Correlation of ischemia-induced extracellular and intracellular ion changes to cell-to-cell electrical uncoupling in isolated blood-perfused rabbit hearts

Background The relationships between the metabolic, ionic, and electrical changes of acute ischemia have not been determined precisely because they have been studied under different experimental conditions. We used ion-selective electrodes, nu clear magnetic resonance spectroscopy, and the four-electrode method to perform four series of experiments in the isolated blood-perfused rabbit heart loaded with 5F-BAPTA during 30 to 35 minutes of no-flow ischemia. We sought to determine the relationship between changes in phosphocreatine (PCr), adenosine triphosphate (ATP), intracellular calcium ([Ca2+](i)), intracellular pH (pH(i)), extracellular potassium ([K+](e)), extracellular pH (pH(c)), and whole-tissue resistance (r(t)). Methods and Results In the first 8 minutes of ischemia, [K+](e) rose from 4.9 to 10.8 mmol/L, PCr fell by 90%, ATP decreased by 25%, and pH(i) and pH(e), decreased by 0.5 U, while [Ca2+](i) and r(t) changed only slightly. Between 8 and 23 minutes, [K+](e) changed only slightly; pH(i), pH(e). and ATP continued to fall, and [Ca2+](i) rose. r(t) did not increase until > 20 minutes of ischemia, when pH(i) was < 6.0 and [Ca2+](i) had increased more than threefold. The increase in r(t), indicating electrical uncoupling, coincided with the third phase of the [K+](e) change. Conclusions Our study suggests that cellular uncoupling oc curs only after a significant rise in [Ca2+](i) and fall in pH(i) and that these ionic and electrical changes can be identified by the change in [K+](e). Our study underscores the importance of using a common model while attempting to formulate an integrated picture of the ionic, metabolic, and electrical events that occur during acute ischemia.