Hyperkalemia Exposure Impairs EDHF-Mediated Endothelial Function in the Human Coronary Artery

Background. My colleagues and I have found in the porcine coronary artery that the pathway other than the nitric oxide (NG-nitro- -arginine [L-NNA]-sensitive) and cyclooxygenase (indomethacin-sensitive) pathways of endothelium-dependent relaxation, related to the endothelium-derived hyperpolarizing factor (K+ channel–related), are altered after exposure to hyperkalemia. The present study was designed to examine whether this effect exists in the human coronary artery. Methods. Coronary artery rings obtained from explanted fresh human hearts were studied in organ chambers under physiologic pressure. The endothelium-dependent relaxation in response to calcium ionophore A23187 was studied in U46619 (30 nmol/L)-induced precontraction in the presence of the cyclooxygenase inhibitor indomethacin (7 μmol/L) and the nitric oxide biosynthesis inhibitor L-NNA (300 μmol/L). The effect of incubation with 20 mmol/L K+ for 1 hour on the relaxation was examined in other coronary rings. Results. In control rings, A23187 induced a maximal relaxation of 50.7% ± 3.2% (n = 6). After 1 hour of exposure to 20 mmol/L K+, the relaxation was reduced to 30.4% ± 4.6% (n = 6; p = 0.005). Incubation with hyperkalemia also significantly reduced the sensitivity (increased effective concentration that caused 50% of maximal relaxation) of the indomethacin- and L-NNA–resistant relaxation (−7.37 ± 0.17 versus −8.28 ± 0.27 log mol/L; p = 0.019). Conclusions. Exposure to hyperkalemia reduces the indomethacin- and L-NNA–resistant, endothelium-dependent (endothelium-derived hyperpolarizing factor–related) relaxation in the human coronary artery. This suggests that the previously proposed mechanism of coronary dysfunction after exposure to cardioplegic and organ preservation solutions in animal vessels is also valid in the human heart. (Ann Thorac Surg 1997;63:84–7)