Hyperkalemic Cardioplegia-Induced Myocyte Swelling and Contractile Dysfunction: Prevention by Diazoxide

Background Hyperkalemic cardioplegia (9°C) results in significant myocyte swelling and reduced contractility, representing a possible mechanism of myocardial stunning. Adenosine triphosphate–sensitive potassium channel (KATP) openers have been shown to ameliorate stunning. This study evaluated the hypothesis that a KATP opener would prevent hyperkalemic cardioplegia-induced myocyte swelling and reduced contractility. Methods Isolated rabbit myocytes were perfused with 37°C Tyrode’s solution for 20 minutes, followed by test solution (9°C or 37°C) including control Tyrode’s, Tyrode’s + 100 μmol/L diazoxide (KATP opener), St. Thomas’s solution; or 9°C St. Thomas’s + 100 μmol/L diazoxide or St. Thomas’s + 100 μmol/L diazoxide + 20 μmol/L HMR1098 or 50 μmol/L 5-hydroxydeconoate (KATP blockers) for 20 minutes (n = 8 per group). Myocytes were then reexposed to 37°C Tyrode’s solution for 20 minutes. Volume and contractility were measured by videomicroscopy and video-based edge detection, respectively. Results St. Thomas’s solution (9°C) caused significant myocyte swelling and associated reduced contractility (p< 0.05). The addition of diazoxide abolished myocyte swelling (p< 0.0001), and eliminated the associated reduced contractility (p< 0.05). Findings were unchanged by the addition of HMR 1098 and 5-hydroxydeconoate. Conclusions Diazoxide prevented myocyte swelling and reduced contractility secondary to hyperkalemic cardioplegia, and this was unchanged by the addition of either KATP channel blocker. Prevention of myocyte swelling was associated with improved contractility, consistent with the hypothesis that myocyte swelling may be a mechanism of myocardial stunning. Diazoxide may play a role in myocyte volume homeostasis by means of a mechanism separate from opening the KATP channel.