Controlled reperfusion after myocardial ischemia in a canine model monitored by two-dimensional phosphorus 31 chemical shift spectroscopic imaging

Long-term magnetic resonance imaging/spectroscopy study of cariporide in a canine cardiac ischemia/reperfusion model

Using both 31P and 1H cardiac magnetic resonance techniques, it is possible to monitor the functional (ejection fraction [EF]) and biochemical (pH) status of the heart following a reperfused ischemic insult. This study assessed the effects of Na+/H+ exchange inhibition with cariporide in a closed-chest canine ischemia/reperfusion model. Dogs received 1-mg/kg cariporide treatments for 3 days after occlusion, but were monitored for 10 days. Baseline intracellular pH (+/-SEM) for the control and treated groups were 7.10 +/- 0.03 and 7.14 +/- 0.04, respectively, and dropped to 6.25 +/- 0.08 and 6.38 +/- 0.08 during occlusion. There was a significant increase in pH from occlusion to early reperfusion in the control group (P = 0.03) but, during the same time period, this increase was not seen in the cariporide group. There was a significant (P = 0.01) drug interaction in recovery of EF over the 10-day protocol. Individual time-point analysis revealed significant differences at immediate reperfusion through day 3 (73.9% +/- 2.5%, 84.5% +/- 3.1%; baseline normalized EF controls and cariporide, respectively). Neither pH nor EF measurements were significantly different between the groups at day 10. Despite early functional and metabolic benefits, infarct size, as measured at day 10, was 13.2% +/- 2.2% for the controls and 11.8% +/- 2.3% for the cariporide group (NS). Thus there were no long-term cariporide functional or biochemical benefits.

MRI/MRS evaluation of cariporide in a canine long-term model of reperfused ischemic insults. Magnetic resonance imaging/magnetic resonance spectroscopy

PURPOSE

To examine with magnetic resonance imaging (MRI)/magnetic resonance spectroscopy (MRS) the long-term effects of cariporide in a canine cardiac ischemia/reperfusion model.

MATERIALS AND METHODS

Twenty-two beagles underwent a 2-hour occlusion followed by 10 days of reperfusion. Cine MRI and (31)P MRS were performed to monitor function and metabolism of the heart in the control (N = 10) and cariporide (N = 12) groups. Radioactively labeled microspheres were injected to determine coronary blood flow, and contrast-enhanced ex vivo MRI assessed infarct volumes.

RESULTS

Cariporide produced a significant reduction vs. controls, in intracellular pH, during ischemia (P < 0.05) and at days 3 and 10 postreperfusion (P < 0.0005). Functional recovery of the myocardium was significantly improved immediately upon reperfusion (percent of baseline: 63.5% +/- 3.5% for controls, 90.5% +/- 7.2% for cariporide) and at day 3, but not by day 10. Normalized infarct ratios (IRs) were similar for controls and cariporide (0.58 +/- 0.08, 0.58 +/- 0.06, respectively).

CONCLUSION

Cariporide augments early functional recovery, while delaying normalization of intracellular pH following ischemia/reperfusion, but confers neither long-term functional or metabolic protection nor, most importantly, myocardial salvage.

Similar long-term cardiovascular effects of propofol or isoflurane anesthesia during ischemia/ reperfusion in dogs

PURPOSE

To compare the long-term functional and metabolic effects of propofol or isoflurane general anesthesia in a canine model of ischemia/reperfusion.

METHODS

Using magnetic resonance (MR) techniques, we monitored both regional metabolism ((31)P MR spectroscopy) and systolic function of the heart ((1)H MR imaging) throughout a two-hour occlusion of the left anterior descending coronary artery and ten days of reperfusion. Twenty-two beagles were randomized into isoflurane and propofol general anesthesia groups (n = 10, n = 12 respectively). Contrast-enhanced MR imaging was used to measure infarct size (% of left ventricle that was necrotic) and coronary blood flow was determined using radioactively labelled microspheres.

RESULTS

Cardiac metabolism, as monitored by intracellular pH and high-energy phosphate ratios, was not significantly different between the two groups throughout the protocol. Relative to propofol, isoflurane reduced the depression of left ventricular ejection fraction (EF) during the ischemic period [isoflurane 68.5% +/- 4.2%, propofol 58.3% +/- 2.0% of baseline (B); P = 0.04], propofol increased the recovery of EF at day three (isoflurane 63.9% +/- 4.3%, propofol 74.0% +/- 2.5% of B; P = 0.05). By day ten, EF in both groups was similar. Infarct sizes were also similar at day ten (isoflurane 15.7% +/- 3.0%, propofol 13.2% +/- 2.2%). Normalizing these by the region at risk (volume of tissue with low blood flow during the occlusion) to assess infarct ratios was also not significant (isoflurane 0.58% +/- 0.08%, propofol 0.54% +/- 0.07%).

CONCLUSIONS

There were no significant differences between the two anesthetic groups at day ten, suggesting that any apparent dissimilarities in early cardiovascular effects were short-term only. These results indicate that isoflurane and propofol produce equivalent long-term cardiovascular effects following ischemia/reperfusion.