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Wang X, Liang L, Giridharan GA, Sethu P, Wang Y, Qin KR, Qu P, Wang Y. Development of in vitro microfluidic models to study endothelial responses to pulsatility with different mechanical circulatory support devices. Analyst 2024; 149:3661-3672. [PMID: 38819086 DOI: 10.1039/d4an00507d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Continuous-flow ventricular assist devices (CFVAD) and counterpulsation devices (CPD) are used to treat heart failure (HF). CFVAD can diminish pulsatility, but pulsatile modes have been implemented to increase vascular pulsatility. The effects of CFVAD in a pulsatile mode and CPD support on the function of endothelial cells (ECs) are yet to be investigated. In this study, two in vitro microfluidic models for culturing ECs are proposed to reproduce blood pressure (BP) and wall shear stress (WSS) on the arterial endothelium while using these medical devices. The layout and parameters of the two microfluidic systems were optimized based on the principle of hemodynamic similarity to efficiently simulate physiological conditions. Moreover, the unique design of the double-pump and double afterload systems could successfully reproduce the working mode of CPDs in an in vitro microfluidic system. The performance of the two systems was verified by numerical simulations and in vitro experiments. BP and WSS under HF, CFVAD in pulsatile modes, and CPD were reproduced accurately in the systems, and these induced signals improved the expression of Ca2+, NO, and reactive oxygen species in ECs, proving that CPD may be effective in normalizing endothelial function and replacing CFVAD to a certain extent to treat non-severe HF. This method offers an important tool for the study of cell mechanobiology and a key experimental basis for exploring the potential value of mechanical circulatory support devices in reducing adverse events and improving outcomes in the treatment of HF in the future.
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Affiliation(s)
- Xueying Wang
- School of Optoelectronic Engineering and Instrumentation Science, Dalian University of Technology, Dalian 116024, Liaoning Province, P. R. China
| | - Lixue Liang
- School of Mechanical Engineering, Dalian University of Technology, Dalian 116024, Liaoning Province, P. R. China
| | | | - Palaniappan Sethu
- Department of Biomedical Engineering, School of Engineering, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Yanxia Wang
- School of Rehabilitation Medicine, Shandong Second Medical University, Weifang 261053, Shandong Province, P. R. China
| | - Kai-Rong Qin
- School of Biomedical Engineering, Faculty of Medicine, Dalian University of Technology, Dalian 116024, Liaoning Province, P. R. China.
| | - Peng Qu
- School of Biomedical Engineering, Faculty of Medicine, Dalian University of Technology, Dalian 116024, Liaoning Province, P. R. China.
| | - Yu Wang
- School of Biomedical Engineering, Faculty of Medicine, Dalian University of Technology, Dalian 116024, Liaoning Province, P. R. China.
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Diagbouga MR, Lemeille S, Morel S, Kwak BR. Impact of disrupted cyclic stretch in intracranial aneurysms: Insights from endothelial cell transcriptomic dataset. Data Brief 2024; 52:110014. [PMID: 38235173 PMCID: PMC10792734 DOI: 10.1016/j.dib.2023.110014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/19/2024] Open
Abstract
Intracranial aneurysm (IA) rupture is a common cause of hemorrhagic stroke. The treatment of unruptured IAs is a challenging decision that requires delicate risk stratification. The rate of poor clinical outcomes after surgical intervention (aneurysm clipping) or endovascular coiling remains elevated (6.7% and 4.8%, respectively), and they do not provide an absolute guarantee to prevent IA growth and rupture. Currently, there is no pharmaceutical treatment to cure or stabilize IAs. Improving the current or developing new treatments for IA disease would require a better understanding of the cellular and molecular mechanisms occurring in the different stages of the disease. Hemodynamic forces play a critical role in IA disease. While the role of wall shear stress in IAs is well-established, the influence of cyclic circumferential stretch (CCS) still needs clarification. IAs are generally characterized by a lack of CCS. In this investigation, we sought to understand the effect of aneurysmal CCS on endothelial cell (EC) function and its potential significance in IA disease, hypothesizing that CCS can influence IA wall remodelling. RNA-seq data were generated from human umbilical vein ECs (HUVECs) exposed to physiological (6%) or aneurysmal CCS (static). We performed differential gene expression and pathway enrichment analysis. Additionally, we highlighted cell junction gene expression between static and 6% CCS to contribute to the debate about how cell junctions affect endothelium stability and integrity. Researchers in the vascular biology field may benefit from this transcriptomic profile to understand the effect of mechanical stretch on EC biology and its potential significance in vascular disease development.
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Affiliation(s)
- Mannekomba R. Diagbouga
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva. Rue Michel-Servet 1, 1211 Geneva, Switzerland
| | - Sylvain Lemeille
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva. Rue Michel-Servet 1, 1211 Geneva, Switzerland
- Geneva Center for Inflammation Research, Faculty of Medicine, University of Geneva. Rue Michel-Servet 1, 1211 Geneva, Switzerland
| | - Sandrine Morel
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva. Rue Michel-Servet 1, 1211 Geneva, Switzerland
- Geneva Center for Inflammation Research, Faculty of Medicine, University of Geneva. Rue Michel-Servet 1, 1211 Geneva, Switzerland
- Division of Neurosurgery, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals and University of Geneva. Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
| | - Brenda R. Kwak
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva. Rue Michel-Servet 1, 1211 Geneva, Switzerland
- Geneva Center for Inflammation Research, Faculty of Medicine, University of Geneva. Rue Michel-Servet 1, 1211 Geneva, Switzerland
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Cheng L, Yue H, Zhang H, Liu Q, Du L, Liu X, Xie J, Shen Y. The influence of microenvironment stiffness on endothelial cell fate: Implication for occurrence and progression of atherosclerosis. Life Sci 2023; 334:122233. [PMID: 37918628 DOI: 10.1016/j.lfs.2023.122233] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 11/04/2023]
Abstract
Atherosclerosis, the primary cause of cardiovascular diseases (CVDs), is characterized by phenotypic changes in fibrous proliferation, chronic inflammation and lipid accumulation mediated by vascular endothelial cells (ECs) and vascular smooth muscle cells (SMCs) which are correlated with the stiffening and ectopic remodeling of local extracellular matrix (ECM). The native residents, ECs and SMCs, are not only affected by various chemical factors including inflammatory mediators and chemokines, but also by a range of physical stimuli, such as shear stress and ECM stiffness, presented in the microenvironmental niche. Especially, ECs, as a semi-selective barrier, can sense mechanical forces, respond quickly to changes in mechanical loading and provide context-specific adaptive responses to restore homeostasis. However, blood arteries undergo stiffening and lose their elasticity with age. Reports have shown that the ECM stiffening could influence EC fate by changing the cell adhesion, spreading, proliferation, cell to cell contact, migration and even communication with SMCs. The cell behaviour changes mediated by ECM stiffening are dependent on the activation of a signaling cascade of mechanoperception and mechanotransduction. Although the substantial evidence directly indicates the importance of ECM stiffening on the native ECs, the understanding about this complex interplay is still largely limited. In this review, we systematically summarize the roles of ECM stiffening on the behaviours of endothelial cells and elucidate the underlying details in biological mechanism, aiming to provide the process of how ECs integrate ECM mechanics and the highlights for bioaffinity of tissue-specific engineered scaffolds.
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Affiliation(s)
- Lin Cheng
- Institute of Biomedical Engineering, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, China
| | - Hongyan Yue
- Institute of Biomedical Engineering, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, China
| | - Huaiyi Zhang
- Institute of Biomedical Engineering, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, China
| | - Qiao Liu
- Institute of Biomedical Engineering, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, China
| | - Lingyu Du
- Institute of Biomedical Engineering, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, China
| | - Xiaoheng Liu
- Institute of Biomedical Engineering, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, China
| | - Jing Xie
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
| | - Yang Shen
- Institute of Biomedical Engineering, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, China; JinFeng Laboratory, Chongqing 401329, China.
