Cellular mechanism of the positive inotropic effect of hydralazine in mammalian myocardium.

1 The purpose of this study was to elucidate the cellular mechanism of the positive inotropic effect of hydralazine, a vasodilator widely used for afterload reduction in patients with heart failure that has also been reported to have positive inotropic effects on the heart. After isolation, right ventricular papillary muscles from the ferret were maintained in bicarbonate-buffered salt solution (30°C). A concentration-response relationship was obtained for hydralazine (10−6 to 10−3 m). In order to mimic different levels of catecholamine release found in heart failure, we utilized two methods of stimulation: (a) threshold punctate pulses and (b) suprathreshold punctate stimulation with voltage approximately 10% above threshold. 2 In a first group of muscles (n = 16), a maximally effective concentration of hydralazine (10−3 m) increased peak isometric tension by 39 ± 9% (P < 0.05). Doses lower than 10−5 m had no significant effect. The bioluminescent Ca2+ indicator, aequorin, was loaded into a subset of these muscles (n = 7). A significant increase in peak light (i.e., intracellular Ca2+) developed, concurrently with an increase in peak tension (38 ± 5% to 66 ± 8%). This inotropic response was associated with a decrease in time to peak tension (ms), 221 ± 7 to 186 ± 5 (P < 0.05), and time to peak light, 65 ± 4 to 52 ± 2 (P < 0.05). These effects were markedly attenuated by pretreatment with autonomic blocking agents. 3 In a second group of muscles (n = 12), histamine was used to stimulate cyclic AMP production in the presence of propranolol. Hydralazine (3 × 10−4 m) led to a shift in the pD2 (i.e. the negative log of the concentration of histamine producing 50% of the maximal response) from 6.1 ± 0.1 to 5.9 ± 0.1 (P < 0.05), thus increasing the sensitivity of the muscles to histamine. Hydralazine also increased maximum tension from 160 ± 77% to 195 ± 57% (P < 0.05) above baseline. Thus, hydralazine altered the potency and efficacy of histamine despite the presence of β-adrenoceptor blockade. 4 A third group of muscles were chemically skinned to examine the effects of hydralazine on myofilament Ca2+ responsiveness. Pretreatment of ferret papillary muscles with hydralazine (10−3 m) before skinning did not shift the force-pCa curve after skinning (n = 16). However, hydralazine added to previously skinned fibres desensitized the myofilaments, as indicated by a rightward shift of the force-pCa curve (n = 12). Maximum tension development was not changed. 5 The pharmacological effects of hydralazine are characteristic of inotropic drugs that act mainly via cyclic AMP; however, the increase in peak tension demonstrated with histamine in the presence of hydralazine also suggests an effect on cyclic AMP-independent second messenger pathways. These data are consistent with reports that large doses of hydralazine may increase cellular levels of cyclic AMP, as well as other second messengers, by direct cardiac and indirect neuronal mechanisms.