Background
—Na
+
/H
+
exchange inhibition with HOE642 (cariporide) improves postischemic recovery of cardiac function, but the mechanisms of action remain speculative. Because Na
+
/H
+
exchange is activated on reperfusion, it was hypothesized that its inhibition delays realkalinization and decreases intracellular Na
+
and, via Na
+
/Ca
2+
exchange, Ca
2+
overload. Attenuated Ca
2+
overload and prolonged acidosis are known to be cardioprotective.
Methods and Results
—Left ventricular developed and end-diastolic pressures were measured in isolated buffer-perfused rat hearts subjected to 30 minutes of no-flow ischemia and 30 minutes of reperfusion (37°C) with or without 1 μmol/L HOE642 added to the perfusate 15 minutes before ischemia. Intracellular Ca
2+
concentration ([Ca
2+
]
i
) and pH
i
were measured with aequorin (n=10 per group) and
31
P NMR spectroscopy (n=6 per group), respectively. HOE642 did not affect preischemic mechanical function, [Ca
2+
]
i
, or pH
i
. Mechanical recovery after 30 minutes of reperfusion was substantially improved with HOE642: left ventricular developed pressure (in percent of preischemic values) was 92±3 versus 49±7 and left ventricular end-diastolic pressure was 16±3 versus 46±5 mm Hg (
P
<0.05 for HOE642-treated versus untreated hearts). End-ischemic [Ca
2+
]
i
was significantly lower in HOE642-treated than in untreated hearts (1.04±0.06 versus 1.84±0.02 μmol/L,
P
<0.05). Maximal intracellular Ca
2+
overload during the first 60 seconds of reperfusion was attenuated with HOE642 compared with untreated hearts: 2.0±0.3 versus 3.2±0.3 μmol/L (
P
<0.05). pH
i
was not different at end ischemia (≈5.9±0.05). Realkalinization was similar in the first 90 seconds of reperfusion and significantly delayed in the next 3 minutes (eg, 6.8±0.07 in HOE642-treated hearts compared with 7.2±0.07 in untreated hearts;
P
<0.05).
Conclusions
—HOE642 improves postischemic recovery by reducing Ca
2+
overload during ischemia and early reperfusion and by prolonging postischemic acidosis.