RESUMEN
AIMS: We sought to establish whether an oxidised zirconium (OxZr) femoral component causes less loss of polyethylene volume than a cobalt alloy (CoCr) femoral component in total knee arthroplasty. MATERIALS AND METHODS: A total of 20 retrieved tibial inserts that had articulated with OxZr components were matched with 20 inserts from CoCr articulations for patient age, body mass index, length of implantation, and revision diagnosis. Changes in dimensions of the articular surfaces were compared with those of pristine inserts using laser scanning. The differences in volume between the retrieved and pristine surfaces of the two groups were calculated and compared. RESULTS: The loss of polyethylene volume was 122 mm3 (standard deviation (sd) 87) in the OxZr group and 170 mm3 (sd 96) in the CoCr group (p = 0.033). The volume loss in the OxZr group was also lower in the medial (72 mm3 (sd 67) versus 92 mm3 (sd 60); p = 0.096) and lateral (49 mm3 (sd 36) versus 79 mm3 (sd 61); p = 0.096) compartments separately, but these differences were not significant. CONCLUSION: Our results corroborate earlier findings from in vitro testing and visual retrieval analysis which suggest that polyethylene volume loss is lower with OxZr femoral components. Since both OxZr and CoCr are hard surfaces that would be expected to create comparable amounts of polyethylene creep, the differences in volume loss may reflect differences in the in vivo wear of these inserts. Cite this article: Bone Joint J 2017;99-B:793-8.
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Artroplastia de Reemplazo de Rodilla/instrumentación , Cobalto , Prótesis de la Rodilla , Circonio , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Rodilla/métodos , Aleaciones de Cromo , Femenino , Humanos , Imagenología Tridimensional/métodos , Rayos Láser , Masculino , Ensayo de Materiales/métodos , Persona de Mediana Edad , Polietileno , Diseño de Prótesis , Falla de Prótesis , Reoperación , Propiedades de SuperficieRESUMEN
BACKGROUND Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematodermic malignancy neoplasm with highly aggressive course and poor prognosis. This disease typically presents with cutaneous involvement as the first manifestation, with subsequent or simultaneous spread to bone marrow and peripheral blood. CASE REPORT Here, we report the case of a 51-year-old woman who presented a violaceus skin lesion on the lateral region of the right thigh, weight loss, fever, and lymphadenopathies. Computed tomography (CT) displayed thoracic and abdominal lymph node and alveolar bleeding. Flow cytometry from circulating blastic cells was compatible with BPDCN (CD4+, CD56+ and CD123+). She underwent 5 cycles of hyper-CVAD alternating with high-dose methotrexate and cytarabine, but the patient died due to alveolar bleeding and sepsis. CONCLUSIONS We report a rare case of BPDCN characterized by an aggressive course, presence of atypical skin lesion, a finding suggestive of pulmonary infiltration, and nonresponse to induction chemotherapy, leading to late diagnosis and therapeutic management. Because of the late recognition of the skin lesion, neoplastic cells infiltrated the dermis and spread as the disease progressed rapidly to a fatal course.
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Células Dendríticas/patología , Neoplasias Hematológicas/patología , Neoplasias Pulmonares/patología , Neoplasias Cutáneas/patología , Resultado Fatal , Femenino , Humanos , Ganglios Linfáticos/patología , Persona de Mediana EdadRESUMEN
A 9-year-old Thoroughbred gelding was presented for swelling over the left neck and inappetence. There was recent history of intramuscular administration of flunixin meglumine into the left neck. On examination, there was evidence of focal myositis, anaemia, haemolysis and pigmenturia. Culture of aspirated fluid from the left side of the neck produced a heavy growth of a Clostridium species. Complications of infection included haemolytic anaemia, hepatopathy, osteitis and transient hypertrophic cardiomyopathy. Treatment included intravenous fluid therapy, antibiotics, anti-inflammatory drugs, blood transfusion and surgical debridement. There was complete resolution of clinical, haematological, biochemical and echocardiographic abnormalities, and the horse returned to ridden work. This report highlights the complications that can arise from clostridial myonecrosis, including the effect on the myocardium.
