“…An important characteristic of the cardiac sarcolemmal Na+-Ca 2+ exchange protein (Nicoll, Longoni, and Phillipson, 1990) is its ability to transport Ca 2+ ions across the plasma membrane in either a forward or reverse direction during changes in membrane potential associated with various phases of the cardiac cycle (Mullins, 1981;Eisner and Lederer, 1985;Hilgemann and Noble, 1987). The extent to which Ca 2+ can enter or leave the cell via this mechanism appears to be due to the physiochemical properties of the exchanger, including its stoichiometry (Phillipson and Nishimoto, 1982;Phillipson, 1985;Reeves, 1985), kinetics (Miura and Kimura, 1989;Crespo, Grantham, and Cannell, 1990;Li and Kimura, 1990), binding affinities for intracellular and extracellular Na + and Ca 2+ ions (Miura and Kimura, 1989;Hilgemann, 1990;Li and Kimura, 1990), and the voltage across the sarcolemma at a given time in the cycle of contraction to relaxation. Accordingly, quantitative relationships have been descrilzed between the inotropic state of mammalian cardiac muscle and the concentration of Na + ions in the perfusate, [Na+]o (Reuter and Sietz, 1968;Reuter, 1974;Bers, 1987;Watanabe, Ishide, and Takishima, 1987), intracellular Na + activity, anal (Cohen, Fozzard, and Sheu, 1982;Eisner, Lederer, and Vaughan-Jones, 1984;Boyett, Hart, Levi, and Roberts, 1987;Brill, Fozzard, Makielski, and Wasserstrom, 1987;Wang, Chae, Gong, and Lee, 1988), and various time-, voltage-, and stimulation-dependent ionic currents attributed to an electrogenic Na+-Ca 2+ exchange process (Hume and Uehara, 1986;Kimura, Miyamae, and Noma, 1987;Fedida, Noble, Shimoni, and Spindler, 1987;Beuckelmann and Wier, 1989;Egan, Noble, Powell, Spindler, and Twist, 1989;Terrar and Whit...…”