Myocardial Resistance to Metabolic Acidosis

Smith, N.

doi:10.1001/archsurg.1966.01320240080017

Cited by 28 publications

(4 citation statements)

References 16 publications

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“…38 However, other studies failed to show a link between acidosis and impaired cardiac function 39 and that debate was solved with the discovery that the direct effect of acute acidosis on the myocardium could be masked by the effect of catecholamines. 40, 41 This might be indeed the rationale behind our previous found link between serum bicarbonate and heart failure events, but negative association with systolic or diastolic dysfunction. Neurohumoral activation of sympathetic and renin-angiotensin-aldosterone systems induced by chronic acidosis potentially leads to endothelial dysfunction, increase in peripheral venous and arterial resistance, with subsequent increase in preload and afterload, progressive retention of salt and water and edema.…”

Section: Discussionmentioning

confidence: 65%

Serum Bicarbonate and Structural and Functional Cardiac Abnormalities in Chronic Kidney Disease - A Report from the Chronic Renal Insufficiency Cohort Study

et al. 2016

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Background: Heart failure (HF) is a frequent occurrence in chronic kidney disease (CKD) patients and predicts poor survival. Serum bicarbonate is associated with increased rates of HF in CKD; however, the mechanisms leading to this association are incompletely understood. This study aims to assess whether serum bicarbonate is independently associated with structural and functional cardiac abnormalities in CKD. Methods: The association between serum bicarbonate and left ventricular (LV) hypertrophy (LVH), LV mass indexed to height^2.7, LV geometry, ejection fraction (EF) and diastolic dysfunction was assessed in 3,483 participants without NYHA class III/IV HF, enrolled in the Chronic Renal Insufficiency Cohort study. Results: The mean estimated glomerular filtration rate was 42.5 ± 17 ml/min/1.73 m². The overall prevalence of LVH was 51.2%, with 57.8, 50.9 and 47.7% for bicarbonate categories <22, 22-26 and >26 mmol/l, respectively. Participants with low bicarbonate were more likely to have LVH and abnormal LV geometry (OR 1.32; 95% CI 1.07-1.64, and OR 1.57; 95% CI 1.14-2.16, respectively). However, the association was not statistically significant after adjustment for demographics, traditional cardiovascular risk factors, medications and kidney function (OR 1.07; 95% CI 0.66-1.72, and OR 1.27; 95% CI 0.64-2.51, respectively). No association was found between bicarbonate and systolic or diastolic dysfunction. During follow-up, no significant changes in LV mass or EF were observed in any bicarbonate strata. Conclusions: In a large CKD study, serum bicarbonate was associated with LV mass and concentric LVH; however, this association was attenuated after adjustment for clinical factors suggesting that the observed cardiac effects are mediated through yet unknown mechanisms.

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Section: Discussionmentioning

confidence: 65%

Serum Bicarbonate and Structural and Functional Cardiac Abnormalities in Chronic Kidney Disease - A Report from the Chronic Renal Insufficiency Cohort Study

et al. 2016

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“…The release of intramyocardial noradrenaline stores, as has been suggested by Smith and Corbascio (1966) during metabolic acidosis.…”

Section: Discussionmentioning

confidence: 78%

Intrinsic myocardial recovery from the negative inotropic effects of acute hypercapnia

Foëx¹,

Fordham²

1972

Cardiovascular Research

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“…The fall in cardiac output in acidosis was mainly due to a fall in heart rate, with no change in stroke volume. However, the lack of compensatory rise of stroke volume suggests a negative inotropic action of acidosis (see also Smith & Corbascio, 1966;Wildenthal, Mierzwiak, Myers & Mitchell, 1968) in addition to the chronotropic effect.…”

Section: Discussionmentioning

confidence: 99%

“…In the anaesthetized dog, cardiac output and heart rate fell with metabolic acidosis but the changes of blood pressure were variable (Smith & Corbascio, 1966; Kittle, Aoki & Brown, 1965).…”

Section: Discussionmentioning

confidence: 99%

The Haemodynamic Effects of Metabolic Acidosis in the Rat

1976

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1. The effect of metabolic acidosis of 4-6 h duration on cardiac output, blood pressure, heart rate, and hepatic and renal blood flow has been studied in the rat. 2. In anaesthetized rats, blood pressure and heart rate fell linearly with blood pH in both sham-operated and nephrectomized rats. There was no significant difference between the two groups in the effect of acidosis on either variable. 3. Cardiac output showed a significant fall with increasing acidosis in the conscious rat. 4. Estimated hepatic blood flow in conscious rats showed a significant positive correlation with blood pH in both sham-operated and nephrectomized animals. There was no significant difference in estimated hepatic blood flow between the two groups of animals at any blood pH. 5. In conscious rats, increasing acidosis caused a progressive decrease in estimated renal blood flow. 6. It is concluded that the increase in the previously described apparent renal contribution to lactate removal in the acidotic rat cannot be explained by any circulatory effect mediated by the kidney. The possible relevance of the findings to lactate homeostasis is discussed.

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Myocardial Resistance to Metabolic Acidosis

Cited by 28 publications

References 16 publications

Serum Bicarbonate and Structural and Functional Cardiac Abnormalities in Chronic Kidney Disease - A Report from the Chronic Renal Insufficiency Cohort Study

Serum Bicarbonate and Structural and Functional Cardiac Abnormalities in Chronic Kidney Disease - A Report from the Chronic Renal Insufficiency Cohort Study

Intrinsic myocardial recovery from the negative inotropic effects of acute hypercapnia

The Haemodynamic Effects of Metabolic Acidosis in the Rat

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