Effect of alkali therapy with NaHCO3 or THAM on cardiac contractility.
We examined the impact of alkali therapy on myocardial contractility in a model of myocardial ischemia in dogs using direct measurements of myocardial contractile function. Myocardial ischemia in the left anterior descending (LAD) artery territory was induced using a perfusion circuit from the internal carotid artery to the LAD artery. Myocardial contractile function was assessed using sonomicrometry for measurement of percent systolic shortening (%SS), preload recruitable stroke work (PRSW) slope, and end-systolic pressure-length relationship (ESPLR) area. Because the blood flow in LAD artery was diminished by approximately 70%, there was a significant decrease in O2 delivery and uptake by the ischemic myocardium. Ischemia led to a significant fall in LAD regional contractile function with %SS decreasing from 15 +/- 2 to 7 +/- 2%, PRSW slope from 82 +/- 10 to 37 +/- 5 mmHg, and ESPLR area from 121 +/- 2 to 48 +/- 14 mmHg.mm (P < 0.05). In six dogs, the intracoronary administration of NaHCO(3) resulted in a significant increase in pH in LAD arterial and venous blood. There was, however, no significant increase in %SS (6 +/- 2), PRSW slope (43 +/- 10 mmHg), or ESPLR area (60 +/- 13 mmHg.mm). Since administration of NaHCO(3) resulted in a significant increase in PCO2 in LAD arterial and venous blood, similar experiments were carried out in five dogs, but with the intracoronary infusion of the amine buffer THAM [tris(hydroxymethyl)aminomethane (Tris) buffer; 2-amino-2-hydroxyl-1,3-propandiol] instead of NaHCO3. Although administration of THAM resulted in a significant increase in pH and a significant decrease in PCO2, in both LAD arterial and venous blood, there was no significant improvement in any of the parameters used to assess myocardial contractile function. In conclusion, administration of alkali (NaHCO3 or THAM) does not enhance the contractile function of the ischemic myocardium.
Mazer
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CD
Department of Anaesthesia, St. Michael's Hospital, University of Toronto, Ontario, Canada.
Naser
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B
Kamel
K S
KS
D000468:Alkalies / Q000627:therapeutic use; D000818:Animals; D003326:Coronary Circulation / Q000187:drug effects; D003331:Coronary Vessels / Q000503:physiopathology; D004285:Dogs; D006439:Hemodynamics / Q000187:drug effects; D006863:Hydrogen-Ion Concentration; D009200:Myocardial Contraction / Q000187:drug effects*; D017202:Myocardial Ischemia / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology*; D010101:Oxygen Consumption / Q000187:drug effects; D017693:Sodium Bicarbonate / Q000627:therapeutic use*; D014325:Tromethamine / Q000627:therapeutic use*
D000468:Alkalies; D014325:Tromethamine; D017693:Sodium Bicarbonate