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Xu Z, Chen Y, Wang Y, Han W, Xu W, Liao X, Zhang T, Wang G. Matrix stiffness, endothelial dysfunction and atherosclerosis. Mol Biol Rep 2023; 50:7027-7041. [PMID: 37382775 DOI: 10.1007/s11033-023-08502-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 04/28/2023] [Indexed: 06/30/2023]
Abstract
Atherosclerosis (AS) is the leading cause of the human cardiovascular diseases (CVDs). Endothelial dysfunction promotes the monocytes infiltration and inflammation that participate fundamentally in atherogenesis. Endothelial cells (EC) have been recognized as mechanosensitive cells and have different responses to distinct mechanical stimuli. Emerging evidence shows matrix stiffness-mediated EC dysfunction plays a vital role in vascular disease, but the underlying mechanisms are not yet completely understood. This article aims to summarize the effect of matrix stiffness on the pro-atherosclerotic characteristics of EC including morphology, rigidity, biological behavior and function as well as the related mechanical signal. The review also discusses and compares the contribution of matrix stiffness-mediated phagocytosis of macrophages and EC to AS progression. These advances in our understanding of the relationship between matrix stiffness and EC dysfunction open the avenues to improve the prevention and treatment of now-ubiquitous atherosclerotic diseases.
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Affiliation(s)
- Zichen Xu
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China
| | - Yi Chen
- Chongqing Engineering Laboratory of Nano/Micro Biomedical Detection, Chongqing Key Laboratory of Nano/Micro Composite Material and Device, School of Metallurgy and Materials Engineering, Chongqing University of Science and Technology, Chongqing, 401331, China
| | - Yi Wang
- College of Basic Medical Sciences, Chongqing Medical University, Chongqing, 400016, China
| | - Wenbo Han
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China
| | - Wenfeng Xu
- Chongqing Engineering Laboratory of Nano/Micro Biomedical Detection, Chongqing Key Laboratory of Nano/Micro Composite Material and Device, School of Metallurgy and Materials Engineering, Chongqing University of Science and Technology, Chongqing, 401331, China
| | - Xiaoling Liao
- Chongqing Engineering Laboratory of Nano/Micro Biomedical Detection, Chongqing Key Laboratory of Nano/Micro Composite Material and Device, School of Metallurgy and Materials Engineering, Chongqing University of Science and Technology, Chongqing, 401331, China
| | - Tao Zhang
- Chongqing Engineering Laboratory of Nano/Micro Biomedical Detection, Chongqing Key Laboratory of Nano/Micro Composite Material and Device, School of Metallurgy and Materials Engineering, Chongqing University of Science and Technology, Chongqing, 401331, China.
| | - Guixue Wang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China.
- Bioengineering College of Chongqing University, NO.174, Shazheng Street, Shapingba District, Chongqing, 400030, PR China.
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Winder NR, Reeve EH, Kronquist EK, Khurana A, Lee B, Nguyen T, Henson GD, Walker AE. High pulse pressure impairs cerebral artery endothelial function in young, but not old, mice. Exp Gerontol 2023; 173:112101. [PMID: 36690049 PMCID: PMC9974894 DOI: 10.1016/j.exger.2023.112101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 01/09/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023]
Abstract
One of the hallmarks of vascular aging is increased pulse pressure. This elevated pulse pressure is associated with deleterious effects on cerebral vascular function; however, it is unknown if age modulates the susceptibility to high pulse pressure. To examine the effects of age on the cerebral artery response to pulse pressure, we studied isolated cerebral arteries collected from young (6.1 ± 0.2 mo) and old (26.7 ± 0.5 mo) male C57BL/6 mice. Isolated cerebral arteries were exposed ex vivo to static pressure, low pulse pressure (25 mmHg), and high pulse pressure (50 mmHg). In cerebral arteries from young mice, endothelium-dependent dilation was similar between the static and low pulse pressure conditions. Exposure to high pulse pressure impaired endothelium-dependent dilation in cerebral arteries from young mice, mediated by less nitric oxide bioavailability and greater oxidative stress. Cerebral arteries from old mice had impaired cerebral artery endothelium-dependent dilation at static pressure compared with young cerebral arteries. However, exposure to low or high pulse pressure did not cause any further impairments to endothelium-dependent dilation in old cerebral arteries compared with static pressure. The old cerebral arteries had less distension during exposure to high pulse pressure and greater stiffness compared with young cerebral arteries. These results indicate that acute exposure to high pulse pressure impairs endothelium-dependent dilation in young, but not old, cerebral arteries. The greater stiffness of cerebral arteries from old mice potentially protects against the negative consequences of high pulse pressure.
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Affiliation(s)
- Nick R Winder
- Department of Human Physiology, University of Oregon, Eugene, OR, USA
| | - Emily H Reeve
- Department of Human Physiology, University of Oregon, Eugene, OR, USA
| | - Elise K Kronquist
- Department of Human Physiology, University of Oregon, Eugene, OR, USA
| | - Aleena Khurana
- Department of Human Physiology, University of Oregon, Eugene, OR, USA
| | - Byron Lee
- Department of Human Physiology, University of Oregon, Eugene, OR, USA
| | - Thuan Nguyen
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
| | - Grant D Henson
- Department of Human Physiology, University of Oregon, Eugene, OR, USA
| | - Ashley E Walker
- Department of Human Physiology, University of Oregon, Eugene, OR, USA.
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Hotta K, Muller-Delp J. Microvascular Adaptations to Muscle Stretch: Findings From Animals and the Elderly. Front Physiol 2022; 13:939459. [PMID: 35860661 PMCID: PMC9289226 DOI: 10.3389/fphys.2022.939459] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Microcirculation in skeletal muscle is disturbed with advancing aging, causing limited capillary blood flow and exercise incapacity. Muscle stretch has been widely performed in physical therapy, sports medicine, and health promotion. However, the effect of stretch on microvascular reactivity and muscle blood flow remains unknown. This review focuses on stretch-induced microvascular adaptations based on evidence from cultured cells, small animals, and human studies. Vascular endothelium senses and responds to mechanical stimuli including stretch. This endothelial mechanotransduction potentially plays a vital role in the stretch-induced microvascular adaptation alongside hypoxia. Aging impairs microvascular endothelial function, but muscle stretch has the potential to restore it. Muscle stretch may be an alternative to improve vascular function and enhance exercising blood flow, especially for those who have difficulties in participating in exercise due to medical, functional, or psychological reasons.
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Affiliation(s)
- Kazuki Hotta
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
- *Correspondence: Kazuki Hotta,
| | - Judy Muller-Delp
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, FL, United States
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Meki M, El-Baz A, Sethu P, Giridharan G. Effects of Pulsatility on Arterial Endothelial and Smooth Muscle Cells. Cells Tissues Organs 2022; 212:272-284. [PMID: 35344966 PMCID: PMC10782761 DOI: 10.1159/000524317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/16/2022] [Indexed: 01/04/2023] Open
Abstract
Continuous flow ventricular assist device (CFVAD) support in advanced heart failure patients causes diminished pulsatility, which has been associated with adverse events including gastrointestinal bleeding, end organ failure, and arteriovenous malformation. Recently, pulsatility augmentation by pump speed modulation has been proposed as a means to minimize adverse events. Pulsatility primarily affects endothelial and smooth muscle cells in the vasculature. To study the effects of pulsatility and pulse modulation using CFVADs, we have developed a microfluidic co-culture model with human aortic endothelial (ECs) and smooth muscle cells (SMCs) that can replicate physiologic pressures, flows, shear stresses, and cyclical stretch. The effects of pulsatility and pulse frequency on ECs and SMCs were evaluated during (1) normal pulsatile flow (120/80 mmHg, 60 bpm), (2) diminished pulsatility (98/92 mmHg, 60 bpm), and (3) low cyclical frequency (115/80 mmHg, 30 bpm). Shear stresses were estimated using computational fluid dynamics (CFD) simulations. While average shear stresses (4.2 dynes/cm2) and flows (10.1 mL/min) were similar, the peak shear stresses for normal pulsatile flow (16.9 dynes/cm2) and low cyclic frequency (19.5 dynes/cm2) were higher compared to diminished pulsatility (6.45 dynes/cm2). ECs and SMCs demonstrated significantly lower cell size with diminished pulsatility compared to normal pulsatile flow. Low cyclical frequency resulted in normalization of EC cell size but not SMCs. SMCs size was higher with low frequency condition compared to diminished pulsatility but did not normalize to normal pulsatility condition. These results may suggest that pressure amplitude augmentation may have a greater effect in normalizing ECs, while both pressure amplitude and frequency may be required to normalize SMCs morphology. The co-culture model may be an ideal platform to study flow modulation strategies.
