Document Detail


Increase in myocardial interstitial adenosine and net lactate production in brain-dead pigs: an in vivo microdialysis study.
MedLine Citation:
PMID:  9846509     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Brain death-related cardiovascular dysfunction has been documented; however, its mechanisms remain poorly understood. We investigated changes in myocardial function and metabolism in brain-dead and control pigs. METHODS: Heart rate, systolic (SAP) and mean (MAP) arterial pressure, left ventricular (LV) dP/dtmax, rate-pressure product, cardiac output (CO), left anterior descending coronary artery blood flow, lactate metabolism, and interstitial myocardial purine metabolite concentrations, monitored by cardiac microdialysis, were studied. A volume expansion protocol was performed at the end of the study. RESULTS: After brain death, a transient increase in heart rate (from 90 [67-120] to 158 [120-200] beats/min) (median, with range in brackets), MAP (82 [74-103] to 117 [85-142] mmHg), LV dP/dtmax (1750 [1100-2100] to 5150 [4000-62,000] mmHg x sec(-1), rate-pressure product (9100 [7700-9700] beats mmHg/min to 22,750 [20,000-26,000] beats mmHg/min), CO (2.2 [2.0-4.0] to 3.3 [3.0-6.0] L/min), and a limited increase in left anterior descending coronary artery blood flow (40 [30-60] to 72 [50-85] ml/min) were observed. Net myocardial lactate production occurred (27 [4-40] to -22 [-28, -11] mg/L, P<0.05) and persisted for 2 hr. A 6-7-fold increase in adenosine dialysate concentration was observed after brain death induction (2.9 [1.0-5.8] to 15.8 [7.0-50.7] micromol/L), followed by a slow decline. Volume expansion significantly increased MAP, CO, and LV dP/dtmax in control animals, but decreased LV dP/dtmax and slightly increased CO in brain-dead animals. A significant increase in adenosine concentration was observed in both groups, with higher levels (P<0.05) in brain-dead animals. CONCLUSIONS: Brain death increased oxygen demand in the presence of a limited increase in coronary blood flow, resulting in net myocardial lactate production and increased interstitial adenosine concentration consistent with an imbalance between myocardial oxygen demand and supply. This may have contributed to the early impairment of cardiac function in brain-dead animals revealed by rapid volume infusion.
Authors:
P Halejcio-Delophont; E M Siaghy; Y Devaux; D Ungureanu-Longrois; J P Richoux; B Beck; C Burlet; J P Villemot; P M Mertes
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Transplantation     Volume:  66     ISSN:  0041-1337     ISO Abbreviation:  Transplantation     Publication Date:  1998 Nov 
Date Detail:
Created Date:  1998-12-29     Completed Date:  1998-12-29     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0132144     Medline TA:  Transplantation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1278-84     Citation Subset:  IM    
Affiliation:
Laboratoire de Chirurgie Experimentale, UPRES 971068, Faculté de Médecine de Nancy, Université Henri Poincaré, France.
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MeSH Terms
Descriptor/Qualifier:
Adenosine / metabolism*
Animals
Blood Gas Analysis
Brain Death / metabolism*,  physiopathology
Hemodynamics
Lactic Acid / blood,  metabolism*
Microdialysis
Myocardium / metabolism*
Swine
Time Factors
Chemical
Reg. No./Substance:
50-21-5/Lactic Acid; 58-61-7/Adenosine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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