title: Regional heterogeneity of decreased myocardial norepinephrine and increased lipid peroxidation levels in patients with end-stage failing heart secondary to dilated or ischemic cardiomyopathy.
abstract: BACKGROUND
  Regional alterations in norepinephrine (NE) and lipid peroxidation in the myocardium of patients with heart failure is not well known. This study was designed to investigate regional myocardial NE levels and lipid peroxidation index and their relationships with the functional parameters in two pathologic conditions: dilated cardiomyopathy (DCM) and ischemic cardiomyopathy (ICM).
  
  
  METHODS
  Biopsied heart samples were obtained from 13 DCM and 10 ICM patients (orthotopic cardiac transplantation). Tissue NE was assayed by high-pressure liquid chromatography with electrochemical detection. Tissue lipid peroxidation (malondialdehyde, MDA) was evaluated by the thiobarbituric acid (TBA) reaction.
  
  
  RESULTS
  Non-failing hearts (controls, n = 4) were included in this study for comparison. Left ventricular dysfunction was present at rest with a mean left ventricular ejection fraction (LVEF) of 19.1 +/- 2.6% for DCM patients and 17.4 +/- 2.0% for ICM patients. The amount of NE in control hearts was significantly lower (p < 0.05) than in DCM or ICM hearts. For all patients, there were several differences in distribution of NE among the sub-divisions of the atria and ventricles studied. NE content was significantly higher in the right atria than in the left atria or ventricles. A significant correlation between LVEF and NE concentrations was observed in the left septum of ICM and DCM patients and in the left ventricle of the ICM group. In DCM and ICM patients, some parts of the left ventricle showed higher levels of lipid peroxides compared with controls. MDA levels in patients with DCM varied little from one region to another, whereas in ICM patients there was considerable variation.
  
  
  CONCLUSIONS
  This study is the first demonstration of a correlation between the values of pre-operative LVEF and cardiac NE concentrations in specific parts of the myocardium. This effect could not be generalized to the entire heart. The pattern of myocardial MDA distribution did not follow that of the NE distribution.
authors.affiliation: Facultés de Médecine et de Pharmacie, Laboratoire de Physiologie et Pharmacologie Cardiovasculaires Expérimentales, Centre Hospitalier Universitaire, Dijon, France. luc.rochette@u-bourgogne.fr
authors.forename: Luc
authors.initials: L
authors.lastname: Rochette
authors.forename: Etienne
authors.initials: E
authors.lastname: Tatou
authors.forename: Catherine
authors.initials: C
authors.lastname: Vergely
authors.forename: Véronique
authors.initials: V
authors.lastname: Maupoil
authors.forename: Olivier
authors.initials: O
authors.lastname: Bouchot
authors.forename: Claude
authors.initials: C
authors.lastname: Mossiat
authors.forename: Sahed
authors.initials: S
authors.lastname: Jazayeri
authors.forename: Salima
authors.initials: S
authors.lastname: Benkhadra
authors.forename: Roger
authors.initials: R
authors.lastname: Brenot
authors.forename: Claude
authors.initials: C
authors.lastname: Girard
authors.forename: Michel
authors.initials: M
authors.lastname: David
mesh_terms: D001706:Biopsy; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000378:metabolism* / Q000473:pathology; D005260:Female; D006333:Heart Failure / Q000378:metabolism* / Q000473:pathology; D006801:Humans; D015227:Lipid Peroxidation; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000378:metabolism* / Q000473:pathology; D009206:Myocardium / Q000737:chemistry*; D009638:Norepinephrine / Q000032:analysis*; D012720:Severity of Illness Index
chemical_list: D009638:Norepinephrine