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Infecciones por Clostridium/veterinaria , Enfermedades de los Caballos/etiología , Inyecciones Intramusculares/veterinaria , Anemia Hemolítica/etiología , Anemia Hemolítica/microbiología , Anemia Hemolítica/veterinaria , Animales , Cardiomiopatía Hipertrófica/etiología , Cardiomiopatía Hipertrófica/microbiología , Cardiomiopatía Hipertrófica/veterinaria , Infecciones por Clostridium/complicaciones , Enfermedades de los Caballos/microbiología , Caballos , Inyecciones Intramusculares/efectos adversos , Hepatopatías/etiología , Hepatopatías/microbiología , Hepatopatías/veterinaria , Masculino , Osteítis/etiología , Osteítis/microbiología , Osteítis/veterinariaRESUMEN
Rheumatic fever (RF) and its sequel, Rheumatic Heart Disease (RHD) is a disease of significant medical and public health concern in the Federated States of Micronesia. In this preliminary study the feasibility of a rheumatic heart disease primary prevention strategy was examined. Throat swabs were taken from 667 school-aged children and tested for group A streptococci (GAS) by a rapid antigen detection test (RADT): a subset was also tested by conventional culture, so as to compare the RADT with the reference (conventional culture) test. GAS was detected in 124% of the children tested by either rapid antigen test or conventional culture; for RADT alone the detection rate was 11.5% and for culture alone the detection rate was 9.4%. Detection rate of GAS was analyzed in symptomatic and asymptomatic subgroups. The subgroups were compared using Fisher's exact method. The identification of children with GAS allows for their further examination and treatment so that the prevalence of GAS in this vulnerable population, currently with an annual incidence of rheumatic fever of 50-134/100,000, may be reduced. The routine testing of school-aged children appears to be possible with current resources in Kosrae and can be a cost-effective public health measure.
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Fiebre Reumática/epidemiología , Fiebre Reumática/prevención & control , Adolescente , Niño , Preescolar , Humanos , Tamizaje Masivo , Micronesia/epidemiología , Proyectos Piloto , Prevención Primaria , Fiebre Reumática/diagnóstico , Streptococcus/aislamiento & purificaciónRESUMEN
The autonomic innervation of the canine heart develops with considerable regional asymmetry during the early neonatal period. To examine the development of the peptidergic component of the innervation, 28 mongrel puppies 1-6 weeks of age from five litters were studied at weekly intervals. Four of the mothers were also studied as adult and breed controls. Tissue neuropeptide Y (NPY) and vasoactive intestinal peptide (VIP) concentrations were determined by radioimmunoassay in myocardial specimens obtained from several specific sites of the cardiac chambers and from the proximal coronary arteries. Data were analysed according to age, cardiac chamber/vessel, gender and individual litter. In general, NPY concentrations in pg/mg protein were six- to eight-fold higher than those of VIP. Also concentrations for both peptides were about two-fold higher in the coronary arteries than the myocardium and differed among chambers, being higher and similar in the atria and lower in the ventricles, particularly for NPY. No gender differences were identified. Concentrations varied among litters, but the developmental pattern was similar with the highest peptide concentrations identified in the first and fourth week. Whereas the differences among chambers may also reflect differing rates of developmental increase of myocardial mass, the pattern corresponds only in part to previously identified functional changes in sympathetic innervation since, in contrast to previous findings, high NPY concentrations in the first 2 weeks suggest anatomically advanced innervation.
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Corazón/crecimiento & desarrollo , Corazón/inervación , Péptidos/fisiología , Factores de Edad , Animales , Perros , Electrofisiología , Atrios Cardíacos/metabolismo , Ventrículos Cardíacos/metabolismo , Neuropéptido Y/fisiología , Péptidos/metabolismo , Factores Sexuales , Distribución Tisular , Péptido Intestinal Vasoactivo/fisiologíaRESUMEN
Coronary venous hypertension induced by partial coronary sinus obstruction (CSO) in the dog, prevents or delays the predictable ventricular fibrillation (VF) of the early phase of acute ischemia. Also, CSO acting presumably through enhanced myocardial hydration, normalizes the inhomogenous extracellular potassium ([K+]o) accumulation, a major factor in producing the electrophysiological disparities, characteristic of arrhythmogenic substrate. To further clarify the mechanism of early ischemic VF prevention in dogs, radioactive microspheres were used to evaluate regional perfusion changes, resulting from CSO sufficient to raise the coronary sinus pressure to 40 mmHg, before and during ischemia induced by double coronary artery occlusion (CAO) (n=5). Also, global or regional unipolar electrogram mapping was used to assess changes of epicardial ventricular activation times (AT) and sequence and activation recovery intervals (ARI) during CSO, CAO and combined CSO and CAO, induced in random order (n=8). CSO did not affect regional perfusion nor improved collateral blood flow during ischemia. With CSO, AT shortened modestly over time (0.41+/-1.1 ms/min, r=0.85, P<0. 05) and ARI transiently decreased by up to 5.5%. With CAO, AT became variably delayed and isochrone map distortions were indicative of localized conduction delays or blocks, consistent with elevated [K+]o. In contrast, when CAO was preceded by CSO, AT delays were homogenous and normal activation sequence was preserved. Also, whereas with CAO, ARI shortened unequally over the ischemic region by as much as 43% at individual sites (average of 38.3+/-6.8 ms, P<0. 001), with combined CSO and CAO, ARI shortening was less pronounced and more homogenous (26.1+/-5.6 ms, P<0.05), not exceeding 29% at any site. Thus, in accordance with previous findings of enhanced [K+]o homogeneity, coronary venous hypertension reduces the disparities of activation and refractoriness of ischemia attributable, at least in part, to disparate [K+]o accumulation. Since no collateral blood flow improvement could be identified, the salutary electrophysiological effects of CSO may reflect a more homogenous extracellular environment, due to preservation of normal microvascular pressure (Pmv) and sustained filtration and lymph flow.
