Abstract-The aim of the present study was to determine whether cardiac nitric oxide (NO) production changes during the progression of pacing-induced heart failure and whether this occurs in association with alterations in myocardial metabolism. Dogs (nϭ8) were instrumented and the heart paced until left ventricular end-diastolic pressure reached 25 mm Hg and clinical signs of severe failure were evident. Every week, hemodynamic measurements were recorded and blood samples were withdrawn from the aorta and the coronary sinus for measurement of NO metabolites, O 2 content, free fatty acids (FFAs), and lactate and glucose concentrations. ne of the proposed mechanisms of cardiac dysfunction in heart failure attributes a major role to an excessive production of nitric oxide (NO) in the heart and, specifically, in myocytes.1,2 Circulating proinflammatory cytokines, found in high concentrations in plasma of patients with heart failure, 3 would stimulate the expression of inducible NO synthase (iNOS) with consequent overproduction of NO. NO has, among other functions, negative inotropic effects at high concentrations, as demonstrated in vitro.4-6 A similar mechanism of cardiac depression has been recognized previously in septic shock, although the levels of circulating cytokines and NO catabolites in this syndrome are much higher than those found during heart failure. 3,[7][8][9] However, to date, evidence of an increase in cardiac production of NO, sufficient to cause a negative inotropic action during heart failure, has not been provided. The finding that iNOS is expressed in tissue from failing hearts does not necessarily imply that cardiomyocytes are exposed to toxic concentrations of NO. Indeed, it is the amount of NO and not the enzyme isotype generating it that determines the degree to which cardiac function would be depressed. Numerous studies suggest that NO release is rather low in heart failure. In clinical and animal studies, 2,10 pharmacological blockade of NO synthases (NOS) did not alter baseline hemodynamics, indicating that, rather than being characterized by overproduction, systemic NO synthesis could already be minimal. Several investigations, including our own, in patients and in animal models of heart failure report an impairment of endothelial release of NO in large arteries and in coronary microvessels.11-14 The reduced vascular NO

Inhibition of NO synthesis has recently been shown to increase oxygen extraction in vivo, and NO has been proposed to play a significant role in the regulation of oxygen consumption by both skeletal and cardiac muscle in vivo and in vitro. It was our aim to determine whether NO also has such a role in the kidney, a tissue with a relatively low basal oxygen extraction. In chronically instrumented conscious dogs, administration of an inhibitor of NO synthase, nitro-L-arginine (NLA, 30 mg/kg i.v.), caused a maintained increase in mean arterial pressure and renal vascular resistance and a decrease in heart rate (all P<0.05). At 60 minutes, urine flow rate and glomerular flow rate decreased by 44+/-12% and 45+/-7%, respectively; moreover, the amount of sodium reabsorbed fell from 16+/-1.7 to 8.5+/-1.1 mmol/min (all P<0.05). At this time, oxygen uptake and extraction increased markedly by 115+/-37% and 102+/-34%, respectively (P<0.05). Oxygen consumption also significantly increased from 4.5+/-0.6 to 7.1+/-0.9 mL O2/min. Most important, the ratio of oxygen consumption to sodium reabsorbed increased dramatically from 0.33+/-0.07 to 0.75+/-0.11 mL O2/mmol Na+ (P<0.05), suggesting a reduction in renal efficiency for transporting sodium. In vitro, both a NO-donating agent and the NO synthase-stimulating agonist bradykinin significantly decreased both cortical and medullary renal oxygen consumption. In conclusion, NO plays a role in maintaining a balance between oxygen consumption and sodium reabsorption, the major ATP-consuming process in the kidney, in conscious dogs, and NO can inhibit mitochondrial oxygen consumption in canine renal slices in vitro.

The role of nitric oxide (NO) in the control of coronary blood flow (CBF) during the development of diabetes is unknown. To study this, mongrel dogs were chronically instrumented using sterile techniques for measurements of systemic hemodynamics and CBF. With heart rate controlled (150 beats/min), veratrine (1–10 μg/kg) caused dose-dependent increases in CBF; e.g., 5 μg/kg of veratrine increased CBF by 57 ± 7% from 41 ± 1.3 ml/min ( P < 0.05). The dogs developed diabetes 4–5 wk after injection of alloxan (40–60 mg/kg iv, blood glucose levels were 384 ± 18 mg/dl). After diabetes the same doses of veratrine caused smaller increases in CBF; i.e., 5 μg/kg of veratrine increased CBF by 32 ± 2% ( P < 0.05 compared with control) from 28 ± 4 ml/min. ACh- and adenosine-induced coronary vasodilation were reduced after diabetes as well. In anesthetized dogs after diabetes, vagal stimulation caused smaller increases in CBF. ACh and bradykinin caused smaller increases in[Formula: see text] production in coronary microvessels from diabetic dogs. Furthermore, despite the fact that mRNA for endothelial cell NO synthase from the aorta was increased twofold with the use of Northern blotting, the protein for aortic endothelial constitutive NO synthase was reduced by 66% after diabetes, as determined by Western blotting. Our results indicate that the NO-dependent coronary vasodilation by the Bezold-Jarisch reflex is impaired in conscious dogs after diabetes. The mechanism responsible for the impaired endothelium-dependent coronary vasodilation is most likely the decreased release of NO from the endothelium.

It is not known whether the ratio between the concentrations of NO metabolites (NOx) in plasma (pNOx) and in erythrocytes (eNOx) is constant or correlates with chemical parameters of the blood. We measured pH, PO(2), and PCO(2) and calculated bicarbonate concentration in 19 blood samples from the aorta, coronary sinus, and leg veins of 7 dogs. Erythrocytes were then separated by centrifugation and lysed with distilled water, and the lysate was ultrafiltered with a molecular cutoff of 50 kDa to remove the hemoglobin. NOx were measured in plasma and in the ultrafiltrate. NOx concentration was higher in erythrocytes, with eNOx/pNOx ranging from 4.38 to 14.60. Linear and significant correlations were found between the natural logarithm of eNOx/pNOx and PCO(2) (r = 0.70, P < 0.001) or bicarbonate concentration (r = 0.72, P < 0.001). These results demonstrate, for the first time, that plasma NOx cannot be considered as a constant fraction of the total NOx in blood but varies dramatically in proportion to the CO(2)/bicarbonate concentration. To prevent an underestimation of venous-arterial difference of NOx across organs, NOx should be measured in whole blood.

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