1
|
Vasques-Nóvoa F, Angélico-Gonçalves A, Alvarenga JMG, Nobrega J, Cerqueira RJ, Mancio J, Leite-Moreira AF, Roncon-Albuquerque R. Myocardial oedema: pathophysiological basis and implications for the failing heart. ESC Heart Fail 2022; 9:958-976. [PMID: 35150087 PMCID: PMC8934951 DOI: 10.1002/ehf2.13775] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/27/2021] [Accepted: 12/02/2021] [Indexed: 12/04/2022] Open
Abstract
Myocardial fluid homeostasis relies on a complex interplay between microvascular filtration, interstitial hydration, cardiomyocyte water uptake and lymphatic removal. Dysregulation of one or more of these mechanisms may result in myocardial oedema. Interstitial and intracellular fluid accumulation disrupts myocardial architecture, intercellular communication, and metabolic pathways, decreasing contractility and increasing myocardial stiffness. The widespread use of cardiac magnetic resonance enabled the identification of myocardial oedema as a clinically relevant imaging finding with prognostic implications in several types of heart failure. Furthermore, growing experimental evidence has contributed to a better understanding of the physical and molecular interactions in the microvascular barrier, myocardial interstitium and lymphatics and how they might be disrupted in heart failure. In this review, we summarize current knowledge on the factors controlling myocardial water balance in the healthy and failing heart and pinpoint the new potential therapeutic avenues.
Collapse
Affiliation(s)
- Francisco Vasques-Nóvoa
- Cardiovascular R&D Center, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - António Angélico-Gonçalves
- Cardiovascular R&D Center, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - José M G Alvarenga
- Cardiovascular R&D Center, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - João Nobrega
- Cardiovascular R&D Center, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - Rui J Cerqueira
- Cardiovascular R&D Center, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - Jennifer Mancio
- Cardiovascular R&D Center, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - Adelino F Leite-Moreira
- Cardiovascular R&D Center, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - Roberto Roncon-Albuquerque
- Cardiovascular R&D Center, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| |
Collapse
|
2
|
Lou B, Cui Y, Gao H, Chen M. Meta-analysis of the effects of ischemic postconditioning on structural pathology in ST-segment elevation acute myocardial infarction. Oncotarget 2018; 9:8089-8099. [PMID: 29487717 PMCID: PMC5814284 DOI: 10.18632/oncotarget.23450] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 10/05/2017] [Indexed: 01/08/2023] Open
Abstract
In this meta-analysis, we assessed cardiac magnetic resonance imaging data to determine the effects of local and remote ischemic postconditioning (LPoC and RPoC, respectively) on structural pathology in ST-segmentel elevation acute myocardial infarction (STEMI). We searched the Pubmed, Embase and Cochrane Library databases up to May 2017 and included 12 randomized controlled trials (10 LPoC and 2 RPoC)containing 1069 study subjects with thrombolysis in myocardial infarction flow grade 0~1. Weighed mean difference (WMD), standardized mean difference (SMD), and odds ratio (OR) were used for the pooled analysis. Random-effect model was used for the potential clinical inconsistency. LPoC and RPoC increased the myocardial salvage index (n = 5; weighted mean difference (WMD) = 5.52; P = 0.005; I2 = 76.0%), and decreased myocardial edema (n = 7; WMD = -3.35; P = 0.0009; I2 = 18.0%). However, LPoC and RPoC did not reduce the final infarct size (n = 10; WMD = -1.01; P > 0.05; I2 = 68.0%), left ventricular volume (n = 10; standardized mean difference = 0.23; P > 0.05; I2 = 93.0%), the incidence of microvascular obstruction (n = 6; OR = 0.99; P > 0.05; I2 = 0.0%) or the extent of microvascular obstruction (n = 3; WMD = -0.09; P > 0.05; I2 = 6.0%). This meta-analysis shows that LPoC and/or RPoC improves myocardial salvage and decreases myocardial edema in STEMI patients without affecting final infarct size, left ventricular volume or microvascular obstruction.
Collapse
Affiliation(s)
- Baohui Lou
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Yadong Cui
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Haiyang Gao
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Min Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, China
| |
Collapse
|
3
|
Dongaonkar RM, Stewart RH, Quick CM, Uray KL, Cox CS, Laine GA. Award article: Microcirculatory Society Award for Excellence in Lymphatic Research: time course of myocardial interstitial edema resolution and associated left ventricular dysfunction. Microcirculation 2013; 19:714-22. [PMID: 22708850 DOI: 10.1111/j.1549-8719.2012.00204.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Although the causal relationship between acute myocardial edema and cardiac dysfunction has been established, resolution of myocardial edema and subsequent recovery of cardiac function have not been established. The time to resolve myocardial edema and the degree that cardiac function is depressed after edema resolves are not known. We therefore characterized temporal changes in cardiac function as acute myocardial edema formed and resolved. METHODS Acute myocardial edema was induced in the canine model by elevating coronary sinus pressure for three hours. Myocardial water content and cardiac function were determined before and during coronary sinus pressure elevation, and after coronary sinus pressure restoration. RESULTS Although no change in systolic properties was detected, accumulation of water in myocardial interstitium was associated with increased diastolic stiffness. When coronary sinus pressure was relieved, myocardial edema resolved within 180 minutes. Diastolic stiffness, however, remained significantly elevated compared with baseline values, and cardiac function remained compromised. CONCLUSIONS The present work suggests that the cardiac dysfunction caused by the formation of myocardial edema may persist after myocardial edema resolves. With the advent of new imaging techniques to quantify myocardial edema, this insight provides a new avenue for research to detect and treat a significant cause of cardiac dysfunction.