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Vasos Coronarios/fisiopatología , Hipertensión/fisiopatología , Isquemia Miocárdica/complicaciones , Isquemia Miocárdica/fisiopatología , Fibrilación Ventricular/prevención & control , Enfermedad Aguda , Animales , Agua Corporal/metabolismo , Constricción , Perros , Electrofisiología , Espacio Extracelular/metabolismo , Potasio/metabolismo , Fibrilación Ventricular/etiología , Fibrilación Ventricular/fisiopatologíaRESUMEN
Neuropeptide Y (NPY) exerts coronary vasomotor and inotropic effects on the canine heart. To test whether NPY also exerts regional myocardial electrophysiological effects, dose-response and time course changes resulting from intravenous and regional intracoronary infusions of NPY were obtained in 14 alpha-chloralose-anesthetized dogs. Under constant ventricular pacing, activation (A), recovery (R), and A-R interval (ARI) maps were constructed from multiplexed unipolar surface electrograms recorded simultaneously from 64 sites within a 1.6 x 1.6-cm left ventricular region. Effects were compared with those of vasoactive intestinal peptide (VIP) infusions and supramaximal left ansae subclaviae sympathetic nerve stimulation (SNS). The main finding was a uniform shortening of ARI, which reached a maximum of 8.7 +/- 1.2 ms, or 7% of control (P < 0.001), at about three times the baseline NPY plasma concentration (21.6 +/- 1.9 pg/ml). This effect decayed slowly (> 15 min) along with NPY plasma levels. The effect of similar VIP infusions and of SNS was 11%. Thus, compared with the previously identified maximal effect of adenylate cyclase activation (20%), exogenous NPY exerts a moderate but markedly sustained ventricular myocardial electrophysiological effect, which reaches maximum in relatively low plasma concentrations.
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Corazón/fisiología , Neuropéptido Y/farmacología , Animales , Perros , Estimulación Eléctrica , Electrofisiología/métodos , Corazón/efectos de los fármacos , Corazón/inervación , Frecuencia Cardíaca/efectos de los fármacos , Infusiones Intravenosas , Neuropéptido Y/administración & dosificación , Neuropéptido Y/sangre , Sistema Nervioso Simpático/fisiología , Factores de Tiempo , Péptido Intestinal Vasoactivo/administración & dosificación , Péptido Intestinal Vasoactivo/sangre , Péptido Intestinal Vasoactivo/farmacología , Función Ventricular Izquierda/efectos de los fármacosRESUMEN
The relationship between vagal-induced tachycardia (VT) and release of vasoactive intestinal peptide (VIP) and peptide HI (PHI) into cardiac lymph and coronary sinus blood was studied in 23 alpha-chloralose-anesthetized open-chest dogs that were autonomically decentralized and pretreated with atropine and propranolol. After simultaneous right and left cervical vagal stimulation at 5 V, 20 Hz for 3 min mean +/- SE, increase in heart rate was 38 +/- 6 beats/min, and increase in lymph VIP output from control was 0.308 +/- 0.093 pg/min (P = 0.004). The decrease in VIP arterial minus coronary sinus concentration was not significant. The increase in heart rate did not significantly correlate with increase in lymph VIP output (R2 = 0.141) or decrease in VIP arterial minus coronary sinus concentration (R2 = 0.059). The increases in heart rate and lymph VIP output were blocked by hexamethonium. Increase in lymph PHI output from control during VT (5 dogs) was 0.797 +/- 0.658 pg/min. Arterial-coronary sinus PHI concentration difference did not change in these dogs. These data indicate that VT is associated but not significantly correlated with VIP and PHI release into cardiac lymph. Cholinoceptive nicotinic receptors may mediate VIP release and VT in anesthetized dogs.
