Intracellular Na ⁺ Concentration Is Elevated in Heart Failure But Na/K Pump Function Is Unchanged

BACKGROUND: Intracellular sodium concentration ([Na(+)](i)) modulates cardiac contractile and electrical activity through Na/Ca exchange (NCX). Upregulation of NCX in heart failure (HF) may magnify the functional impact of altered [Na(+)](i). METHODS AND RESULTS: We measured [Na(+)](i) by using sodium binding benzofuran isophthalate in control and HF rabbit ventricular myocytes (HF induced by aortic insufficiency and constriction). Resting [Na(+)](i) was 9.7+/-0.7 versus 6.6+/-0.5 mmol/L in HF versus control. In both cases, [Na(+)](i) increased by approximately 2 mmol/L when myocytes were stimulated (0.5 to 3 Hz). To identify the mechanisms responsible for [Na(+)](i) elevation in HF, we measured the [Na(+)](i) dependence of Na/K pump-mediated Na(+) extrusion. There was no difference in V(max) (8.3+/-0.7 versus 8.0+/-0.8 mmol/L/min) or K(m) (9.2+/-1.0 versus 9.9+/-0.8 mmol/L in HF and control, respectively). Therefore, at measured [Na(+)](i) levels, the Na/K pump rate is actually higher in HF. However, resting Na(+) influx was twice as high in HF versus control (2.3+/-0.3 versus 1.1+/-0.2 mmol/L/min), primarily the result of a tetrodotoxin-sensitive pathway. CONCLUSIONS: Myocyte [Na(+)](i) is elevated in HF as a result of higher diastolic Na(+) influx (with unaltered Na/K-ATPase characteristics). In HF, the combined increased [Na(+)](i), decreased Ca(2+) transient, and prolonged action potential all profoundly affect cellular Ca(2+) regulation, promoting greater Ca(2+) influx through NCX during action potentials. Notably, the elevated [Na(+)](i) may be critical in limiting the contractile dysfunction observed in HF.