title: The risk of myocardial stunning is decreased concentration-dependently by KATP channel activation with nicorandil before high K+ cardioplegia.
abstract: BACKGROUND
  Drug-induced opening of the adenosine triphosphate-sensitive potassium channel (KATP) during hypoxia and/or ischemia, achieved significant myocardial protection in several in vitro and in vivo models. Pretreatment with KATP openers simulated preconditioning and thus enhanced recovery from ischemia. We have demonstrated that the risk of hypoxia-induced myocardial stunning is reversed by KATP activation with 1 mmol/l nicorandil before cold cardioplegic arrest. Whether lower concentrations were effective is not known.
  
  
  METHODS
  In guinea pig papillary muscle preparations contracting isometrically (driven at 1600 ms cycle), nicorandil was superfused (15 min) either 1 mumol/l (n = 4), 30 mumol/l (n = 4), 100 mumol/l (n = 4), or 1 mmol/l (n = 8) in Tyrode's solution (oxygen content 16 ml/l, 37 degrees C, 5 ml/min). Controls were superfused with saline (Tyrode's solution: n = 8). A group containing vehicle (DMSO 1%, n = 8) was also studied. In four preparations the KATP channel blocker glibenclamide 1 mumol/l was given before nicorandil 1 mmol/l. Then, long-lasting (120 min) but moderately hypoxic (oxygen content 5 ml/l: 31% of Tyrode's solution) superfusion with hypothermic (20 degrees C) high K+ (16 mmol/l) cardioplegic solution (5 ml/min) was performed. Recovery of contractility was evaluated after further 60 min of reoxygenation with Tyrode's solution based on DT/TPT (developed tension divided by time to peak tension) as percent of prehypoxia basal values (%DT/TPT60). DT/TPT was also studied following 15 min of inotropic stimulation with dobutamine 10 mumol/l (%DT/TPT75). To assess the risk of stunning, we used a multivariate linear model by all possible subsets analysis (BMDP-9R) aimed at predicting both %DT/TPT60 and %DT/TPT75 (as continuous dependent variables).
  
  
  RESULTS
  During cardioplegia induction, time to arrest (TTA) was (mean +/- S.D.) 103 +/- 48s in control preparations which had poor recovery of contractility (stunning) after reoxygenation (%DT/TPT60: 71 +/- 20%; %DT/TPT75: 443 +/- 272%). Nicorandil (1 mumol/l-1 mmol/l) abbreviated TTA concentration-dependently (163 +/- 74, 149 +/- 103, 82 +/- 20, and 56 +/- 27s) and improved both %DT/TPT60 (63 +/- 9, 78 +/- 17, 87 +/- 13, and 98 +/- 11%) and %DT/TPT75 (587 +/- 333, 619 +/- 107, 971 +/- 301, and 666 +/- 400%). Glibenclamide reversed the effects of nicorandil 1 mmol/l (TTA: 165 +/- 30 s, P < 0.01; %DT/TPT60: 43 +/- 12, P < 0.01; %DT/TPT75: 272 +/- 147, P < 0.05). Multivariate prediction of myocardial stunning at both 60 and 75 min reoxygenation showed that nicorandil (30 mumol/l-1 mmol/l) was a significant (P < 0.001) protectant whereas glibenclamide was a significant risk factor (P = 0.009). It is unclear whether negative inotropic effects of nicorandil (%DT/TPT at the end of pretreatment) was mechanistically related to reduced risk of stunning since contribution was seen only to predict %DT/TPT75 (t = 3.24, P = 0.003) whereas a positive association was observed with %DT/TPT60 (t = 1.89, P = 0.068).
  
  
  CONCLUSIONS
  Pretreatment with nicorandil concentration-dependently enhanced the cardioprotective effect of hypothermic high K+ cardioplegia. The risk of myocardial stunning was decreased by KATP opening with nicorandil and increased by KATP block with glibenclamide. Inotropic stimulation with dobutamine might unravel the role of negative inotropic effect of KATP opening as a contributory factor to explain the efficacy of nicorandil in our model.
authors.affiliation: Department of Cardiac Surgery, University of Rome La Sapienza, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Sugimoto
authors.forename: K
authors.initials: K
authors.lastname: Iwashiro
authors.forename: F
authors.initials: F
authors.lastname: Monti
authors.forename: A A
authors.initials: AA
authors.lastname: Dawodu
authors.forename: M
authors.initials: M
authors.lastname: Schiariti
authors.forename: P E
authors.initials: PE
authors.lastname: Puddu
mesh_terms: D000255:Adenosine Triphosphate / Q000378:metabolism; D000818:Animals; D002314:Cardioplegic Solutions / Q000627:therapeutic use*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005905:Glyburide / Q000627:therapeutic use*; D006168:Guinea Pigs; D006324:Heart Arrest, Induced / Q000379:methods*; D007036:Hypothermia, Induced; D007552:Isotonic Solutions / Q000627:therapeutic use*; D008955:Models, Cardiovascular; D015999:Multivariate Analysis; D009200:Myocardial Contraction / Q000187:drug effects; D017682:Myocardial Stunning / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D020108:Nicorandil; D015221:Potassium Channels / Q000187:drug effects* / Q000378:metabolism; D011312:Pressure; D012307:Risk Factors; D013997:Time Factors; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D002314:Cardioplegic Solutions; D002316:Cardiotonic Agents; D007552:Isotonic Solutions; D015221:Potassium Channels; C037692:Tyrode's solution; D014665:Vasodilator Agents; D009536:Niacinamide; D020108:Nicorandil; D000255:Adenosine Triphosphate; D005905:Glyburide