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Frecuencia Cardíaca/fisiología , Péptido PHI/metabolismo , Taquicardia/fisiopatología , Nervio Vago/fisiología , Péptido Intestinal Vasoactivo/metabolismo , Animales , Presión Sanguínea , Perros , Estimulación Eléctrica , Electrocardiografía , Sistema Linfático/fisiología , Sistema Linfático/fisiopatología , Péptido PHI/sangre , Péptido Intestinal Vasoactivo/sangreRESUMEN
Partial coronary sinus obstruction (CSO) in the dog prevents or delays the predictable ventricular fibrillation (VF) of the early phase of acute ischemia, by normalizing regional electrophysiological disparities which presumably reflect inhomogeneous extracellular potassium ([K+]o) accumulation. To clarify whether CSO indeed affects [K+]o inhomogeneity, we determined in 12 chloralose anesthetized dogs the dynamic [K+]o changes occurring early during reversible coronary artery occlusion (CAO) involving the mid-left anterior descending branch. These changes were compared to those observed during CAO preceded by CSO sufficient to increase the coronary sinus pressure to 40 mmHg. [K+]o was determined using valinomycin coated electrodes implanted within the ischemic (IZ) and the normal (NZ) zones, as well as immediately inside (BZi) and outside (BZo) the visible border. [K+]o increased rapidly within the IZ and the BZi reaching plateau 5 min after CAO, at about three-fold control (11.89 +/- 1.12 mEq/l). Unexpectedly, [K+]o also increased initially outside the border (BZo) but declined after 3 min to a lower level (7.00 +/- 0.40 mEq/l), thus creating a steep gradient of up to 5.54 +/- 0.20 mEq/l, P < 0.001) across the visible border. In four trials, the gradient coincided with VF. With CSO preceding CAO, the development of this border zone gradient was entirely prevented. Moreover, [K+]o reached a significantly lower and similar level in the IZ, BZi and BZo (9.5 +/- 0.89 mEq/l, P < 0.001) and no VF was observed. Thus the beneficial electrophysiologic and antiarrhythmic effects of CSO in acute ischemia may be explained by [K+]o equalization.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Agua Corporal/fisiología , Enfermedad Coronaria/metabolismo , Potasio/metabolismo , Fibrilación Ventricular/prevención & control , Potenciales de Acción , Animales , Transporte Biológico , Hipoxia de la Célula , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/patología , Perros , Espacio Extracelular/metabolismo , Hemodinámica , Fibrilación Ventricular/metabolismoRESUMEN
The effects of right cervical vagal and left sympathetic stimulation on release of immunoreactive vasoactive intestinal peptide (VIP) and neuropeptide Y (NPY) into cardiac venous and lymphatic effluent was tested in 11 anesthetized adult mongrel dogs. After stimulation of the right cervical vagus (1 ms, 20 Hz, 5 V) for 3 min, VIP output in lymphatic effluent was significantly increased at 1.90 +/- 0.56 pg/min compared with control of 0.90 +/- 0.42 pg/min. NPY output in lymphatic effluent and VIP and NPY release into coronary venous effluent, as measured by the arterial-coronary sinus concentration difference, were not changed. After stimulation of the ansae of the left sympathetic ganglion (1 ms, 10 Hz, 5 V) for 3 min, NPY output in lymphatic effluent was significantly increased at 4.72 +/- 1.58 pg/min compared with a control of 0.73 +/- 0.66 pg/min. VIP output in lymphatic effluent was not changed. VIP arterial-coronary sinus concentration difference decreased slightly but significantly, and NPY arterial-coronary sinus concentration difference decreased markedly after left sympathetic stimulation. In three additional dogs in which coronary sinus blood flow was measured, NPY overflow during left sympathetic stimulation increased from 28.2 +/- 23.5 to 129.6 +/- 212.7 pg/min. Thus VIP and NPY release from the canine heart can be evoked by right cervical vagal and left sympathetic stimulation, respectively. VIP and NPY may play a role as cardiac noncholinergic-nonadrenergic neurotransmitters.