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Affiliation(s)
- Moustafa Meki
- Bioengineering, University of Louisville, Louisville, KY, USA
| | - Ayman El-Baz
- Bioengineering, University of Louisville, Louisville, KY, USA
| | - Palanaippan Sethu
- Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL, USA
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Salmanpour M, Soori R, H'mida C, Halouani J, Clarck CT, Pournemati P, Yari SM, Trabelsi K, Ammar A, Chtourou H, Taheri M. The effect of 8 weeks of combined interval (resistance-interval training) and combined endurance (endurance-resistance training) on plasma levels of adropin and nitric oxide in males with high blood pressure. Ir J Med Sci 2022; 191:2559-2568. [PMID: 35029793 DOI: 10.1007/s11845-021-02873-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/24/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Nitric oxide (NO) is a vasodilator that plays an important role in blood pressure control. The purpose of the present study was to compare the effect of 8 weeks of resistance-interval and endurance-resistance trainings on plasma levels of adropin and NO in males with hypertension. METHOD Forty-five patients with hypertension were recruited and divided into 3 groups of control (age = 51.1 ± 6.4 years, body mass = 80.4 ± 9.2 kg), resistance-interval training (age = 50.7 ± 5.5 years, body mass = 78.1 ± 11 kg), and endurance-resistance training (age = 52.8 ± 6.1 years, body mass = 79.6 ± 9.2 kg). The resistance training program was performed in 2 sets, 10 to 15 repetitions, with 50% intensity of one repetition maximum. Increasing endurance training was performed for 30-40 min at 60-70% of maximum heart rate (HRmax) on the bike. The high-intensity interval training program consisted of 4 intervals of 80 to 90% of HRmax and 3-min recovery periods of 60 to 70% of HRmax. Blood samples were collected 1 week before the start of the training program and 48 h after the last training session. Plasma levels of adropin and nitrite/nitrate were measured by ELISA before and after the exercise interventions. RESULTS Eight weeks of resistance-interval and endurance-resistance trainings increased plasma levels of adropin and NO and decreased blood pressure (P ≤ 0.05). Furthermore, plasma levels of adropin increased in both exercise groups, whereas NO levels increased only in the endurance-resistance training. Systolic blood pressure decreased in the resistance-interval training (P ≤ 0.05) while it remained unchanged in the endurance-resistance group. CONCLUSION Resistance-interval and endurance-resistance trainings are effective in decreasing blood pressure by increasing cardiorespiratory capacity and plasma levels of adropin and NO.
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Affiliation(s)
| | - Rahman Soori
- Professor of Exercise Physiology, Faculty of Sport and Exercise Sciences, University of Tehran, Tehran, Iran.
| | - Cyrine H'mida
- Institut Supérieur du Sport Et de L'éducation Physique de Sfax, Université de Sfax, Sfax, Tunisia
- Research Laboratory: Education, Motricity, Sport and Health. EM2S, LR19JS01., High Institute of Sport and Physical Education of Sfax., Sfax, Tunisia
| | - Jamel Halouani
- Research Laboratory: Education, Motricity, Sport and Health. EM2S, LR19JS01., High Institute of Sport and Physical Education of Sfax., Sfax, Tunisia
| | - Cain T Clarck
- Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5FB, UK
| | - Parisa Pournemati
- Department of Sport Physiology, Faculty of Physical Education, University of Tehran, Tehran, Iran
| | | | - Khaled Trabelsi
- Institut Supérieur du Sport Et de L'éducation Physique de Sfax, Université de Sfax, Sfax, Tunisia
- Research Laboratory: Education, Motricity, Sport and Health. EM2S, LR19JS01., High Institute of Sport and Physical Education of Sfax., Sfax, Tunisia
| | - Achraf Ammar
- Institute of Sport Science, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
| | - Hamdi Chtourou
- Institut Supérieur du Sport Et de L'éducation Physique de Sfax, Université de Sfax, Sfax, Tunisia
- Activité Physique, Sport et Santé, UR18JS01, Observatoire National du Sport, Tunis, Tunisia
| | - Morteza Taheri
- Department of Sport Sciences, Imam Khomeini International University, Qazvin, Iran
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Sakellariou XM, Papafaklis MI, Domouzoglou EM, Katsouras CS, Michalis LK, Naka KK. Exercise-mediated adaptations in vascular function and structure: Beneficial effects in coronary artery disease. World J Cardiol 2021; 13:399-415. [PMID: 34621486 PMCID: PMC8462042 DOI: 10.4330/wjc.v13.i9.399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/30/2021] [Accepted: 07/21/2021] [Indexed: 02/06/2023] Open
Abstract
Exercise exerts direct effects on the vasculature via the impact of hemodynamic forces on the endothelium, thereby leading to functional and structural adaptations that lower cardiovascular risk. The patterns of blood flow and endothelial shear stress during exercise lead to atheroprotective hemodynamic stimuli on the endothelium and contribute to adaptations in vascular function and structure. The structural adaptations observed in arterial lumen dimensions after prolonged exercise supplant the need for acute functional vasodilatation in case of an increase in endothelial shear stress due to repeated exercise bouts. In contrast, wall thickness is affected by rather systemic factors, such as transmural pressure modulated during exercise by generalized changes in blood pressure. Several mechanisms have been proposed to explain the exercise-induced benefits in patients with coronary artery disease (CAD). They include decreased progression of coronary plaques in CAD, recruitment of collaterals, enhanced blood rheological properties, improvement of vascular smooth muscle cell and endothelial function, and coronary blood flow. This review describes how exercise via alterations in hemodynamic factors influences vascular function and structure which contributes to cardiovascular risk reduction, and highlights which mechanisms are involved in the positive effects of exercise on CAD.
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Affiliation(s)
- Xenofon M Sakellariou
- Michailideion Cardiac Centre, University of Ioannina, Ioannina 45100, Epirus, Greece
| | - Michail I Papafaklis
- Michailideion Cardiac Centre, University of Ioannina, Ioannina 45100, Epirus, Greece
- 2nd Department of Cardiology, University Hospital of Ioannina, Ioannina 45100, Epirus, Greece
| | - Eleni M Domouzoglou
- Michailideion Cardiac Centre, University of Ioannina, Ioannina 45100, Epirus, Greece
- Department of Pediatrics, University Hospital of Ioannina, Ioannina 45100, Epirus, Greece
| | - Christos S Katsouras
- Michailideion Cardiac Centre, University of Ioannina, Ioannina 45100, Epirus, Greece
- 2nd Department of Cardiology, University Hospital of Ioannina, Ioannina 45100, Epirus, Greece
| | - Lampros K Michalis
- Michailideion Cardiac Centre, University of Ioannina, Ioannina 45100, Epirus, Greece
- 2nd Department of Cardiology, University Hospital of Ioannina, Ioannina 45100, Epirus, Greece
| | - Katerina K Naka
- Michailideion Cardiac Centre, University of Ioannina, Ioannina 45100, Epirus, Greece
- 2nd Department of Cardiology, University Hospital of Ioannina, Ioannina 45100, Epirus, Greece
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10
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Yu H, Kang D, Whang M, Kim T, Kim J. A Microfluidic Model Artery for Studying the Mechanobiology of Endothelial Cells. Adv Healthc Mater 2021; 10:e2100508. [PMID: 34297476 DOI: 10.1002/adhm.202100508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/25/2021] [Indexed: 11/07/2022]
Abstract
Recent vascular mechanobiology studies find that endothelial cells (ECs) convert multiple mechanical forces into functional responses in a nonadditive way, suggesting that signaling pathways such as those regulating cytoskeleton may be shared among the processes of converting individual forces. However, previous in vitro EC-culture platforms are inherent with extraneous mechanical components, which may saturate or insufficiently activate the shared signaling pathways and accordingly, may misguide EC mechanobiological responses being investigated. Here, a more physiologically relevant model artery is reported that accurately reproduces most of the mechanical forces found in vivo, which can be individually varied in any combination to pathological levels to achieve diseased states. Arterial geometries of normal and diseased states are also realized. By mimicking mechanical microenvironments of early-stage atherosclerosis, it is demonstrated that the elevated levels of the different types of stress experienced by ECs strongly correlate with the disruption of barrier integrity, suggesting that boundaries of an initial lesion could be sites for efficient disease progression.
