Background: Depressed myocardial performance is an important clinical problem after open heart surgery. We hypothesized pretreating with bradykinin would pharmacologically precondition the heart and improve post-ischemic performance, and induce myocardial preconditioning by activating nitric oxide synthase.
Methods: Thirty-three rabbit hearts underwent retrograde perfusion with Krebs-Henseleit buffer (KHB) followed by 50 minutes of 37 degrees C cardioplegic ischemia with St. Thomas' cardioplegia solution (StTCP). Ten control hearts received no pretreatment. Ten bradykinin-pretreated hearts received a 10-minute infusion of 0.1 microMol/L bradykinin-enriched KHB and cardioplegic arrest with 0.1 microMol/L bradykinin-enriched StTCP. Six other hearts received 0.1 microMol/L HOE 140, a selective B2 receptor antagonist, added to both the 0.1 microMol/L bradykinin-enriched KHB and 0.1 microMol/L bradykinin-enriched StTCP solutions. Finally, six other hearts received 100 microMol/L of N-omega-nitro-L-arginine methyl ester (L-NAME), an inhibitor of nitric oxide synthase, added to both the 0.1 microMol/L bradykinin-enriched KHB and 0.1 microMol/L bradykinin-enriched StTCP solutions.
Results: Bradykinin pretreatment significantly improved postischemic performance and coronary flow (CF) compared with control (LVDP: 53 +/- 5* vs 27 +/- 4 mm Hg; +dP/dtmax: 1,025 +/- 93* vs 507 +/- 85 mm Hg/s; CF: 31 +/- 3* vs 22 +/- 2 mL/min; *p < 0.05). Both HOE 140 and L-NAME abolished bradykinin-induced protection, resulting in recovery equivalent to untreated controls.
Conclusions: Bradykinin pretreatment improves recovery of ventricular and coronary vascular function via nitric oxide-dependent mechanisms. Pharmacologic preconditioning by bradykinin pretreatment may be an important new strategy for improving myocardial protection during heart surgery.