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Miocardio/metabolismo , Neuropéptido Y/metabolismo , Péptido Intestinal Vasoactivo/metabolismo , Animales , Arterias , Vasos Coronarios , Perros , Estimulación Eléctrica , Hemodinámica , Linfa/metabolismo , Neuropéptido Y/sangre , Concentración Osmolar , Nervio Vago/fisiología , Péptido Intestinal Vasoactivo/sangreRESUMEN
The hypotheses that vasoactive intestinal peptide (VIP) is evenly distributed throughout atrial and ventricular myocardium and is present in postganglionic parasympathetic neurons in the regions of the sinoatrial and atrioventricular nodes were tested in three groups of dogs. Neuropeptide Y (NPY) tissue concentrations were determined in each group. In six sham dogs VIP and NPY concentrations were evenly distributed and were higher in atria compared with ventricles. In nine parasympathectomized dogs, VIP concentrations in sample sites from regions of the sinoatrial and atrioventricular nodes were comparable to those in sham-operated controls. In nine denervated dogs VIP concentrations were significantly decreased in three adjacent sample sites along the atrioventricular groove. In these dogs NPY concentrations were not detectable or were significantly decreased at all sample sites of both atria and ventricles. These data suggest that VIP neurons are evenly distributed in atrial and ventricular myocardium but do not originate in parasympathetic ganglia supplying the sinoatrial and atrioventricular nodes. The data also demonstrate the possible presence of extrinsic VIP neurons in the canine right ventricle and indicate that NPY may be a useful marker of myocardial adrenergic innervation.
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Miocardio/metabolismo , Neuropéptido Y/metabolismo , Sistema Nervioso Parasimpático/fisiología , Péptido Intestinal Vasoactivo/metabolismo , Animales , Desnervación , Perros , Femenino , Masculino , Concentración Osmolar , Distribución TisularRESUMEN
We examined whether partial coronary sinus obstruction affects the latency of the early ventricular fibrillation (VF) of acute ischemia. During baseline trials 15 of 19 open-chest dogs fibrillated repeatedly and predictably within 2 to 5 minutes (251.6 +/- 64 seconds) after reversible, double coronary artery occlusion without developing profound hemodynamic deterioration. The effect of partial coronary sinus obstruction sufficient to increase coronary sinus pressure to 40 mm Hg could be adequately tested in 11 dogs. Coronary sinus obstruction consistently prevented VF in five dogs, significantly prolonged the VF latency in three (p < 0.01 to p < 0.001), and had no clear effect in another three. The overall effect was significant at the p < 0.01 level. VF latency prolongation/prevention was also positively correlated to the residual coronary sinus pressure at the time of VF (r = 0.76; p < 0.008), as well as the baseline VF latency (r = 0.75; (p < 0.008). The protective effect of coronary venous hypertension most likely reflects preservation of adequate extracellular fluid in the ischemic region after the perfusion arrest. This extracellular fluid may constitute a key component in the prevention of early ischemic arrhythmias by preserving interstitial hydraulic continuity and tissue homogeneity through enhanced dilution and diffusion of solutes.
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Enfermedad Coronaria/complicaciones , Vasos Coronarios , Fibrilación Ventricular/etiología , Animales , Enfermedad Coronaria/fisiopatología , Perros , Corazón/fisiopatología , Frecuencia Cardíaca , Hemodinámica , Ligadura , Daño por Reperfusión Miocárdica , Presión , Tiempo de Reacción , Reproducibilidad de los ResultadosRESUMEN
In order to investigate the general cause of beta-adrenergic receptor neuroeffector abnormalities in the failing human heart, we measured ventricular myocardial adrenergic receptors, adrenergic neurotransmitters, and beta-adrenergic receptor-effector responses in nonfailing and failing hearts taken from nonfailing organ donors, subjects with endstage biventricular failure due to idiopathic dilated cardiomyopathy (IDC), and subjects with primary pulmonary hypertension (PPH) who exhibited isolated right ventricular failure. Relative to nonfailing PPH left ventricles, failing PPH right ventricles exhibited (a) markedly decreased beta 1-adrenergic receptor density, (b) marked depletion of tissue norepinephrine and neuropeptide Y, (c) decreased adenylate cyclase stimulation in response to the beta agonists isoproterenol and zinterol, and (d) decreased adenylate cyclase stimulation in response to Gpp(NH)p and forskolin. These abnormalities were directionally similar to, but generally more pronounced than, corresponding findings in failing IDC right ventricles, whereas values for these parameters in nonfailing left ventricles of PPH subjects were similar to values in the nonfailing left ventricles of organ donors. Additionally, relative to paired nonfailing PPH left ventricles and nonfailing right ventricles from organ donors, failing right ventricles from PPH subjects exhibited decreased adenylate cyclase stimulation by MnCl2. These data indicate that: (a) Adrenergic neuroeffector abnormalities present in the failing human heart are due to local mechanisms; systemic processes do not produce beta-adrenergic neuroeffector abnormalities. (b) Pressure-overloaded failing right ventricles of PPH subjects exhibit decreased activity of the catalytic subunit of adenylate cyclase, an abnormality not previously described in the failing human heart.