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Affiliation(s)
- Hyeonji Yu
- Department of Chemical and Biomolecular Engineering, Sogang University, Seoul, 04107, Republic of Korea
| | - Dongwon Kang
- Department of Chemical and Biomolecular Engineering, Sogang University, Seoul, 04107, Republic of Korea
| | - Minji Whang
- Department of Chemical and Biomolecular Engineering, Sogang University, Seoul, 04107, Republic of Korea
| | - Taeyoung Kim
- Department of Chemical and Biomolecular Engineering, Sogang University, Seoul, 04107, Republic of Korea
| | - Jungwook Kim
- Department of Chemical and Biomolecular Engineering, Sogang University, Seoul, 04107, Republic of Korea
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11
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Yuan J, Li Y, Sun J. Pulmonary Congestion Due to Right and Left Heart Output Mismatching: A Case Report and Literature Review. Front Physiol 2021; 12:665483. [PMID: 33927647 PMCID: PMC8076790 DOI: 10.3389/fphys.2021.665483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/19/2021] [Indexed: 11/13/2022] Open
Abstract
We report a new pulmonary circulation model during cardiopulmonary bypass that is able to cause pulmonary congestion but without left heart failure. This kind of congestion is characterized by right and left heart output mismatching. The pathophysiological mechanism, clinical manifestations, diagnosis, differential diagnosis, and treatment of this pulmonary congestion are reviewed and discussed in the following article.
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Affiliation(s)
- Jing Yuan
- Department of Anesthesiology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Yongjun Li
- Department of Anesthesiology, Lianshui County People's Hospital, Huai'an, China
| | - Jie Sun
- Department of Anesthesiology, Zhongda Hospital, Southeast University, Nanjing, China
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12
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Zhu Y, Yang M, Zhang Y, Meng F, Yang T, Fang Z. Effects of Pulsatile Frequency of Left Ventricular Assist Device (LVAD) on Coronary Perfusion: A Numerical Simulation Study. Med Sci Monit 2020; 26:e925367. [PMID: 32940255 PMCID: PMC7521069 DOI: 10.12659/msm.925367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Left ventricular assist devices (LVADs) with counter-pulsation mode have been widely used to support left ventricular function and improve coronary circulation. However, the frequency characteristics of the coronary system have not been considered. The aim of this study was to investigate the effects of pulsatile frequency of LVADs on coronary perfusion. Material/Methods First, a lumped parameter (LP) model incorporating coronary circulation, systemic circulation, left heart, and LVAD was established to simulate the cardiovascular system. Then, the frequency characteristics of the coronary system were analyzed and the calculation results showed that the pulsatile frequency of the LVAD has a substantial effect on coronary blood flow. To verify the accuracy of the theoretical analysis, the hemodynamic effects of the LVAD on the coronary artery were compared under 4 support modes: co-pulsation mode, and counter-pulsation modes in synchronization ratios of 1: 1, 2: 1, and 3: 1. Results We found that the coronary flow increased by 5% when the working mode changed from co-pulsation to counter-pulsation in a synchronization ratio of 1: 1, and by an additional 6% when the working mode changed from counter-pulsation in a synchronization ratio of 1: 1 to counter-pulsation in a synchronization ratio of 3: 1. Conclusions This work provides a useful method to increase coronary perfusion and may be beneficial for improving myocardial function in patients with end-stage heart failure, especially those with ischemic cardiomyopathy (ICM).
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Affiliation(s)
- Yuanfei Zhu
- Department of Instrument Science and Engineering, Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Ming Yang
- Department of Instrument Science and Engineering, Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Yan Zhang
- Department of Cardiovascular Surgery, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (mainland)
| | - Fan Meng
- Department of Instrument Science and Engineering, Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Tianyue Yang
- Department of Instrument Science and Engineering, Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Zhiwei Fang
- Department of Instrument Science and Engineering, Shanghai Jiao Tong University, Shanghai, China (mainland)
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Clerkin KJ, Mancini DM, Stehlik J, Cherikh WS, Lund LH. Continuous-flow mechanical circulatory support is not associated with early graft failure: An analysis of the International Society for Heart and Lung Transplantation registry. Clin Transplant 2019; 33:e13752. [PMID: 31693247 DOI: 10.1111/ctr.13752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/20/2019] [Accepted: 10/25/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Continuous-flow mechanical circulatory support (CF-MCS) is associated with impaired vascular function and increased risk of vasoplegia. One contributing factor to early graft failure (EGF) is severe vasoplegia. We tested the hypothesis that CF-MCS is associated with increased risk of EGF. METHODS Adult primary heart transplant recipients in the ISHLT Registry from 2005 to 2013 were stratified into three groups based on pre-transplant MCS: No MCS (n = 11 748), pulsatile (P)-MCS (n = 718), and CF-MCS (n = 3818). EGF was defined as death/retransplantation due to graft failure within 30 days after HT. Comparisons were made using descriptive statistics and associations. EGF was assessed with multivariable Cox proportional hazard regression. RESULTS The incidence of EGF within 30 days was similar between groups (No MCS 2.2%, P-MCS 3.3%, CF-MCS 2.1%, P = .10). Following multivariable adjustment, the risk of EGF was not statistically different for those with CF-MCS compared with P-MCS (HR 0.75, 95% CI 0.46-1.21, P = .24). The risk of EGF was numerically, but not statistically significantly higher for CF-MCS compared with No MCS (HR 1.24, 95% CI 0.92-1.67, P = .16). CONCLUSION CF-MCS use was not associated with a statistically significant increased risk of EGF resulting in death or retransplantation in the first 30 days after transplant.
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Affiliation(s)
- Kevin J Clerkin
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Donna M Mancini
- Department of Medicine, Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Josef Stehlik
- Department of Medicine, Division of Cardiology, University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Lars H Lund
- Department of Medicine, Karolinska Institutet & Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
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14
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Meza D, Musmacker B, Steadman E, Stransky T, Rubenstein DA, Yin W. Endothelial Cell Biomechanical Responses are Dependent on Both Fluid Shear Stress and Tensile Strain. Cell Mol Bioeng 2019; 12:311-325. [PMID: 31719917 DOI: 10.1007/s12195-019-00585-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 06/28/2019] [Indexed: 12/15/2022] Open
Abstract
Introduction The goal of this study was to investigate how concurrent shear stress and tensile strain affect endothelial cell biomechanical responses. Methods Human coronary artery endothelial cells were exposed to concurrent pulsatile shear stress and cyclic tensile strain in a programmable shearing and stretching device. Three shear stress-tensile strain conditions were used: (1) pulsatile shear stress at 1 Pa and cyclic tensile strain at 7%, simulating normal stress/strain conditions in a healthy coronary artery; (2) shear stress at 3.7 Pa and tensile strain at 3%, simulating pathological stress/strain conditions near a stenosis; (3) shear stress at 0.7 Pa and tensile strain at 5%, simulating pathological stress/strain conditions in a recirculation zone. Cell morphology was quantified using immunofluorescence microscopy. Cell surface PECAM-1 phosphorylation, ICAM-1 expression, ERK1/2 and NF-κB activation were measured using ELISA or Western blot. Results Simultaneous stimulation from pulsatile shear stress and cyclic tensile strain induced a significant increase in cell area, compared to that induced by shear stress or tensile strain alone. The combined stimulation caused significant increases in PECAM-1 phosphorylation. The combined stimulation also significantly enhanced EC surface ICAM-1 expression (compared to that under shear stress alone) and transcriptional factor NF-κB activation (compared to that under control conditions). Conclusion Pulsatile shear stress and cyclic tensile strain could induce increased but not synergistic effect on endothelial cell morphology or activation. The combined mechanical stimulation can be relayed from cell membrane to nucleus. Therefore, to better understand how mechanical conditions affect endothelial cell mechanotransduction and cardiovascular disease development, both shear stress and tensile strain need to be considered.
