title: Catecholamine stimulation is associated with impaired myocardial O(2) utilization in heart failure.
abstract: OBJECTIVE
  To investigate the effect of alpha,beta(1) and beta(2) adrenergic receptor (AR) stimulation on coronary hemodynamics, myocardial oxygen consumption (M(v)O(2)) and metabolic substrate preference in advanced dilated cardiomyopathy (DCM).
  
  
  METHODS
  We studied 19 conscious, instrumented dogs with pacing-induced DCM. We evaluated systemic, coronary hemodynamics and M(v)O(2) in response to norepinephrine (NOR, 0.05-0.4 microg/kg per min), dobutamine (DOB, 1-10 microg/kg per min), phenylephrine (PHE, 1-5 microg/kg per min) and isoproterenol (ISO, 0.05-0.4 microg/kg per min) alone or in the presence of metoprolol (ISO+MET). Experiments were conducted in control state and in advanced DCM, 4-5 weeks after the initiation of pacing.
  
  
  RESULTS
  Contractile responses (LV dP/dt) to catecholamines were desensitized and accompanied by a parallel decrease in heart rate-adjusted myocardial O(2) consumption (M(v)O(2/beat)), when alpha(PHE) or beta(1) (DOB) or both alpha/beta(1) (NOR) AR were stimulated in DCM. This was due to impaired transmyocardial (Ao-Cs) O(2) extraction rather than limitations in CBF responses. There was an associated shift in myocardial metabolism, evidenced by an increased preference for glycolytic substrates (Respiratory Quotient) following administration of any of these three adrenergic agonists in DCM. Combined beta(1)/beta(2) stimulation with ISO or beta(2)-AR stimulation (ISO+MET) in DCM resulted in greater M(v)O(2/beat), [(Ao-Cs) O(2)] extraction, and decreases in myocardial RQ consistent with a shift toward oxidation of FFA.
  
  
  CONCLUSIONS
  The impairment in contractile responses to dobutamine and norepinephrine in DCM is associated with impaired myocardial O(2) extraction, and a shift toward a preference for glycolysis. A different myocardial metabolic pattern suggestive of increased oxidation of FFA with increased myocardial O(2) extraction was observed in the presence of combined beta(1)/beta(2) stimulation with isoproterenol or beta(2) stimulation (ISO+MET). These data suggest that beta(2)-AR stimulation in DCM shifts substrate preference toward FFA oxidation associated with greater M(v)O(2) requirements. These findings identify a putative metabolic effect of beta(2) -AR in DCM that may be deleterious.
authors.affiliation: Department of Medicine, Allegheny General Hospital, MCP-Hahneman University School of Medicine, 320 E. North Avenue, Pittsburgh, PA 15212, USA.
authors.forename: Lazaros A
authors.initials: LA
authors.lastname: Nikolaidis
authors.forename: Teresa
authors.initials: T
authors.lastname: Hentosz
authors.forename: Aaron
authors.initials: A
authors.lastname: Doverspike
authors.forename: Rhonda
authors.initials: R
authors.lastname: Huerbin
authors.forename: Carol
authors.initials: C
authors.lastname: Stolarski
authors.forename: You-Tang
authors.initials: YT
authors.lastname: Shen
authors.forename: Richard P
authors.initials: RP
authors.lastname: Shannon
mesh_terms: D000316:Adrenergic alpha-Agonists / Q000494:pharmacology; D000318:Adrenergic beta-Agonists / Q000494:pharmacology; D000319:Adrenergic beta-Antagonists / Q000494:pharmacology*; D000704:Analysis of Variance; D000818:Animals; D002311:Cardiomyopathy, Dilated / Q000378:metabolism*; D002395:Catecholamines / Q000494:pharmacology*; D004280:Dobutamine / Q000494:pharmacology; D004285:Dogs; D005260:Female; D007545:Isoproterenol / Q000494:pharmacology; D008297:Male; D008790:Metoprolol / Q000494:pharmacology*; D023421:Models, Animal; D009200:Myocardial Contraction / Q000187:drug effects; D009206:Myocardium / Q000378:metabolism*; D009638:Norepinephrine / Q000494:pharmacology; D010101:Oxygen Consumption; D010656:Phenylephrine / Q000494:pharmacology; D013268:Stimulation, Chemical
chemical_list: D000316:Adrenergic alpha-Agonists; D000318:Adrenergic beta-Agonists; D000319:Adrenergic beta-Antagonists; D002395:Catecholamines; D010656:Phenylephrine; D004280:Dobutamine; D008790:Metoprolol; D007545:Isoproterenol; D009638:Norepinephrine