Asunto(s)
Insuficiencia Cardíaca/fisiopatología , Corazón/fisiopatología , Hipertensión Pulmonar/fisiopatología , Receptores Adrenérgicos beta/fisiología , Adenilil Ciclasas/análisis , Adulto , Cardiomiopatía Dilatada/fisiopatología , Catecolaminas/análisis , Femenino , Humanos , Yodocianopindolol , Isoproterenol/metabolismo , Masculino , Contracción Miocárdica , Neuropéptido Y/análisis , Pindolol/análogos & derivados , Pindolol/metabolismo , Receptores Adrenérgicos alfa/análisis , Receptores Adrenérgicos alfa/fisiología , Receptores Adrenérgicos beta/análisisRESUMEN
The effect of total cardiac denervation on the distribution of cardiac immunoreactive vasoactive intestinal peptide (IR-VIP) was determined in four groups of dogs. Denervated dogs killed at either 7 days (group 1) or 30 days (group 3) were compared with sham-operated dogs killed at either 7 days (group 2) or 30 days (group 4). The highest concentrations of IR-VIP were found in the left atrium and proximal left anterior descending and circumflex coronary arteries and were not affected by denervation. Concentrations of IR-VIP in the left ventricle were barely detectable. Only right ventricular IR-VIP concentrations were significantly lower in denervated compared with sham-operated dogs in both groups. Thus these data provide evidence of intrinsic VIP innervation of the atria and epicardial coronary arteries and localized extrinsic VIP innervation of the right ventricle of the canine heart.
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Sistema de Conducción Cardíaco/fisiología , Miocardio/metabolismo , Péptido Intestinal Vasoactivo/metabolismo , Animales , Desnervación , Perros , Femenino , Técnicas para Inmunoenzimas , Masculino , Concentración Osmolar , RadioinmunoensayoRESUMEN
The purpose of this study was to investigate the relationship between dopamine (DA) exposure and myocardial catecholamine and neuropeptide Y (NPY) concentrations in patients with severe congestive heart failure due to idiopathic dilated cardiomyopathy (IDC). Both nonfailing (NF) and failing (F) hearts were obtained in collaboration with the Utah Cardiac Transplantation Program and the Intermountain Organ Recovery System. The patients were stratified into five groups according to their preoperative exposure to dobutamine (DBT) and/or DA. Compared to 12 untreated, NF control hearts, norepinephrine (NE) concentrations were significantly decreased in 30 untreated F hearts obtained from patients with IDC. Norepinephrine concentrations were also significantly decreased in DA-treated NF hearts and in DA-treated F hearts compared to untreated NF and untreated or DBT-treated failing hearts, respectively. NPY concentrations were significantly decreased in untreated F hearts and were further decreased in dopamine-treated NF and DA-treated F hearts compared to untreated NF and untreated or DBT-treated F hearts. Thus, NE and NPY depletion related to DA administration was evident in both NF and F myocardium and was specific for DA in that it was not evident in patients who received the direct-acting beta-agonist inotrope DBT. These data suggest that the major inotropic mechanism of action of DA is through cardiac adrenergic neurotransmitter release. The data also provide further support for the concept that indirect acting inotropes such as DA may have limited inotropic potential in F hearts where neuronal NE has been depleted.
Asunto(s)
Cardiomiopatía Dilatada/metabolismo , Catecolaminas/metabolismo , Dopamina/farmacología , Insuficiencia Cardíaca/tratamiento farmacológico , Miocardio/metabolismo , Neuropéptido Y/metabolismo , Adulto , Dobutamina/farmacología , Electrocardiografía , Femenino , Corazón/efectos de los fármacos , Insuficiencia Cardíaca/metabolismo , Hemodinámica/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Receptores Adrenérgicos beta/análisisRESUMEN
BACKGROUND: Myocardial adrenergic neurotransmitters and beta-adrenergic receptor levels were measured in left and right ventricular myocardial specimens obtained from 30 patients with biventricular failure resulting from idiopathic dilated cardiomyopathy. METHODS AND RESULTS: Nonfailing myocardium obtained from 12 organ donors provided control data. Norepinephrine, dopamine, and neuropeptide Y concentrations were significantly decreased in failing compared with nonfailing control hearts. The mean ratio of dopamine to norepinephrine and of dopamine to neuropeptide Y in failing hearts was also significantly decreased compared with nonfailing control hearts. Compared with nonfailing control hearts, Bmax and beta 1-receptor density were significantly decreased in failing hearts and there were weak but significantly positive correlations of Bmax and beta 1-adrenergic receptors with norepinephrine, dopamine, and neuropeptide Y. CONCLUSIONS: Norepinephrine and its cotransmitter neuropeptide Y are depleted in failing human ventricular myocardium. Decreased norepinephrine stores correlate weakly with beta 1-adrenergic receptor downregulation consistent with the hypothesis that norepinephrine depletion occurs in response to increased adrenergic drive. Decreased dopamine relative to norepinephrine implies that an abnormality of dopamine conversion to norepinephrine is not present in failing human heart.