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Affiliation(s)
- Daphne Meza
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794 USA
| | - Bryan Musmacker
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794 USA
| | - Elisabeth Steadman
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794 USA
| | - Thomas Stransky
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794 USA
| | - David A Rubenstein
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794 USA
| | - Wei Yin
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794 USA
- Stony Brook University, Bioengineering Building, Room 109, Stony Brook, NY 11794 USA
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15
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Impact and Measurement of Blood Pressure During Continuous Flow Left Ventricular Assist Device Support: The Pressure Is On! ASAIO J 2019; 65:101-103. [PMID: 30688719 DOI: 10.1097/mat.0000000000000960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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16
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Gu K, Zhang Z, Chang Y, Gao B, Wan F. Computational analysis of the hemodynamic characteristics under interaction influence of β-blocker and LVAD. Biomed Eng Online 2018; 17:178. [PMID: 30509276 PMCID: PMC6276231 DOI: 10.1186/s12938-018-0602-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 11/09/2018] [Indexed: 12/12/2022] Open
Abstract
Background Hemodynamic characteristics of the interaction influence among support level and model of LVAD, and coupling β-blocker has not been reported. Methods In this study, the effect of support level and model of LVAD on cardiovascular hemodynamic characteristics is investigated. In addition, the effect of β-blocker on unloading with LVAD is analyzed to elucidate the mechanism of LVAD coupling β-blocker. A multi-scale model from cell level to system level is proposed. Moreover, LVAD coupling β-blocker has been researching to explain the hemodynamics of cardiovascular system. Results Myocardial force was decreased along with the increase of support level of LVAD, and co-pulse mode was the lowest among the three support modes. Additionally, the β-blocker combined with LVAD significantly reduced the left ventricular volume compared with LVAD support without β-blocker. However, the left ventricular pressure under both cases has no significant difference. External work of right ventricular was increased along with the growth of support level of only LVAD. The LVAD under co-pulse mode achieved the lowest right-ventricular EW among the three support modes. Conclusions Co-pulse mode with β-blocker could be an optimal strategy for promoting cardiac structure and function recovery.
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Affiliation(s)
- Kaiyun Gu
- Peking University Third Hospital, Peking University Health Science Center, 49 North Garden Rd, Haidian District, Beijing, 100191, China
| | - Zhe Zhang
- Peking University Third Hospital, Peking University Health Science Center, 49 North Garden Rd, Haidian District, Beijing, 100191, China.
| | - Yu Chang
- College of Life Science & Bio-Engineering, Beijing University of Technology, Beijing, 100124, China.
| | - Bin Gao
- College of Life Science & Bio-Engineering, Beijing University of Technology, Beijing, 100124, China
| | - Feng Wan
- Peking University Third Hospital, Peking University Health Science Center, 49 North Garden Rd, Haidian District, Beijing, 100191, China
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Haglund TA, Rajasekaran NS, Smood B, Giridharan GA, Hoopes CW, Holman WL, Mauchley DC, Prabhu SD, Pamboukian SV, Tallaj JA, Rajapreyar IN, Kirklin JK, Sethu P. Evaluation of flow-modulation approaches in ventricular assist devices using an in-vitro endothelial cell culture model. J Heart Lung Transplant 2018; 38:456-465. [PMID: 30503074 DOI: 10.1016/j.healun.2018.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 09/11/2018] [Accepted: 10/24/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Continuous-flow ventricular assist devices (CF-VADs) produce non-physiologic flow with diminished pulsatility, which is a major risk factor for development of adverse events, including gastrointestinal (GI) bleeding and arteriovenous malformations (AVMs). Introduction of artificial pulsatility by modulating CF-VAD flow has been suggested as a potential solution. However, the levels of pulsatility and frequency of CF-VAD modulation necessary to prevent adverse events are currently unknown and need to be evaluated. METHODS The purpose of this study was to use human aortic endothelial cells (HAECs) cultured within an endothelial cell culture model (ECCM) to: (i) identify and validate biomarkers to determine the effects of pulsatility; and (ii) conclude whether introduction of artificial pulsatility using flow-modulation approaches can mitigate changes in endothelial cells seen with diminished pulsatile flow. Nuclear factor erythroid 2-related factor 2 (Nrf-2)-regulated anti-oxidant genes and proteins and the endothelial nitric oxide synthase/endothelin-1 (eNOS/ET-1) signaling pathway are known to be differentially regulated in response to changes in pulsatility. RESULTS Comparison of HAECs cultured within the ECCM (normal pulsatile vs CF-VAD) with aortic wall samples from patients (normal pulsatile [n = 5] vs CF-VADs [n = 5]) confirmed that both the Nrf-2-activated anti-oxidant response and eNOS/ET-1 signaling pathways were differentially regulated in response to diminished pulsatility. Evaluation of 2 specific CF-VAD flow-modulation protocols to introduce artificial pulsatility, synchronous (SYN, 80 cycles/min, pulse pressure 20 mm Hg) and asynchronous (ASYN, 40 cycles/min, pulse pressure 45 mm Hg), suggested that both increased expression of Nrf-2-regulated anti-oxidant genes and proteins along with changes in levels of eNOS and ET-1 can potentially be minimized with ASYN and, to a lesser extent, with SYN. CONCLUSIONS HAECs cultured within the ECCM can be used as an accurate model of large vessels in patients to identify biomarkers and select appropriate flow-modulation protocols. Pressure amplitude may have a greater effect in normalizing anti-oxidant response compared with frequency of modulation.
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Affiliation(s)
- Thomas A Haglund
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA; Department of Biomedical Engineering, School of Engineering, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Namakkal S Rajasekaran
- Division of Molecular and Cellular Pathology, Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA; Division of Cardiovascular Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA; School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Benjamin Smood
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Guruprasad A Giridharan
- Department of Bioengineering, Speed School of Engineering, University of Louisville, Louisville, Kentucky, USA
| | - Charles W Hoopes
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - William L Holman
- Department of Bioengineering, Speed School of Engineering, University of Louisville, Louisville, Kentucky, USA
| | - David C Mauchley
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sumanth D Prabhu
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Salpy V Pamboukian
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jose A Tallaj
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Indranee N Rajapreyar
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James K Kirklin
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Palaniappan Sethu
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA; Department of Biomedical Engineering, School of Engineering, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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18
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The Physiological Rationale for Incorporating Pulsatility in Continuous-Flow Left Ventricular Assist Devices. Cardiol Rev 2018; 26:294-301. [DOI: 10.1097/crd.0000000000000202] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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19
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Sajgalik P, Kim CH, Stulak JM, Kushwaha SS, Maltais S, Joyce DL, Joyce LD, Johnson BD, Schirger JA. Pulmonary function assessment post-left ventricular assist device implantation. ESC Heart Fail 2018; 6:53-61. [PMID: 30311748 PMCID: PMC6351887 DOI: 10.1002/ehf2.12348] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 07/26/2018] [Indexed: 12/22/2022] Open
Abstract
Aim The lungs—and particularly the alveolar‐capillary membrane—may be sensitive to continuous flow (CF) and pulmonary pressure alterations in heart failure (HF). We aimed to investigate long‐term effects of CF pumps on respiratory function. Methods and results We conducted a retrospective study of patients with end‐stage HF at our institution. We analysed pulmonary function tests [e.g. forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1)] and diffusing capacity of the lung for carbon monoxide (DLCO) from before and after left ventricular assist device (LVAD) implantation and compared them with invasive haemodynamic studies. Of the 274 patients screened, final study analysis involved 44 patients with end‐stage HF who had CF LVAD implantation between 1 February 2007 and 31 December 2015 at our institution. These patients [mean (standard deviation, SD) age, 50 (9) years; male sex, n = 33, 75%] received either the HeartMate II (Thoratec Corp.) pump (77%) or the HeartWare (HeartWare International Inc.) pump. The mean (SD) left ventricular ejection fraction was 21% (13%). At a median of 237 days post‐LVAD implantation, we observed significant DLCO decrease (−23%) since pre‐implantation (P < 0.001). ΔDLCO had an inverse relationship with changes in pulmonary capillary wedge pressure (PCWP) and right atrial pressure (RAP) from pre‐LVAD to post‐LVAD implantation: ΔDLCO to ΔPCWP (r = 0.50, P < 0.01) and ΔDLCO to ΔRAP (r = 0.39, P < 0.05). We observed other reductions in FEV1, FVC, and FEV1/FVC between pre‐LVAD and post‐LVAD implantation. In mean (SD) values, FEV1 changed from 2.3 (0.7) to 2.1 (0.7) (P = 0.005); FVC decreased from 3.2 (0.8) to 2.9 (0.9) (P = 0.01); and FEV1/FVC went from 0.72 (0.1) to 0.72 (0.1) (P = 0.50). Landmark survival analysis revealed that ΔDLCO from 6 months after LVAD implantation was predictive of death for HF patients [hazard ratio (95% confidence interval), 0.60 (0.28–0.98); P = 0.03]. Conclusions Pulmonary function did not improve after LVAD implantation. The degree of DLCO deterioration is related to haemodynamic status post‐LVAD implantation. The ΔDLCO within 6 months post‐operative was associated with survival.
