The energy metabolism of the heart in failure and the influence of drugs upon it

Peters, H. C.; Visscher, Maurice B.

doi:10.1016/s0002-8703(36)90413-1

Cited by 70 publications

(10 citation statements)

References 33 publications

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“…As mentioned earlier, digitalis glycosides increased MT;o2 in experiments in which ventricular end-diastolic volume was held constant (22)(23)(24). Furthermore, the findings in two of our experiments, in which the level of LVEDP and left ventricular end-diastolic volume before the administration of acetylstrophanthidin were purposely elevated, also support the view that the fall in myocardial tension occurring in the failing heart may mask the increase in MVo2 produced by digitalis.…”

Section: Fig 1 Effects Of Acetylstrophanthidin (Acs)mentioning

confidence: 67%

Studies on digitalis. XVI. Effects on myocardial oxygen consumption.

Covell¹,

Braunwald²,

Ross³

et al. 1966

J. Clin. Invest.

160

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The effects of cardiac glycosides on myocardial oxygen consumption (MVo2) have been investigated extensively, and although the results of these studies have not been entirely uniform, it is now generally considered that these agents are "the only drugs which increase the force of contraction of the myocardium without at the same time increasing oxygen consumption" (1). The finding in previous investigations that digitalis does not increase MVo2 (2-8) would not appear to be compatible with observations that the glycosides increase the velocity of myocardial fiber shortening (9, 10), since recent studies have suggested that the latter variable is an important determinant of MVo2 (11,12). These considerations prompted an examination of the effect of acetylstrophanthidin on MVo2 in a preparation that allowed control of hemodynamic variables other than contraction velocity that can significantly influence MVo2. MethodsExperiments were performed on eight dogs weighing 15.5 to 17.2 kg and anesthetized with morphine, 2.8 mg per kg; chloralose, 96 mg per kg; and urethane, 620 mg per kg. The chest was entered through a sternal splitting incision, and ventilation was maintained with a Harvard respiratory pump, using 100%o 02. Heparin (500 U per kg) was administered. The venae cavae were then cannulated, and the venous return was diverted into a reservoir, from which bypass of the right side of the heart was achieved with an occlusive roller pump, as described in detail previously (12). The pump supplied blood to the pulmonary artery through a cannula inserted via the right ventricular outflow tract; the right ventricle was therefore empty and performing no external work. Fresh blood obtained from donor dogs and exchanged with that of the experimental animal was used to prime the reservoir and circuit. Mean systemic arterial pressure was regulated by a reservoir connected to a com-* Submitted for publication April 25, 1966; accepted June 16, 1966. tAddress requests for reprints to Dr. Eugene Braunwald, Cardiology Branch, National Heart Institute, Bethesda, Md. 20014. pressed air circuit and attached by large bore cannulae to the femoral arteries. The sino-atrial node was crushed, and heart rate was maintained constant by electrical stimulation 1 of the right atrium or ventricle.Stroke volume could therefore be controlled by maintaining the output of the pump constant.A flow transducer was placed around the ascending aorta, and instantaneous aortic blood flow was measured with a gated-sine wave electromagnetic flowmeter.2 Left ventricular pressure was measured with a Statham P23Db pressure transducer attached directly to a largebore metal cannula that was inserted through the the ventricular apex. Central aortic pressure was measured through a similar cannula inserted into the aortic arch through the left subclavian artery. The first derivative (dp/dt) of the left ventricular pressure pulse was determined with an analogue differentiating circuit 3 In two hearts the effects of acetylstrophanthidin were studied at high...

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Section: Fig 1 Effects Of Acetylstrophanthidin (Acs)mentioning

confidence: 67%

Studies on digitalis. XVI. Effects on myocardial oxygen consumption.

Covell¹,

Braunwald²,

Ross³

et al. 1966

J. Clin. Invest.

160

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“…Evans (37) reported that while digitalis increased cardiac output and efficiency, the oxygen consumption of the heart diminished. Peters and Visscher (9) found that digitalis increases both oxygen consumption and efficiency of the perfused heart. However, the increase in efficiency on a percentile basis was four to five times as great as the increase in myocardial oxygen consumption (9).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the cardiac glycosides also influence the ionic gradient between the muscle cell and the surrounding medium (2)(3)(4)(5)(6)(7)(8). Its effect on oxygen consumption and foodstuff utilization of the heart has been repeatedly investigated in the heart-lung preparation, in tissue slices and in tissue homogenates (9). The reader is here referred to the review article of Wollenberger (10).…”

mentioning

confidence: 99%

Studies on Myocardial Metabolism. V. The Effects of Lanatoside-C on the Metabolism of the Human Heart 1

Blain¹,

Eddleman²,

Siegel³

et al. 1956

J. Clin. Invest.

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“…The experiments of Peters and Visscher, 15 recently confirmed by Lorber,- 11 have made it clear that in experiments with "failing" hearts cardiac output and external work fall, while cardiac oxygen consumption, inflow pressure and diastolie volume can remain stable. Decreased ventricular distensibility per se would suffice to explain the low mechanical efficiency characteristic of experi- Mean ± S.E.…”

Section: Circulation Research Volume Viji July 19c0mentioning

confidence: 92%

Distensibility and Water Content of Heart Muscle Before and After Injury

Salisbury¹,

Cross²,

Rieben³

1960

Circulation Research

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HEN we studied physiologic changes associated with overdistention of the left ventricle, the heart muscle appeared stiffer at the end of an experiment than at the beginning. We therefore arranged the procedure reported here in which the left ventricle was distended in a controlled manner at the beginning of the experimental period and at varying times thereafter while subjected to different hemodynamic conditions between observations. The data show that excessive stretch and other injury caused the left ventricle to become less distensible; injury also increased the water content of the myocardium.Methods Details of the experimental method and procedure have been described elsewhere.1 Briefly, the systemic circulation was supported by a heart-lung machine; both atria were drained into the venous reservoir of the machine so that the left ventricle was virtually bloodless. The left ventricular pressure was registered through a semirigid polyethylene tube with the tip in the left ventricular cavity (Statham strain gage P23G) and was recorded at paper speeds of 1 mm./sec. and 50 mm./sec. About 90 minutes elapsed between the anesthesia of an animal and the first experimental observation.A balloon was inserted into the left ventricle through a purse-string controlled stab wound at the apex. The balloon communicated with a 3-way stopcock and a syringe, so that known volumes of air could be injected into it. Before each standard observation of distensibility, the balloon was emptied and the systemic arterial flow (heart-lung machine) was set at a constant, known value. The syringe was then filled with a known volume of air at atmospheric pressure, which was rapidly inFrom the Intensive Treatment Center and the Department

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The energy metabolism of the heart in failure and the influence of drugs upon it

Cited by 70 publications

References 33 publications

Studies on digitalis. XVI. Effects on myocardial oxygen consumption.

Studies on digitalis. XVI. Effects on myocardial oxygen consumption.

Studies on Myocardial Metabolism. V. The Effects of Lanatoside-C on the Metabolism of the Human Heart 1

Distensibility and Water Content of Heart Muscle Before and After Injury

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