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Gasto Cardíaco Bajo/metabolismo , Dopamina/deficiencia , Regulación hacia Abajo , Miocardio/metabolismo , Neuropéptido Y/deficiencia , Norepinefrina/deficiencia , Receptores Adrenérgicos beta/metabolismo , Adulto , Gasto Cardíaco Bajo/fisiopatología , Dopamina/análisis , Femenino , Ventrículos Cardíacos , Hemodinámica , Humanos , Masculino , Neuropéptido Y/análisis , Norepinefrina/análisis , Receptores Adrenérgicos beta/análisisRESUMEN
BACKGROUND: We measured the content and activities of components of the beta-adrenergic receptor-G protein-adenylate cyclase complex and adrenergic neurotransmitter levels in left and right ventricular myocardial preparations derived from 77 end-stage failing human hearts from patients with idiopathic dilated cardiomyopathy (IDC) or ischemic dilated cardiomyopathy (ISCDC). METHODS AND RESULTS: The results were compared with data obtained in 21 nonfailing hearts removed from organ donors. Compared with ISCDC ventricles, IDC left and right ventricles exhibited a greater degree of total beta- or beta 1-receptor downregulation. In contrast, compared with IDC right ventricles, isolated tissue preparations of ISCDC right ventricles exhibited a greater degree of subsensitivity to the inotropic effect of isoproterenol, indicating a relatively greater degree of functional uncoupling of right ventricular ISCDC beta-receptors from mechanical response. In addition, relative to IDC left ventricles, preparations of ISCDC left ventricle exhibited greater subsensitivity to beta-agonist-mediated adenylate cyclase stimulation, indicating functional uncoupling of left ventricular ISCDC beta-receptors from cyclic AMP generation. The uncoupling of beta-receptors in ISCDC left and right ventricles may have been a result of abnormalities in G protein activation of adenylate cyclase; compared with age- and cardiac function-matched respective left or right IDC ventricles, ISCDC left ventricles exhibited less stimulation of adenylate cyclase by NaF or forskolin but no change in Mn2+ stimulation, whereas ISCDC right ventricles exhibited less stimulation by the nonhydrolyzable guanine nucleotide Gpp (NH)p. Also, IDC right ventricles exhibited a "selective" (not present in IDC left ventricles or ISCDC ventricles) decrease in stimulation of adenylate cyclase by Mn2+. Tissue neurotransmitter levels and pertussis toxin-catalyzed ADP ribosylation were altered to similar extents in IDC and ISCDC: CONCLUSIONS: These data indicate that potentially important differences exist in the regulatory behavior of components of the beta-adrenergic receptor-G protein-adenylate cyclase complex in IDC versus ISCDC, differences that presumably relate to the distinct pathophysiologies of these two types of heart muscle disease.
Asunto(s)
Cardiomiopatía Dilatada/fisiopatología , Corazón/inervación , Receptores Adrenérgicos beta/fisiología , Adenilil Ciclasas/metabolismo , Adulto , Catecolaminas/metabolismo , Creatina Quinasa/metabolismo , Regulación hacia Abajo/fisiología , Femenino , Proteínas de Unión al GTP/metabolismo , Humanos , Radioisótopos de Yodo , Yodocianopindolol , Masculino , Persona de Mediana Edad , Neuropéptido Y/metabolismo , Pindolol/análogos & derivadosRESUMEN
To test the general hypothesis that cardiac innervation may participate in myocardial G protein regulation, we examined the effects of complete intrapericardial surgical denervation or sham operation in dogs. In particulate fractions of dog left ventricular (LV) myocardium harvested 28-33 days after denervation or sham operation, Mr 40,000 and Mr 39,000 pertussis toxin-sensitive substrates (G proteins) were increased by 31% (1.31 +/- 0.084 vs 1.00 +/- 0.058 OD, arbitrary units, p less than 0.01) and 40% (1.40 +/- 0.117 vs. 1.000 +/- 0.084 OD, arbitrary units, p less than 0.02), respectively, as compared with sham-operated controls. The Mr 40,000 pertussis toxin-sensitive band comigrated with a pertussis toxin-sensitive substrate in human erythrocyte membranes known to contain an alpha Gi species. In these same preparations basal, GTP and GppNHp stimulated adenylate cyclase activities were decreased in denervated heart by 20, 26, and 19%, respectively, consistent with increased activity of an inhibitory G protein. In contrast, Gs function was not altered, because cyc(-) membranes reconstituted with membrane extracts and fluoride and beta-receptor-stimulated adenylate cyclase activity were not different between groups. Furthermore, adenylate cyclase catalytic subunit function as assessed with forskolin and manganese stimulation was not different between preparations of control and denervated heart. We conclude that in preparations of surgically denervated dog myocardium Mr 40,000 and Mr 39,000 pertussis toxin-sensitive G proteins are increased by 31 and 40%, respectively, and that functional alterations in adenylate cyclase activity exist, consistent with increased inhibitory G-protein function.
