title: Role of calcium desensitization in the treatment of myocardial dysfunction after deep hypothermic circulatory arrest.
abstract: BACKGROUND
  Rewarming from deep hypothermic circulatory arrest (DHCA) produces calcium desensitization by troponin I (cTnI) phosphorylation which results in myocardial dysfunction. This study investigated the acute overall hemodynamic and metabolic effects of epinephrine and levosimendan, a calcium sensitizer, on myocardial function after rewarming from DHCA.
  
  
  METHODS
  Forty male Wistar rats (400 to 500 g) underwent cardiopulmonary bypass (CPB) through central cannulation and were cooled to a core temperature of 13°C to 15°C within 30 minutes. After DHCA (20 minutes) and CPB-assisted rewarming (60 minutes) rats were randomly assigned to 60 minute intravenous infusion with levosimendan (0.2 μg/kg/min; n = 15), epinephrine (0.1 μg/kg/min; n = 15) or saline (control; n = 10). Systolic and diastolic functions were evaluated at different preloads with a conductance catheter.
  
  
  RESULTS
  The slope of left ventricular end-systolic pressure volume relationship (Ees) and preload recruitable stroke work (PRSW) recovered significantly better with levosimendan compared to epinephrine (Ees: 85 ± 9% vs 51 ± 11%, P<0.003 and PRSW: 78 ± 5% vs 48 ± 8%, P<0.005; baseline: 100%). Levosimendan but not epinephrine reduced left ventricular stiffness shown by the end-diastolic pressure-volume relationship and improved ventricular relaxation (Tau). Levosimendan preserved ATP myocardial content as well as energy charge and reduced plasma lactate concentrations. In normothermia experiments epinephrine in contrast to Levosimendan increased cTnI phosphorylation 3.5-fold. After rewarming from DHCA, cTnI phosphorylation increased 4.5-fold in the saline and epinephrine group compared to normothermia but remained unchanged with levosimendan.
  
  
  CONCLUSIONS
  Levosimendan due to prevention of calcium desensitization by cTnI phosphorylation is more effective than epinephrine for treatment of myocardial dysfunction after rewarming from DHCA.
authors.forename: Alessio
authors.initials: A
authors.lastname: Rungatscher
authors.forename: Seth
authors.initials: S
authors.lastname: Hallström
authors.forename: Alice
authors.initials: A
authors.lastname: Giacomazzi
authors.forename: Daniele
authors.initials: D
authors.lastname: Linardi
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Milani
authors.forename: Maddalena
authors.initials: M
authors.lastname: Tessari
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Luciani
authors.forename: Tiziano M
authors.initials: TM
authors.lastname: Scarabelli
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mazzucco
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Faggian
mesh_terms: D000818:Animals; D015153:Blotting, Western; D002315:Cardiopulmonary Bypass; D050792:Circulatory Arrest, Deep Hypothermia Induced; D004837:Epinephrine / Q000494:pharmacology*; D006321:Heart / Q000187:drug effects*; D006439:Hemodynamics / Q000187:drug effects; D006835:Hydrazones / Q000494:pharmacology*; D007124:Immunoenzyme Techniques; D008297:Male; D010766:Phosphorylation; D011724:Pyridazines / Q000494:pharmacology*; D011897:Random Allocation; D051381:Rats; D017208:Rats, Wistar; D017694:Rewarming; D000077464:Simendan; D019210:Troponin I / Q000097:blood
chemical_list: D006835:Hydrazones; D011724:Pyridazines; D019210:Troponin I; D000077464:Simendan; D004837:Epinephrine