Collapse
Affiliation(s)
- Ranjeet M Dongaonkar
- Michael E DeBakey Institute, Texas A&M University, College Station, Texas 77843-4466, USA
| | | | | | | | | | | |
Collapse
|
6
|
Dean DA, Amirhamzeh MM, Jia CX, Cabreriza SE, Rabkin DG, Sciacca R, Dickstein ML, Spotnitz HM. Reversal of iatrogenic myocardial edema and related abnormalities of diastolic properties in the pig left ventricle. J Thorac Cardiovasc Surg 1998; 115:1209-14. [PMID: 9605093 DOI: 10.1016/s0022-5223(98)70423-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study examines the resolution of iatrogenic edema and related changes in systolic and diastolic properties in the intact pig left ventricle. METHODS The coronary arteries were perfused for 50 to 60 seconds with diluted blood (hematocrit value 10% +/- 1%, edema group, n = 5) or whole blood (hematocrit value 28% +/- 1%, control group, n = 6) infused into the aortic root during aortic crossclamping in conditioned, anesthetized pigs. After whole blood reperfusion, preload reduction by vena caval occlusion was used to define systolic and diastolic properties at 15-minute intervals. Left ventricular pressure and conductance, aortic flow, and two-dimensional echocardiography were recorded. RESULTS Left ventricular mass (wall volume) in the edema group increased significantly compared with that in control pigs after crossclamp removal. Mass returned to preperfusion levels after 45 minutes. The ventricular stiffness constant (beta) increased significantly in the edema group versus the control group, returning to baseline by 30 minutes. The diastolic relaxation constant (tau) and base constant (alpha) did not differ between groups. There was no significant change in contractility. CONCLUSION Increases in left ventricular mass and diastolic stiffness induced by coronary perfusion with hemodiluted blood resolve after 45 minutes of whole blood perfusion in pigs. This study defines physiologic effects of edema in the normal heart while eliminating most common confounding experimental errors.
Collapse
Affiliation(s)
- D A Dean
- Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
| | | | | | | | | | | | | | | |
Collapse
|
7
|
Tritto FP, Inserte J, Garcia-Dorado D, Ruiz-Meana M, Soler-Soler J. Sodium/hydrogen exchanger inhibition reduces myocardial reperfusion edema after normothermic cardioplegia. J Thorac Cardiovasc Surg 1998; 115:709-15. [PMID: 9535460 DOI: 10.1016/s0022-5223(98)70337-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The hypothesis was that Na+/H+ exchange occurring during normothermic cardioplegia contributes to the development of myocardial edema during subsequent reperfusion and impairs functional recovery. METHODS Rat hearts were perfused in a Langendorff apparatus and submitted to 60 minutes of normothermic cardioplegia and 90 minutes of reperfusion. Hearts were allocated to one of four groups (n = 8): inhibition of Na+/H+ exchanger with HOE642 throughout the whole experiment (HOE group), only during cardioplegia (HOE-C) or during reperfusion (HOE-R), and a control group. RESULTS In HOE and HOE-C groups, myocardial water content at the end of reperfusion was lower than in the HOE-R and control groups (526 +/- 19 and 533 +/- 18 ml/100 gm dry tissue vs 632 +/- 25 and 634 +/- 17 ml/100 gm dry tissue, respectively, p = 0.001), left ventricular end-diastolic pressure increased less after reperfusion (46.6 +/- 9.7 and 63.2 +/- 10.0 mm Hg vs 75.1 +/- 4.3 mm Hg and 85.7 +/- 8.9 mm Hg, respectively, p = 0.006), and recovery of left ventricular developed pressure was better (46.7% and 45.8% vs 4.5% and 9.8%, p = 0.048). Relative to the control group, total lactate dehydrogenase release during reperfusion was reduced by 80.2%, 69.3% and 36% in HOE, HOE-C, and HOE-R groups, respectively. CONCLUSION Inhibition of the Na+/H+ exchange during normothermic cardioplegia reduces myocardial edema and necrosis during subsequent reperfusion, improving functional recovery. Inhibition of Na+/H+ exchange during reperfusion only has a much smaller effect.
Collapse
Affiliation(s)
- F P Tritto
- Laboratorio de Cardiologia Experimental B. Servicio de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | | | | |
Collapse
|
9
|
Waldenberger FR, Andres J, Flameng W. Effects of unloaded reperfusion on mitochondrial function in the postischemic myocardium. Artif Organs 1994; 18:206-13. [PMID: 8185486 DOI: 10.1111/j.1525-1594.1994.tb02177.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The effect of mechanical unloading on recovery of postischemic myocardial performance, high energy phosphate content, and mitochondrial function was tested in an isolated working rabbit heart model. After 30 min of global ischemia, prolonged unloaded reperfusion could prevent complete loss of contractility, deterioration of mitochondrial function, and depletion of the ATP pool as was found when only short-term unloading was performed. Aortic flow recovered to 21% of preischemic control, and left ventricular dP/dt max to 46% (p < 0.05 vs. short-term unloading). OPR and ADP/O stabilized at 42 and 72%, respectively (p < 0.05 vs. short-term unloading), and ATP at 33% of control (p < 0.05 vs. short-term unloading). These results show the beneficial effect of prolonged unloading in postischemic hearts.
Collapse
Affiliation(s)
- F R Waldenberger
- Department of Cardiac Surgery, Katholieke Universiteit Leuven, Belgium
| | | | | |
Collapse
|