Asunto(s)
Toxina de Adenilato Ciclasa , Corazón/inervación , Miocardio/metabolismo , Toxina del Pertussis , Factores de Virulencia de Bordetella/metabolismo , 5'-Nucleotidasa/metabolismo , Adenosina Difosfato Ribosa/metabolismo , Adenilil Ciclasas/metabolismo , Animales , Catecolaminas/metabolismo , Colforsina/farmacología , Perros , Femenino , Fluoruros/farmacología , Proteínas de Unión al GTP/metabolismo , Guanosina Trifosfato/farmacología , Guanilil Imidodifosfato/farmacología , Corazón/fisiología , Técnicas In Vitro , Masculino , Manganeso/farmacología , Membranas/metabolismo , Desnervación Muscular , Miocardio/enzimología , Radioisótopos de Fósforo , Receptores Adrenérgicos beta/metabolismoRESUMEN
Vasoactive intestinal peptide (VIP) is a potent inotrope and coronary vasodilator. To test whether VIP also exerts regional myocardial electrophysiological (EP) effects, dose-response and time-course effects of intracoronary injections (10(-10)-10(-4) M) were obtained in 4 intact hearts and 12 in situ normoperfused right ventricular flap preparations in chloralose-anesthetized dogs. Under constant rate, activation (A), recovery (R), and A-R interval (ARI) maps were constructed from multiplexed unipolar surface electrograms recorded simultaneously from 32 sites. Effects were compared with those of isoproterenol (Iso) and forskolin (For). The main finding with all agonists was the uniform shortening of ARIs in a dose-response fashion with a maximum of 30 +/- 4 ms or 20% from control. Although the maximal EP changes were similar for all agonists, they occurred at different molecular concentrations (10(-6) Iso, 10(-5) VIP, and 10(-4) For). Also, whereas the duration of EP effect did not exceed 5 min for Iso and For, it was markedly sustained for VIP, outlasting its contractile but paralleling its vasodilatory effect. The physiological endoepicardial differences in ARI and the recovery sequence were preserved for all agonists. Thus VIP, in addition to coronary vasodilation and myocardial inotropy, exerts a strong balanced global myocardial EP effect, similar to, but more sustained than, the adrenergic effect. The difference in duration of inotropic and EP effects may point to different mediating mechanisms.
Asunto(s)
Corazón/efectos de los fármacos , Péptido Intestinal Vasoactivo/farmacología , Animales , Perros , Electrofisiología , Corazón/fisiología , Sistema de Conducción Cardíaco/fisiología , Técnicas In Vitro , Factores de TiempoRESUMEN
We investigated vasoactive intestinal peptide (VIP)-receptor pharmacology in failing and nonfailing human ventricular myocardium by examining [125I]VIP binding in membrane fractions of left ventricle and inotropic effects of VIP in isolated right ventricular trabeculae mounted in tissue baths. [125I]VIP binding demonstrated upwardly concave, curvilinear Scatchard plots consistent with two classes of binding sites. Only the high-affinity (dissociation constant [Kd] 400-800 pM) site could be regulated by guanine nucleotides. Compared with nonfailing heart, membranes derived from failing heart exhibited a twofold reduction in the Kd of the high-affinity VIP binding site, whereas the receptor density (Bmax) was decreased by 62%. In concordance with this decreased receptor density and increased affinity, the maximal contractile response of right ventricular trabeculae from failing right ventricles was decreased by 61%, and the dose-response curve to VIP was left-shifted approximately threefold. We conclude that the VIP receptor in failing human ventricular myocardium exhibits novel regulatory behavior consisting of increased receptor affinity and decreased receptor density.