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Affiliation(s)
- Pavol Sajgalik
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Chul-Ho Kim
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sudhir S Kushwaha
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Simon Maltais
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - David L Joyce
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Lyle D Joyce
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Bruce D Johnson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - John A Schirger
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
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20
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Purohit SN, Cornwell WK, Pal JD, Lindenfeld J, Ambardekar AV. Living Without a Pulse: The Vascular Implications of Continuous-Flow Left Ventricular Assist Devices. Circ Heart Fail 2018; 11:e004670. [PMID: 29903893 PMCID: PMC6007027 DOI: 10.1161/circheartfailure.117.004670] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pulsatility seems to have a teleological role because evolutionary hierarchy favors higher ordered animals with more complex, multichamber circulatory systems that generate higher pulse pressure compared with lower ordered animals. Yet despite years of such natural selection, the modern generation of continuous-flow left ventricular assist devices (CF-LVADs) that have been increasingly used for the last decade have created a unique physiology characterized by a nonpulsatile, nonlaminar blood flow profile with the absence of the usual large elastic artery Windkessel effect during diastole. Although outcomes and durability have improved with CF-LVADs, patients supported with CF-LVADs have a high rate of complications that were not as frequently observed with older pulsatile devices, including gastrointestinal bleeding from arteriovenous malformations, pump thrombosis, and stroke. Given the apparent fundamental biological role of the pulse, the purpose of this review is to describe the normal physiology of ventricular-arterial coupling from pulsatile flow, the effects of heart failure on this physiology and the vasculature, and to examine the effects of nonpulsatile blood flow on the vascular system and potential role in complications seen with CF-LVAD therapy. Understanding these concomitant vascular changes with CF-LVADs may be a key step in improving patient outcomes as modulation of pulsatility and flow characteristics may serve as a novel, yet simple, therapy for reducing complications.
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Affiliation(s)
- Suneet N Purohit
- Division of Cardiology, Department of Medicine (S.N.P., W.K.C, A.V.A.)
| | | | - Jay D Pal
- Division of Cardiothoracic Surgery, Department of Surgery (J.D.P.)
| | - JoAnn Lindenfeld
- University of Colorado, Aurora. Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.)
| | - Amrut V Ambardekar
- Division of Cardiology, Department of Medicine (S.N.P., W.K.C, A.V.A.)
- Consortium for Fibrosis Research and Translation (A.V.A.)
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Leloup A, De Moudt S, Van Hove C, Fransen P. Cyclic Stretch Alters Vascular Reactivity of Mouse Aortic Segments. Front Physiol 2017; 8:858. [PMID: 29163203 PMCID: PMC5674939 DOI: 10.3389/fphys.2017.00858] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/13/2017] [Indexed: 11/13/2022] Open
Abstract
Large, elastic arteries buffer the pressure wave originating in the left ventricle and are constantly exposed to higher amplitudes of cyclic stretch (10%) than muscular arteries (2%). As a crucial factor for endothelial and smooth muscle cell function, cyclic stretch has, however, never been studied in ex vivo aortic segments of mice. To investigate the effects of cyclic stretch on vaso-reactivity of mouse aortic segments, we used the Rodent Oscillatory Tension Set-up to study Arterial Compliance (ROTSAC). The aortic segments were clamped at frequencies of 6–600 bpm between two variable preloads, thereby mimicking dilation as upon left ventricular systole and recoiling as during diastole. The preloads corresponding to different transmural pressures were chosen to correspond to a low, normal or high amplitude of cyclic stretch. At different time intervals, cyclic stretch was interrupted, the segments were afterloaded and isometric contractions by α1-adrenergic stimulation with 2 μM phenylephrine in the absence and presence of 300 μM L-NAME (eNOS inhibitor) and/or 35 μM diltiazem (blocker of voltage-gated Ca2+ channels) were measured. As compared with static or cyclic stretch at low amplitude (<10 mN) or low frequency (0.1 Hz), cyclic stretch at physiological amplitude (>10 mN) and frequency (1–10 Hz) caused better ex vivo conservation of basal NO release with time after mounting. The relaxation of PE-precontracted segments by addition of ACh to stimulate NO release was unaffected by cyclic stretch. In the absence of basal NO release (hence, presence of L-NAME), physiological in comparison with aberrant cyclic stretch decreased the baseline tension, attenuated the phasic contraction by phenylephrine in the absence of extracellular Ca2+ and shifted the smaller tonic contraction more from a voltage-gated Ca2+ channel-mediated to a non-selective cation channel-mediated. Data highlight the need of sufficient mechanical activation of endothelial and vascular smooth muscle cells to maintain basal NO release and low intracellular Ca2+ in the smooth muscle cells in large arteries. Both phenomena may play a vital role in maintaining the high compliance of large arteries.
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Affiliation(s)
- Arthur Leloup
- Laboratory of Physiopharmacology, Department of Pharmaceutical Sciences, University of Antwerp, Antwerp, Belgium
| | - Sofie De Moudt
- Laboratory of Physiopharmacology, Department of Pharmaceutical Sciences, University of Antwerp, Antwerp, Belgium
| | - Cor Van Hove
- Laboratory of Pharmacology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Paul Fransen
- Laboratory of Physiopharmacology, Department of Pharmaceutical Sciences, University of Antwerp, Antwerp, Belgium
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Abstract
An increasing number of end-stage heart failure patients are now implanted with continuous-flow left ventricular assist devices (CF-LVADs). Although this therapeutic approach is associated with improved clinical outcomes, continuous flow physiology reduces arterial pulse pressure and pulsatility to an extent that is unique to this population. Recent data suggest that high blood pressure (BP) contributes to life-threatening complications such as pump thrombosis and stroke of CF-LVAD patients. However, limited understanding of the distinct hemodynamics of these pumps makes measurement and, consequently, medical management of BP quite challenging. Here, we review the evolution of LVAD design, the impact of CF-LVAD flow, and "artificial pulse" technology on hemodynamics and BP measurement, as well as suggest new approaches for the assessment and interpretation of the unique physiology of modern LVADs.
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Patel AK, Suri HS, Singh J, Kumar D, Shafique S, Nicolaides A, Jain SK, Saba L, Gupta A, Laird JR, Giannopoulos A, Suri JS. A Review on Atherosclerotic Biology, Wall Stiffness, Physics of Elasticity, and Its Ultrasound-Based Measurement. Curr Atheroscler Rep 2017; 18:83. [PMID: 27830569 DOI: 10.1007/s11883-016-0635-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Functional and structural changes in the common carotid artery are biomarkers for cardiovascular risk. Current methods for measuring functional changes include pulse wave velocity, compliance, distensibility, strain, stress, stiffness, and elasticity derived from arterial waveforms. The review is focused on the ultrasound-based carotid artery elasticity and stiffness measurements covering the physics of elasticity and linking it to biological evolution of arterial stiffness. The paper also presents evolution of plaque with a focus on the pathophysiologic cascade leading to arterial hardening. Using the concept of strain, and image-based elasticity, the paper then reviews the lumen diameter and carotid intima-media thickness measurements in combined temporal and spatial domains. Finally, the review presents the factors which influence the understanding of atherosclerotic disease formation and cardiovascular risk including arterial stiffness, tissue morphological characteristics, and image-based elasticity measurement.
