Pathogenesis of Cardiac Depression in Acute Destructive Pancreatitis

Objective is to identify the pathogenic factors for progression of pancreatogenic cardiac failure in the nearest and remote periods.

Materials and methods. The study was carried out on 130 male Wistar rats (292±4.0 g) divided into 4 groups. The animals were anesthetized with ethyl ether. Acute destructive pancreatitis was simulated in three experimental groups by infusion of bile (0.15 ml/kg body weight) taken from the bile duct into the pancreatic tissue. The isolated isovolumically contracting rat heart (according to E. L. Fallen et al) was simulated 24 hours, 7 days and 1 month after the bile infusion. The pressure in the left ventricle was measured by electric manometer BMT and registered along with the first derivative at the device N3384P calculating the systolic and diastolic blood pressure, and the speed of contraction and relaxation. At the same time the perfusate samples passed through the coronary arteries were har vested, and aspartate aminotransferase (AST) and glucose were determined by standard methods. To identify the cardiac depression, the high contraction rhythm and hypercalcemic and hypoxic perfusion were applied.

Results. It was found that in acute destructive pancreatitis the power and speed parameters of the heart con tractile function were altered that led to lowering the systolic blood pressure and velocity of contraction and relax ation of the left ventricular myocardium and increased diastolic blood pressure as an indicator of cardyomyocyte contracture rate. These abnormalities were evidently manifested in increased heartbits, including hypercalcemic and hypoxic perfusion of the isolated hearts. Glucose consumption was raised per each mmHg generated by the ventricular pressure.

Conclusion. the most significant pathogenetic factors of pancreatogenic heart failure include hypoxia, car diomyocyte membrane destruction, inhibition of sarcolemma Capump, sarcoplasmic reticulum, and mitochondrial dysfunction. The maximum depression of myocardial contractility of the left ventricle is detecting during the first day and in a month after simulated pancreatic necrosis.

1. Litvin A.A. Infitsirovannyi pankreonekroz. [Infected pancreonecrosis]. Moscow: Integratsiya; 2011: 240. [In Russ.]

2. Poryadin G.V., Vlasov A.P., Anaskin S.G., Vlasova T.I., Potyanova I.V., Turygina S.A. Sistemnye faktory progressirovaniya ostrogo pankreatita. [Systemic factors of acute pancreatitis advance]. Patologicheskaya Fiziologiya i Eksperimentalnaya Terapiya. 2015; 59 (2): 46—50. PMID: 26571807. [In Russ.]

3. Kriger A.G., Vladimirov V.G., Andreitsev I.L., Seregin R.V., Makarova E.E. Lechenie pankreonekroza s porazheniem zabryushinnoi kletchatki. [Treatment of pancreonecrosis with lesion of retroperitoneal adipose tissue]. Khirurgiya. Zhurnal Imeni N.I.Pirogova. 2004; 2: 18—22. PMID: 14983147. [In Russ.]

4. Aliev S.V., Aliev E.S. Nereshennye voprosy khirurgicheskoi taktiki pri infitsirovannom pankreonekroze. [Unsolved issues of surgical treatment of infected pancreonecrosis]. Khirurgiya. Zhurnal Imeni N.I.Pirogova. 2015; 8: 64—69. PMID: 26410891. [In Russ.]

5. Vinnik Yu.S., Miller S.V., Teplyakova O.V. Sovershenstvovanie differentsialnoi diagnostiki i prognozirovaniya techeniya destruktivnykh form ostrogo pankreatita. [Improvement of differential diagnostics and prognostication of the course of destructive forms of acute pancreatitis]. Vestnik Khirurgii Imeni I.I.Grekova. 2009; 168 (6): 16—20. PMID: 20209984. [In Russ.]

6. Werner J., Büchler M.W. Infections complications in necrotizing pancreatitis. Zentrabl. Chir. 2007; 132 (5): 433—437. PMID: 17907086

7. Kizhaeva E.S. Sistemnye shkaly v otsenke poliorgannoi nedostatochnosti pri ostrom pankreatite. [Systemic scales in the evaluation of multipleorgan dysfunction in acute pancreatitis]. Rossiisky Meditsinsky Zhurnal. 2006; 4: 49—52. [In Russ.]

