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Ann Thorac Surg 1999;68:1219-1224
© 1999 The Society of Thoracic Surgeons

Original Articles

Phenylephrine induces delayed cardioprotection against necrosis without amelioration of stunning

Kourosh Baghelai, MDa, Laura J. Graham, BSa, Andrew S. Wechsler, MDa, Emma R. Jakoi, PhDa

a Division of Cardiothoracic Surgery, Department of Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia, USA

Address reprint requests to Dr Baghelai, Division of Cardiothoracic Surgery, Department of Surgery, Medical College of Virginia, 1200 East Broad St, PO Box 981239, Richmond, VA 23298;
e-mail: kbaghela{at}hsc.vcu.edu

Presented at the Forty-fifth Annual Meeting of the Southern Thoracic Surgical Association, Orlando, FL, Nov 12–14, 1998.

Background. {alpha}-Adrenergic stimulation induces protection in reperfused ischemic (I/R) myocardium 24 hours later. We tested the hypothesis that phenylephrine improves dysfunction after global I/R by limiting cell death not stunning.

Methods. Rabbits were pretreated with either phenylephrine or vehicle. Twenty-four hours later, isolated hearts underwent either 45 (infarction protocol) or 20 minutes (stunning protocol) of global ischemia before 2 hours of reperfusion (n = 6 per group). Cell death was determined by triphenyl tetrazolium chloride staining (infarction) and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) (apoptosis).

Results. Compared with vehicle, phenylephrine pretreatment improved post-I/R-developed pressures in hearts after infarction (53.2 ± 4.0 vs 35.8 ± 4.1 mm Hg, p = 0.01) but not stunning protocol (64.3 ± 8.9 vs 57.7 ± 6.2 mm Hg, p = NS). The improved developed pressure was due to better diastolic recovery. Systolic pressures were similar between groups. Phenylephrine markedly decreased infarction (9.0 ± 1.9% vs 40.8 ± 1.8% for vehicle, p < 0.001) and TUNEL-positive staining. Stunned hearts of either group had less than 3% infarction and no apoptosis.

Conclusions. Phenylephrine pretreatment 24 hours before global I/R improves function by limiting infarction but not stunning.




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