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Affiliation(s)
- Anoop K Patel
- Department of Computer Engineering, NIT, Kurukshetra, India
| | | | - Jaskaran Singh
- Department of Computer Engineering, NIT, Kurukshetra, India
| | - Dinesh Kumar
- Point-of-Care Devices, Global Biomedical Technologies, Inc., Roseville, CA, USA
| | | | | | - Sanjay K Jain
- Department of Computer Engineering, NIT, Kurukshetra, India
| | - Luca Saba
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | - Ajay Gupta
- Radiology Department, Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, USA
| | - John R Laird
- UC Davis Vascular Center, University of California, Davis, CA, USA
| | | | - Jasjit S Suri
- Vascular Diagnostic Center, University of Cyprus, Nicosia, Cyprus. .,Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA. .,Department of Electrical Engineering, University of Idaho (Affl.), Moscow, ID, USA. .,Diagnosis and Stroke Monitoring Division, AtheroPoint™, Roseville, CA, USA.
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Cardiovascular Responses to Skeletal Muscle Stretching: “Stretching” the Truth or a New Exercise Paradigm for Cardiovascular Medicine? Sports Med 2017; 47:2507-2520. [DOI: 10.1007/s40279-017-0768-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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25
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Acute Effect of Static Stretching Exercise on Arterial Stiffness in Healthy Young Adults. Am J Phys Med Rehabil 2017; 95:764-70. [PMID: 27088470 DOI: 10.1097/phm.0000000000000498] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Habitual stretching exercise increases carotid arterial compliance, and acute stretching exercise increases arterial compliance in patients with myocardial infarction. However, it is not known whether this arterial adaptation is sustained after exercise. The aim of this study was to examine the effect of a single bout of stretching exercise on the time course of systemic, central, and peripheral arterial stiffness in healthy young subjects. DESIGN Twenty-six healthy young men performed static stretching exercise involving the entire body (trunk, upper limb, and lower limb) for 40 mins. Pulse-wave velocity (PWV; an index of arterial stiffness), blood pressure, and heart rate were measured before and 0, 15, 30, and 60 mins after stretching exercise. RESULTS Femoral-ankle PWV and brachial-ankle PWV were reduced relative to baseline 15 and 30 mins after acute stretching (P < 0.05); however, these arterial responses were not sustained for longer periods, and both PWV values returned to the baseline levels within 60 mins. By contrast, carotid-femoral PWV was unchanged. CONCLUSION These results suggest that chronic and sufficient repetition of muscle stretch stimulation may result in chronic high arterial compliance, although a single bout of stretch exercise acutely affects arterial compliance.
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Disturbed Cyclical Stretch of Endothelial Cells Promotes Nuclear Expression of the Pro-Atherogenic Transcription Factor NF-κB. Ann Biomed Eng 2016; 45:898-909. [PMID: 27796516 PMCID: PMC5362665 DOI: 10.1007/s10439-016-1750-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 10/15/2016] [Indexed: 12/25/2022]
Abstract
Exposure of endothelial cells to low and multidirectional blood flow is known to promote a pro-atherogenic phenotype. The mechanics of the vessel wall is another important mechano-stimulus within the endothelial cell environment, but no study has examined whether changes in the magnitude and direction of cell stretch can be pro-atherogenic. Herein, we developed a custom cell stretching device to replicate the in vivo stretch environment of the endothelial cell and examined whether low and multidirectional stretch promote nuclear translocation of NF-κB. A fluid–structure interaction model of the device demonstrated a nearly uniform strain within the region of cell attachment and a negligible magnitude of shear stress due to cyclical stretching of the cells in media. Compared to normal cyclical stretch, a low magnitude of cyclical stretch or no stretch caused increased expression of nuclear NF-κB (p = 0.09 and p < 0.001, respectively). Multidirectional stretch also promoted significant nuclear NF-κB expression, comparable to the no stretch condition, which was statistically higher than the low (p < 0.001) and normal (p < 0.001) stretch conditions. This is the first study to show that stretch conditions analogous to atherogenic blood flow profiles can similarly promote a pro-atherogenic endothelial cell phenotype, which supports a role for disturbed vessel wall mechanics as a pathological cell stimulus in the development of advanced atherosclerotic plaques.
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Sajgalik P, Grupper A, Edwards BS, Kushwaha SS, Stulak JM, Joyce DL, Joyce LD, Daly RC, Kara T, Schirger JA. Current Status of Left Ventricular Assist Device Therapy. Mayo Clin Proc 2016; 91:927-40. [PMID: 27378038 DOI: 10.1016/j.mayocp.2016.05.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 04/22/2016] [Accepted: 05/03/2016] [Indexed: 02/05/2023]
Abstract
Congestive heart failure (HF) remains a serious burden in the Western World. Despite advances in pharmacotherapy and resynchronization, many patients have progression to end-stage HF. These patients may be candidates for heart transplant or left ventricular assist device (LVAD) therapy. Heart transplants are limited by organ shortages and in some cases by patient comorbidities; therefore, LVAD therapy is emerging as a strategy of bridge to transplant or as a destination therapy in patients ineligible for transplant. Patients initially ineligible for a transplant may, in certain cases, become eligible for transplant after physiologic improvement with LVAD therapy, and a small number of patients with an LVAD may have sufficient recovery of myocardial function to allow device explantation. This clinically oriented review will describe (1) the most frequently used pump types and aspects of the continuous-flow physiology and (2) the clinical indications for and the shift toward the use of LVADs in less sick patients with HF. Additionally, we review complications of LVAD therapy and project future directions in this field. We referred to the Interagency Registry for Mechanically Assisted Circulatory Support, landmark trials, and results from recently published studies as major sources in obtaining recent outcomes, and we searched for related published literature via PubMed. This review focuses primarily on clinical practice for primary care physicians and non-HF cardiologists in the United States.
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Affiliation(s)
- Pavol Sajgalik
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; Department of Internal Medicine, Cardioangiology, International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Avishay Grupper
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Brook S Edwards
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - John M Stulak
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - David L Joyce
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Lyle D Joyce
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Richard C Daly
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Tomas Kara
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; Department of Internal Medicine, Cardioangiology, International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - John A Schirger
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
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Palombo C, Kozakova M. Arterial stiffness, atherosclerosis and cardiovascular risk: Pathophysiologic mechanisms and emerging clinical indications. Vascul Pharmacol 2015; 77:1-7. [PMID: 26643779 DOI: 10.1016/j.vph.2015.11.083] [Citation(s) in RCA: 293] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 08/25/2015] [Accepted: 11/26/2015] [Indexed: 12/14/2022]
Abstract
Arterial stiffness results from a degenerative process affecting mainly the extracellular matrix of elastic arteries under the effect of aging and risk factors. Changes in extracellular matrix proteins and in the mechanical properties of the vessel wall related to arterial stiffening may activate number of mechanisms involved also in the process of atherosclerosis. Several noninvasive methods are now available to estimate large artery stiffness in the clinical setting, including carotid-femoral pulse wave velocity, the reference for aortic stiffness estimate, and local distensibility measures of superficial arteries, namely carotid and femoral. An independent predictive value of arterial stiffness for cardiovascular events has been demonstrated in general as well as in selected populations, and reference values adjusted for age and blood pressure have been established. Thus, arterial stiffness is emerging as an interesting tissue biomarker for cardiovascular risk stratification and estimation of the individual "biological age". This paper overviews the mechanisms accounting for development and progression of arterial stiffness and for associations between arterial stiffness, atherosclerotic burden and incident cardiovascular events, summarizes the evidence and caveat for clinical use of stiffness as surrogate marker of cardiovascular risk, and briefly outlines some emerging methods for large artery stiffness characterization.
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Affiliation(s)
- Carlo Palombo
- Department of Surgical, Medical and Molecular Pathology and Critical Area Medicine, University of Pisa, Italy.
| | - Michaela Kozakova
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
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Davis CA, Zambrano S, Anumolu P, Allen ACB, Sonoqui L, Moreno MR. Device-Based In Vitro Techniques for Mechanical Stimulation of Vascular Cells: A Review. J Biomech Eng 2015; 137:040801. [DOI: 10.1115/1.4029016] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 11/07/2014] [Indexed: 01/19/2023]
Abstract
The most common cause of death in the developed world is cardiovascular disease. For decades, this has provided a powerful motivation to study the effects of mechanical forces on vascular cells in a controlled setting, since these cells have been implicated in the development of disease. Early efforts in the 1970 s included the first use of a parallel-plate flow system to apply shear stress to endothelial cells (ECs) and the development of uniaxial substrate stretching techniques (Krueger et al., 1971, “An in Vitro Study of Flow Response by Cells,” J. Biomech., 4(1), pp. 31–36 and Meikle et al., 1979, “Rabbit Cranial Sutures in Vitro: A New Experimental Model for Studying the Response of Fibrous Joints to Mechanical Stress,” Calcif. Tissue Int., 28(2), pp. 13–144). Since then, a multitude of in vitro devices have been designed and developed for mechanical stimulation of vascular cells and tissues in an effort to better understand their response to in vivo physiologic mechanical conditions. This article reviews the functional attributes of mechanical bioreactors developed in the 21st century, including their major advantages and disadvantages. Each of these systems has been categorized in terms of their primary loading modality: fluid shear stress (FSS), substrate distention, combined distention and fluid shear, or other applied forces. The goal of this article is to provide researchers with a survey of useful methodologies that can be adapted to studies in this area, and to clarify future possibilities for improved research methods.
