Effects of thoracic epidural anesthesia on cardiac function and myocardial cell apoptosis in isoproterenol-induced chronic heart failure rats.

OBJECTIVE This study aimed to investigate the effects of thoracic epidural anesthesia (TEA) on cardiac function and myocardial cell apoptosis in isoproterenol (ISO) induced chronic heart failure (CHF) rats. METHOD Rats were classified into 4 groups: the healthy control, ISO-induced CHF, ISO + TEA, and sham-treated groups. After 4 weeks, the animals in each group were examined by echocardiography. Invasive hemodynamic measurements were also preformed. RESULTS Echocardiographic findings suggested that rats in the ISO + TEA group exhibited decreased left ventricular end-systolic (LVES) and left ventricular end-diastolic (LVED), and increased left ventricular ejection fraction (LVEF) and left ventricular shortening fraction (LVFS) compared with rats in the ISO-induced CHF group. Rats in the ISO + TEA group showed improved left ventricular systolic pressure (LVSP) and left ventricular end-diastolic pressure (LVEDP) compared with rats in the ISO-induced CHF group. Additionally, rats in the ISO + TEA group had significant decrease in LV and RV mass indexes (LVMI and RVMI) compared with rats in the ISO-induced CHF rats. Myocardial ultrastructure in the ISO + TEA group significantly improved compared with the ISO-induced CHF group. TEA significantly reduced the percent of TUNEL-positive cells in the ISO + TEA group compared with the ISO-induced CHF group. Compared with the ISO-induced CHF group, Bcl-2 expression of rats in the ISO + TEA group was significantly increased, while Bax expression was significantly attenuated. CONCLUSION Our findings suggest that TEA may reduce myocardial apoptosis and decrease extent of structural damage and abnormalities in the myocardium.

[1]  D. van Dijk,et al.  Thoracic Epidural Anesthesia for Cardiac Surgery: A Randomized Trial , 2011, Anesthesiology.

[2]  A. Strasser,et al.  The BCL-2 protein family: opposing activities that mediate cell death , 2008, Nature Reviews Molecular Cell Biology.

[3]  M. Mehra,et al.  Chronic heart failure: contemporary diagnosis and management. , 2010, Mayo Clinic proceedings.

[4]  Lihua Hu,et al.  Effects of thoracic epidural blockade on mortality of patients with idiopathic dilated cardiomyopathy and heart failure. , 2011, International journal of cardiology.

[5]  A. Tortolani,et al.  A synopsis of research in cardiac apoptosis and its application to congestive heart failure. , 2007, Texas Heart Institute journal.

[6]  R. D'Hooge,et al.  Mitochondrial Rhomboid PARL Regulates Cytochrome c Release during Apoptosis via OPA1-Dependent Cristae Remodeling , 2006, Cell.

[7]  A. Kotwani,et al.  Mechanistic Clues in the Cardioprotective Effect of Terminalia Arjuna Bark Extract in Isoproterenol-Induced Chronic Heart Failure in Rats , 2011, Cardiovascular Toxicology.

[8]  Xiaoying Li,et al.  Involvement of endoplasmic reticulum stress-associated apoptosis in a heart failure model induced by chronic myocardial ischemia. , 2011, International journal of molecular medicine.

[9]  S. Prabhu,et al.  Cardiomyocyte NF-κB p65 promotes adverse remodelling, apoptosis, and endoplasmic reticulum stress in heart failure. , 2011, Cardiovascular research.

[10]  S. Goldsmith.  Interactions between the sympathetic nervous system and the RAAS in heart failure , 2004, Current heart failure reports.

[11]  R. Lux,et al.  Sympathetic stimulation increases dispersion of repolarization in humans with myocardial infarction. , 2012, American journal of physiology. Heart and circulatory physiology.

[12]  F. Liu,et al.  Effects of high thoracic epidural sympathetic blockade for the treatment of severe chronic heart failure due to dilated cardiomyopathy , 2012, Acta cardiologica.

[13]  E. Arbustini,et al.  Mechanisms of Disease: apoptosis in heart failure—seeing hope in death , 2006, Nature Clinical Practice Cardiovascular Medicine.

[14]  L. Obeid,et al.  The BCL-2 Protein BAK Is Required for Long-chain Ceramide Generation during Apoptosis* , 2010, The Journal of Biological Chemistry.

[15]  Jian-bo Yu,et al.  Effect of sevoflurane combination with epidural anesthesia on myocardial injury in patients with coronary artery disease undergoing non-cardiac surgery. , 2011, Saudi medical journal.

[16]  Liu Fengqi,et al.  Use of a high thoracic epidural analgesia for treatment of end-stage congestive heart failure secondary to coronary artery disease: effect of HTEA on CHF. , 2008, International journal of cardiology.

