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(Circulation. 2001;104:I-197.)
© 2001 American Heart Association, Inc.

Thoracic Transplantation and Ventricular Assist Devices

Evidence of Functional Myocardial Ischemia Associated With Myocardial Dysfunction in Brain-Dead Pigs

Carole Seguin; Yvan Devaux; Sandrine Grosjean, MD; El Medhy Siaghy, PhD; Pierre Mairose; Faiez Zannad, MD, PhD; Nicole de Talancé, MD, PhD; Dan Ungureanu-Longrois, MD, PhD;; Paul Michel Mertes, MD, PhD

Laboratoire de Chirurgie Expérimentale (C.S., Y.D., E.M.S., F.Z., D.U.-L., P.M.M.), Faculté de Médecine de Nancy, Université Henri Poincaré, Nancy I, France; Laboratoire de Biologie Cellulaire (P.M., N.d.T.), Centre Hospitalier et Universitaire de Brabois, Vandoeuvre les Nancy, France; Département d’Anesthésie-Réanimation Chirurgicale (S.G., D.U.-L.), Centre Hospitalier et Universitaire de Brabois, Vandoeuvre les Nancy, France; and Laboratoire de Physiologie (P.M.M.), Faculté de Médecine, Université de Reims Champagne Ardennes, Reims, France.

Correspondence to Paul Michel Mertes, Laboratoire d’ Explorations Fonctionnelles Respiratoires et Allergologiques, Hopital Maison Blanche, CHU de Reims, 45 rue Cognacq-Jay, 51092 Reims, France. E-mail pmmertes{at}chu-reims.fr

Background— Cardiac dysfunction after brain death has been documented, but its mechanisms remain unclear. Myocardial ischemia has been suggested as a possible cause. The aim of the present study was to investigate the existence of an imbalance between myocardial oxygen delivery and demand as a possible cause of myocardial dysfunction in brain-dead pigs.

Methods and Results— Interstitial myocardial lactate and adenosine concentrations were assessed with cardiac microdialysis in 2 groups of animals: brain-dead pigs (n=7) and brain-dead pigs treated with labetalol (10±3 mg/kg) (n=7). Heart rate (HR), left ventricular (LV) dP/dt_max, rate-pressure product (RPP), cardiac output (CO), and left anterior descending coronary artery blood flow (QLAD) were continuously monitored. Brain-dead pigs exhibited a transient significant increase in HR, LV dP/dt_max, RPP, and CO and a limited increase in QLAD. This resulted in functional myocardial ischemia attested to by the significantly increased adenosine and lactate microdialysate concentrations. In brain-dead pigs treated with labetalol, there was a moderate increase in HR, QLAD, and adenosine microdialysate concentrations; LV dP/dt_max, RPP, CO, and myocardial lactate concentrations remained stable, confirming the preservation of aerobic metabolism.

Conclusions— Brain death was associated with an increase in myocardial interstitial adenosine and lactate concentrations, as well as with myocardial dysfunction; all were attenuated by labetalol, suggesting an imbalance between oxygen consumption and oxygen delivery as a possible cause of myocardial dysfunction after brain death.

Key Words: adenosine • ischemia • nervous system, sympathetic • transplantation