8. Dolgikh V.T., Morozov S.V., Ivanov K.A., Ershov A.V. Sposob modelirovaniya pankreonekroza v eksperimente. Patent RF na izobretenie № 2290702. [Methods of pancreonecrosis experimental modelling. RF patent for invention № 2290702]. [In Russ.]

9. Fallen E.L., Elliot W.C., Gorlin R. Apparatus for study of ventricular function and metabolism in the isolated perfused rat heart. J. Appl. Physiol. 1967; 22 (4): 836—839. PMID: 6023203

10. Dolgikh V.T. Povrezhdenie i zashchita serdtsa pri ostroi smertelnoi krovopotere. [Heart damage and protection in acute lethal blood loss]. Omsk; 2002: 203. [In Russ.]

11. Meyerson F.Z., Dolgikh V.T. Preduprezhdenie povrezhdenii serdtsa oksibutiratom natriya pri terminalnykh sostoyaniyakh, vyzvannykh ostroi krovopoterei. [Prevention of heart damage of sodium oxybutyrate in terminal states caused by acute blood loss]. Kardiologiya. 1982; 22 (10): 38—44. PMID: 7176316. [In Russ.]

12. Ershov A.V., Dolgikh V.T. Vliyanie pankreatogennykh faktorov na sokratimost i metabolism izolirovannogo serdtsa krysy. [Influence of pancreatogenic factors on isolated rat heart contractility and metabolism]. Sibirsky Meditsinsky Zhurnal. 2015; 6: 23—30. [In Russ.]

13. Dolgikh V.T., Ershov A.V., Shikunova L.G. K patogenezu serdechnoi nedostatochnosti pri pankreonekroze (eksperimentalnoe issledovanie). Obshchaya Reanimatologiya. [To the pathogenesis of heart failure in pancreonecrosis: experimental study. General Reanimatology]. 2009; 5 (3): 39—44. http://dx.doi.org/10.15360/181397792009339. [In Russ.]

14. Okorokov A.I. Diagnostika boleznei vnutrennikh organov. t.6. Diagnostika boleznei serdtsa i sosudov. [Diagnosis of internal diseases. v.6. Diagnosis of heart and vascular diseases]. Moscow: Meditsinskaya Literatura; 2002: 464. [In Russ.]

15. Tolstoi A.D., Goltsov R.V. Vozmozhnosti «obryva» destruktivnogo protsessa na rannikh stadiyakh pankreonekroza. Obshchaya Reanimatologiya. [The potentialities of abolition of a destructive process in early pancreonecrosis. General Reanimatology]. 2005; 1 (3): 58—60. http://dx.doi.org/10.15360/18139779200535860. [In Russ.]

16. Davydov V.G. Rol apoptoza atsinarnykh kletok podzheludochnoi zhelezy v patogeneze ostrogo pankreatita. [Role of apoptosis of acinar pancreatic cells in the pathogenesis of acute pancreatitits]. Kazansky Meditsinsky Zhurnal. 2004; 85 (5): 377—379. [In Russ.]

17. Ershov A.V. Rol gipoksicheskikh povrezhdenii miokarda v razvitii serdechnoi nedostatochnosti pri pankreonekroze. [Role of myocardial hypoxic lesions in the development of heart failure in the presence of pancreonecrosis]. Patologicheskaya Fiziologiya i Eksperimentalnaya Terapiya. 2009; 4: 17—20. PMID: 20143525. [In Russ.]

18. Lalmanach G., Naudin C., Lecaille F., Fritz H. Kininogens: more than cysteine protease inhibitors and kinin precursors. Biochimie. 2010; 92 (11): 1568—1579. http://dx.doi.org/10.1016/j.biochi.2010.03.011. PMID: 20346387