[17]  H. Aken,et al.  Risks and benefits of thoracic epidural anaesthesia. , 2011, British journal of anaesthesia.

[18]  G. Sethi,et al.  Targeting Cell Signaling and Apoptotic Pathways by Dietary Agents: Role in the Prevention and Treatment of Cancer , 2011, Nutrition and cancer.

[19]  Helmut Baumgartner,et al.  ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012 , 2012, European journal of heart failure.

[20]  D. Newmeyer,et al.  The rheostat in the membrane: BCL-2 family proteins and apoptosis , 2013, Cell Death and Differentiation.

[21]  Zhonghui Liu,et al.  Mechanisms of Ghrelin Anti-Heart Failure: Inhibition of Ang II-Induced Cardiomyocyte Apoptosis by Down-Regulating AT1R Expression , 2014, PloS one.

[22]  J. Conte,et al.  The pathophysiology of heart failure. , 2012, Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology.

[23]  G. Schuler,et al.  Exercise Training Attenuates MuRF-1 Expression in the Skeletal Muscle of Patients With Chronic Heart Failure Independent of Age: The Randomized Leipzig Exercise Intervention in Chronic Heart Failure and Aging Catabolism Study , 2012, Circulation.

[24]  N. Patel,et al.  Pretreatment with EPO reduces the injury and dysfunction caused by ischemia/reperfusion in the mouse kidney in vivo. , 2004, Kidney international.

[25]  C. Nito,et al.  Anti-apoptotic and neuroprotective effects of edaravone following transient focal ischemia in rats. , 2005, European journal of pharmacology.

[26]  F. Iellamo,et al.  Severity of left ventricular dysfunction in heart failure patients affects the degree of serum-induced cardiomyocyte apoptosis. Importance of inflammatory response and metabolism. , 2013, International journal of cardiology.

[27]  M. Fredrikson,et al.  Effect of long-term thoracic epidural analgesia on refractory angina pectoris: a 10-year experience. , 2012, Journal of cardiothoracic and vascular anesthesia.

[28]  Xiao-ting Li,et al.  Liquiritigenin induces mitochondria‐mediated apoptosis via cytochrome c release and caspases activation in heLa Cells , 2011, Phytotherapy research : PTR.

[29]  S. Fu,et al.  The effects of high thoracic epidural anesthesia on sympathetic activity and apoptosis in experimentally induced congestive heart failure. , 2014, Journal of cardiothoracic and vascular anesthesia.

[30]  Liang Xiao,et al.  The central renin-angiotensin system and sympathetic nerve activity in chronic heart failure. , 2014, Clinical science.

[31]  A. Mahajan,et al.  Neuraxial Modulation for Refractory Ventricular Arrhythmias: Value of Thoracic Epidural Anesthesia and Surgical Left Cardiac Sympathetic Denervation , 2010, Circulation.

[32]  Z. Wang,et al.  Effects of high thoracic epidural anesthesia on atrial electrophysiological characteristics and sympathetic nerve sprouting in a canine model of atrial fibrillation , 2011, Basic Research in Cardiology.

[33]  G. Heusch,et al.  TNFalpha in atherosclerosis, myocardial ischemia/reperfusion and heart failure. , 2010, Pharmacology & therapeutics.

[34]  D. Green,et al.  Mitochondria and cell death: outer membrane permeabilization and beyond , 2010, Nature Reviews Molecular Cell Biology.

[35]  R. Witte,et al.  An electrically coupled tissue-engineered cardiomyocyte scaffold improves cardiac function in rats with chronic heart failure. , 2014, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[36]  Xuan Chen,et al.  Release of apoptotic cytochrome C from mitochondria by dimethylarsinous acid occurs through interaction with voltage-dependent anion channel in vitro. , 2012, Toxicological sciences : an official journal of the Society of Toxicology.

[37]  L. Levin,et al.  Ordering of neuronal apoptosis signaling: a superoxide burst precedes mitochondrial cytochrome c release in a growth factor deprivation model , 2012, Apoptosis.

[38]  K. Adams.  Pathophysiologic role of the renin-angiotensin-aldosterone and sympathetic nervous systems in heart failure. , 2004, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[39]  J. Cleary,et al.  Centrally administered orexin A increases motivation for sweet pellets in rats , 2005, Psychopharmacology.

[40]  Yigong Shi,et al.  Structure of the apoptotic protease-activating factor 1 bound to ADP , 2005, Nature.

[41]  A. Lerman,et al.  Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. , 2008, American heart journal.

[42]  Zheng Guo,et al.  Blockade of spinal nerves attenuates myocardial apoptosis in acute myocardial ischaemia/infarction in rats , 2010, European journal of anaesthesiology.