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Affiliation(s)
- Caleb A. Davis
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843-3120 e-mail:
| | - Steve Zambrano
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843-3120 e-mail:
| | - Pratima Anumolu
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843-3120 e-mail:
| | - Alicia C. B. Allen
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712-1801 e-mail:
| | - Leonardo Sonoqui
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843-3120 e-mail:
| | - Michael R. Moreno
- Department of Mechanical Engineering, Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843-3123 e-mail:
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Cheng A, Williamitis CA, Slaughter MS. Comparison of continuous-flow and pulsatile-flow left ventricular assist devices: is there an advantage to pulsatility? Ann Cardiothorac Surg 2014; 3:573-81. [PMID: 25512897 DOI: 10.3978/j.issn.2225-319x.2014.08.24] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 08/23/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Continuous-flow left ventricular assist devices (CFVAD) are currently the most widely used type of mechanical circulatory support as bridge-to-transplant and destination therapy for end-stage congestive heart failure (HF). Compared to the first generation pulsatile-flow left ventricular assist devices (PFVADs), CFVADs have demonstrated improved reliability and durability. However, CFVADs have also been associated with certain complications thought to be linked with decreased arterial pulsatility. Previous studies comparing CFVADs and PFVADs have presented conflicting results. It is important to understand the outcome differences between CFVAD and PFVAD in order to further advance the current VAD technology. METHODS In this review, we compared the outcomes of CFVADs and PFVADs and examined the need for arterial pulsatility for the future generation of mechanical circulatory support. RESULTS CVADs offer advantages of smaller size, increased reliability and durability, and subsequent improvements in survival. However, with the increasing duration of long-term support, it appears that CFVADs may have specific complications and a lower rate of left ventricular recovery associated with diminished pulsatility, increased pressure gradients on the aortic valve and decreased compliance in smaller arterial vessels. PFVAD support or pulsatility control algorithms in CFVADs could be beneficial and potentially necessary for long term support. CONCLUSIONS Given the relative advantages and disadvantages of CFVADs and PFVADs, the ultimate solution may lie in incorporating pulsatility into current and emerging CFVADs whilst retaining their existing benefits. Future studies examining physiologic responses, end-organ function and LV remodeling at varying degrees of pulsatility and device support levels are needed.
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Affiliation(s)
- Allen Cheng
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky 40202, USA
| | - Christine A Williamitis
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky 40202, USA
| | - Mark S Slaughter
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky 40202, USA
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Rezvan A, Ni CW, Alberts-Grill N, Jo H. Animal, in vitro, and ex vivo models of flow-dependent atherosclerosis: role of oxidative stress. Antioxid Redox Signal 2011; 15:1433-48. [PMID: 20712399 PMCID: PMC3144429 DOI: 10.1089/ars.2010.3365] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Atherosclerosis is an inflammatory disease preferentially occurring in curved or branched arterial regions, whereas straight parts of the arteries are protected, suggesting a close relationship between flow and atherosclerosis. However, evidence directly linking disturbed flow to atherogenesis is just emerging, thanks to the recent development of suitable animal models. In this article, we review the status of various animal, in vitro, and ex vivo models that have been used to study flow-dependent vascular biology and atherosclerosis. For animal models, naturally flow-disturbed regions such as branched or curved arterial regions as well as surgically created models, including arterio-venous fistulas, vascular grafts, perivascular cuffs, and complete, incomplete, or partial ligation of arteries, are used. Although in vivo models provide the environment needed to mimic the complex pathophysiological processes, in vitro models provide simple conditions that allow the study of isolated factors. Typical in vitro models use cultured endothelial cells exposed to various flow conditions, using devices such as cone-and-plate and parallel-plate chambers. Ex vivo models using isolated vessels have been used to bridge the gap between complex in vivo models and simple in vitro systems. Here, we review these flow models in the context of the role of oxidative stress in flow-dependent inflammation, a critical proatherogenic step, and atherosclerosis.
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Affiliation(s)
- Amir Rezvan
- Division of Cardiology, Department of Medicine, Emory University, Atlanta, Georgia 30322, USA
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Watanabe K, Oba K, Suzuki T, Ouchi M, Suzuki K, Futami-Suda S, Sekimizu K, Yamamoto N, Nakano H. Oral glucose loading attenuates endothelial function in normal individual. Eur J Clin Invest 2011; 41:465-73. [PMID: 21128931 DOI: 10.1111/j.1365-2362.2010.02424.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We evaluated the relationship between glucose fluctuation and vascular endothelial function. MATERIAL AND METHODS We recruited 25 healthy individuals with no family history of diabetes (14 subjects and 11 controls). Brachial artery flow-mediated dilation (FMD) and elapsed time when the after-hyperaemia maximum brachial artery diameter is reached; the peak times (PT) of each study subject were measured before and at 60, 120, and 180 min after 75-g oral glucose loading. FMD and PT of controls were measured for four consecutive hours in the fasting state from morning. Also, brachial-ankle pulse wave velocity (baPWV) of each subject was measured at 180 min after 75-g oral glucose loading. RESULTS Flow-mediated dilation of the study subjects was significantly lower at 60, 120 and 180 min than at pre-load, and significantly lower than that of the controls at 60 and 120 min, but not significantly different at 0 and 180 min. There was no significant difference between the PT of the subjects and the controls during 75-g oral glucose loading. In contrast, the PT of the subjects was significantly shorter than that of the controls at 120 and 180 min, but showed no significant difference at 0 and 60 min. Moreover, baPWV had no significant relationship with FMD. CONCLUSIONS Our study showed that oral glucose loading attenuates FMD and shortens elapsed time at the maximum after-hyperaemia diameter, and the effect of glucose fluctuation on atherosclerosis in individuals with normal glucose tolerance remains despite only the attenuation of endothelial function.
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Affiliation(s)
- Kentaro Watanabe
- Department of Internal Medicine (Divisions of Cardiology, Hepatology, Geriatrics and Integrated Medicine), Nippon Medical School, Tokyo, Japan
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Newcomer SC, Thijssen DHJ, Green DJ. Effects of exercise on endothelium and endothelium/smooth muscle cross talk: role of exercise-induced hemodynamics. J Appl Physiol (1985) 2011; 111:311-20. [PMID: 21436465 DOI: 10.1152/japplphysiol.00033.2011] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Physical activity, exercise training, and fitness are associated with decreased cardiovascular risk. In the context that a risk factor "gap" exists in the explanation for the beneficial effects of exercise on cardiovascular disease, it has recently been proposed that exercise generates hemodynamic stimuli which exert direct effects on the vasculature that are antiatherogenic. In this review we briefly introduce some of the in vitro and in vivo evidence relating exercise hemodynamic modulation and vascular adaptation. In vitro data clearly demonstrate the importance of shear stress as a potential mechanism underlying vascular adaptations associated with exercise. Supporting this is in vivo human data demonstrating that exercise-mediated shear stress induces localized impacts on arterial function and diameter. Emerging evidence suggests that exercise-related changes in hemodynamic stimuli other than shear stress may also be associated with arterial remodeling. Taken together, in vitro and in vivo data strongly imply that hemodynamic influences combine to orchestrate a response to exercise and training that regulates wall stress and peripheral vascular resistance and contributes to the antiatherogenic impacts of physical activity, fitness, and training.
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Affiliation(s)
- S C Newcomer
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN 47907, USA.
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