Myocardial stretch-induced compliance is abrogated under ischemic conditions and restored by cGMP/PKG-related pathways

Data de publicação: 02/10/2023 Data Ahead of Print: 02/10/2023

Autores da FMUP

• Andre Filipe Mendes Leite Moreira

  Autor

• João Sérgio De Lima Soares Neves

  Autor

• Ricardo Luís Castro E Silva Ferreira

  Autor

• Ricardo José Araújo Ladeiras Lopes

  Autor

• Joaquim Adelino Correia Ferreira Leite Moreira

  Autor

• André Pedro Leite Martins Lourenço

  Autor

Participantes de fora da FMUP

• Almeida Coelho, J

Unidades de investigação

• Cirurgia e Fisiologia

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

• RISE-Health

  

  Investigador

  Fernando Carlos De Landér Schmitt

Abstract

Introduction: Management of acute myocardial infarction (MI) mandates careful optimization of volemia, which can be challenging due to the inherent risk of congestion. Increased myocardial compliance in response to stretching, known as stretch-induced compliance (SIC), has been recently characterized and partly ascribed to cGMP/cGMP-dependent protein kinase (PKG)-related pathways. We hypothesized that SIC would be impaired in MI but restored by activation of PKG, thereby enabling a better response to volume loading in MI.Methods: We conducted experiments in ex vivo rabbit right ventricular papillary muscles under ischemic and non-ischemic conditions as well as pressure-volume hemodynamic evaluations in experimental in vivo MI induced by left anterior descending artery ligation in rats.Results: Acutely stretching muscles ex vivo yielded increased compliance over the next 15 min, but not under ischemic conditions. PKG agonists, but not PKC agonists, were able to partially restore SIC in ischemic muscles. A similar effect was observed with phosphodiesterase-5 inhibitor (PDE5i) sildenafil, which was amplified by joint B-type natriuretic peptide or nitric oxide donor administration. In vivo translation revealed that volume loading after MI only increased cardiac output in rats infused with PDE5i. Contrarily to vehicle, sildenafil-treated rats showed a clear increase in myocardial compliance upon volume loading.Discussion: Our results suggest that ischemia impairs the adaptive myocardial response to acute stretching and that this may be partly prevented by pharmacological manipulation of the cGMP/PKG pathway, namely, with PDE5i. Further studies are warranted to further elucidate the potential of this intervention in the clinical setting of acute myocardial ischemia.

Copyright © 2023 Leite-Moreira, Almeida-Coelho, Neves, Castro-Ferreira, Ladeiras-Lopes, Leite-Moreira and Lourenço.

Keywords

• myocardial ischemia; myocardial infarction; cardiac stretch; volume loading; myocardial compliance; diastolic function; phosphodiesterase-5 inhibitors; cGMP-dependent protein kinase