The cardiac re-AKT-ion to chronic volume overload

Non-coding RNAs and Pathological Cardiac Hypertrophy

Cardiovascular disease (CVD) is a common disease which poses a serious threat to human health and it is characterized by high prevalence, high disability and high mortality. Myocardial hypertrophy (MH) is a common pathological process of various cardiovascular diseases and is considered as an independent risk factor for increased cardiovascular morbidity and mortality. Therefore, it is particularly important to understand its pathological mechanism and treatment. In recent years, it has been found that many non-coding RNAs (ncRNAs) play key regulatory roles in humans' various pathophysiological processes. Abnormal expression of ncRNAs in different types of cardiac cells is associated with pathological cardiac hypertrophy. Understanding the relationship between various ncRNAs and intercellular communication through extracellular vesicles (EV) can identify the key ncRNAs which are the accurate targets of precise therapy in this network of action, it also can potentially be a marker for clinical disease diagnosis, which will reflect the progress of the disease earlier and more accurately. There are many factors that regulate the occurrence and development of cardiac hypertrophy, ncRNAs are only a part of them. There are also mutual promotion or inhibition between ncRNAs and other molecules. It will be helpful for us to comprehend the mechanism of cardiac hypertrophy better and provide a sufficient theoretical basis for clinical diagnosis and treatment by defining these relationships.

The contractile adaption to preload depends on the amount of afterload

Aims

The Frank–Starling mechanism (rapid response (RR)) and the secondary slow response (SR) are known to contribute to increases contractile performance. The contractility of the heart muscle is influenced by pre‐load and after‐load. Because of the effect of pre‐load vs. after‐load on these mechanisms in not completely understood, we studied the effect in isolated muscle strips.

Methods and results

Progressive stretch lead to an increase in shortening/force development under isotonic (only pre‐load) and isometric conditions (pre‐ and after‐load). Muscle length with maximal function was reached earlier under isotonic (L_{max‐isotonic}) compared with isometric conditions (L_{max‐isometric}) in nonfailing rabbit, in human atrial and in failing ventricular muscles. Also, SR after stretch from slack to L_{max‐isotonic} was comparable under isotonic and isometric conditions (human: isotonic 10 ± 4%, isometric 10 ± 4%). Moreover, a switch from isotonic to isometric conditions at L_{max‐isometric} showed no SR proving independence of after‐load. To further analyse the degree of SR on the total contractile performance at higher pre‐load muscles were stretched from slack to 98% L_{max‐isometric} under isotonic conditions. Thereby, the SR was 60 ± 9% in rabbit and 51 ± 14% in human muscle strips.

Conclusions

This work shows that the acute contractile response largely depends on the degree and type of mechanical load. Increased filling of the heart elevates pre‐load and prolongs the isotonic part of contraction. The reduction in shortening at higher levels of pre‐load is thereby partially compensated by the pre‐load‐induced SR. After‐load shifts the contractile curve to a better ‘myofilament function’ by probably influencing thin fibers and calcium sensitivity, but has no effect on the SR.