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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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ORIGINAL ARTICLES CARDIAC PAPERS
The Journal of Cardiovascular Surgery 2000 Dicembre;41(6):807-17
Importance of heart rate for acute hibernation in isolated blood-perfused piglet hearts
Sommerschild H. T. *, Grund F. *, Offstad J. *°, Ilebekk A. *, Kirkebøen K. A. **
From the *Institute for Experimental University of Oslo, °Department of Cardiology, Rikshospitalet Medical Department B
**Department of Anaesthesia, Ullevål Hospital Oslo, Norway
Background. Hibernating myocardium may benefit from revascularization. There are several experimental models for acute hibernation. In intact hearts low-flow ischemia causes time-dependent metabolic alterations, termed “metabolic adaptation”. In isolated heart preparations metabolic responses to low-flow ischemia vary, and signs of metabolic adaptation are not consistently found. In isolated hearts global ischemia may cause bradycardia unless the hearts are paced. We hypothesized that the lack of consistent metabolic adaptation to low-flow ischemia in isolated hearts might be due to bradycardia during ischemia. In this study we investigated the influence of heart rate on metabolism and function in an isolated heart preparation.
Methods. Isolated blood-perfused piglet hearts were subjected to 120 min 10% flow. In groups A (n=9) and B (n=4) hearts were not paced during ischemia, in groups C (n=5) and D (n=5) hearts were paced at pre-ischemic heart rate during ischemia.
Results. Without pacing, heart rate declined to ≈1/3 during ischemia and anaerobic metabolism showed a slight decline over time. With pacing, production of protons, pCO2 and lactate showed a bell-shaped curve which peaked at 20-25 min of ischemia, followed by a subsequent decline towards the end of ischemia (overall p<0.001 for all). However, reperfusion revealed impaired recovery of function in paced hearts compared to non-paced hearts (53±7% vs 77±4%, p<0.05) concomitant with higher release of creatine kinase (455±93 IU/100 g vs 106±13 IU/100 g, p<0.01).
Conclusions. When heart rate is allowed to decline during low-flow ischemia in isolated piglet hearts, signs of metabolic adaptation are not evident. When hearts are paced during ischemia time-dependent alterations in anaerobic metabolism occur, resembling observations seen in intact beating hearts. However, paced hearts also show indications of increased cellular injury, indicating that in paced hearts the metabolic consequences are mostly due to increased irreversible cell injury. Thus, the model for acute hibernation with 10% flow in isolated blood-perfused piglet hearts are critically dependent on bradycardia during ischemia.