 7 to 9 minutes. In consequence of the results, the following recommendations can be given for the clinical use of the Bretschneider cardioplegic solution: a) the solution should be used at a temperature of between 5 degrees and 10 degrees C, b) the cardioplegic coronary flow should be between 60 and 80 ml/min . 100 gww, c) the human heart should be perfused for 8 to 10 minutes and, d) the perfusion pressure should be maintained at 40 to 50 mmHg after cardiac arrest has set in. So far the action of equilibration procedures when using the Bretschneider cardioplegic method has not been compared with that of other cardioplegic methods.

The influence of different cardioplegic methods (Bretschneider, Cardiac Surgery in Hamburg, Kirklin, St. Thomas' Hospital in London) on the progressive myocardial acidosis during global ischemia of up to 24 hours' duration was investigated in arrested, nonperfused canine hearts (n = 36). The increasing acidosis of the ischemic heart muscle was continuously measured and registered with the aid of interstitial pH measurement (pHi) using glass implant electrodes. With various buffered and unbuffered cardioplegic solutions there were relatively wide fluctuations of the pHi courses in the myocardial extracellular space. The "critical" interstitial pH values ("pHcrit") relative to a defined myocardial ATP concentration (4 mumol/g ww) vary between 6.10 (Bretschneider) and 5.6 (Kirklin) (p less than 0.001). These striking results cannot be attributed solely to different total myocardial lactate concentrations, but variations in a "cellular" and an "extracellular factor" must also be taken into account. Measurement of interstitial pH for intraoperative monitoring of myocardial ischemic stress can therefore be used only within limits and with knowledge of the specific protective procedure applied. The method continues an important tool in basic investigations of partial or global ischemia of organs, particularly as regards the spectrum of metabolic, morphological and functional parameters.

Human adult hearts with aortic valve disease (n = 20) and hypertrophic obstructive cardiomyopathy (n = 1) were perfused intraoperatively with cold histidine buffered Bretschneider solution. During a seven minute cardioplegic perfusion the temperature level, the electrolyte level, the resistance of the left (LCA) and right coronary artery (RCA), and myocardial O2 consumption were analysed. Equilibration of K+ was terminated shortly after the start of the perfusion while Na+ equilibration lasted for about 5 minutes. Resistance of RCA did not change significantly, but that of the LCA was diminished significantly (p less than 0.025) within the perfusion period indicating a delayed washout of calcium from the extracellular space. Myocardial O2 consumption was reduced from 2.71 ml/min (1. minute) to 1.51 ml/min (4. minute) to 0.93 ml/min (7. minute) although the temperature had reached a low level after 3 minutes. The difference between 4. to 7. minutes is significant (p less than 0.001). By our results it is concluded that in adult hearts high-volume cardioplegic perfusion at a flow rate of 1 ml/min X gm at a perfusion pressure of 40 to 50 mmHg should be performed for at least 6 to 7 minutes to achieve a sufficient intra-ischemic myocardial protection.