1
|
Ramdat Misier NL, Moore JP, Nguyen HH, Lloyd MS, Dubin AM, Mah DY, Czosek RJ, Khairy P, Chang PM, Nielsen JC, Aydin A, Pilcher TA, O'Leary ET, Shivkumar K, de Groot NMS. Long-Term Outcomes of Cardiac Resynchronization Therapy in Patients With Repaired Tetralogy of Fallot: A Multicenter Study. Circ Arrhythm Electrophysiol 2024; 17:e012363. [PMID: 38344811 DOI: 10.1161/circep.123.012363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/17/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND A growing number of patients with tetralogy of Fallot develop left ventricular systolic dysfunction and heart failure, in addition to right ventricular dysfunction. Although cardiac resynchronization therapy (CRT) is an established treatment option, the effect of CRT in this population is still not well defined. This study aimed to investigate the early and late efficacy, survival, and safety of CRT in patients with tetralogy of Fallot. METHODS Data were analyzed from an observational, retrospective, multicenter cohort, initiated jointly by the Pediatric and Congenital Electrophysiology Society and the International Society of Adult Congenital Heart Disease. Twelve centers contributed baseline and longitudinal data, including vital status, left ventricular ejection fraction (LVEF), QRS duration, and NYHA functional class. Outcomes were analyzed at early (3 months), intermediate (1 year), and late follow-up (≥2 years) after CRT implantation. RESULTS A total of 44 patients (40.3±19.2 years) with tetralogy of Fallot and CRT were enrolled. Twenty-nine (65.9%) patients had right ventricular pacing before CRT upgrade. The left ventricular ejection fraction improved from 32% [24%-44%] at baseline to 42% [32%-50%] at early follow-up (P<0.001) and remained improved from baseline thereafter (P≤0.002). The QRS duration decreased from 180 [160-205] ms at baseline to 152 [133-182] ms at early follow-up (P<0.001) and remained decreased at intermediate and late follow-up (P≤0.001). Patients with upgraded CRT had consistent improvement in left ventricular ejection fraction and QRS duration at each time point (P≤0.004). Patients had a significantly improved New York Heart Association functional class after CRT implantation at each time point compared with baseline (P≤0.002). The transplant-free survival rates at 3, 5, and 8 years after CRT implantation were 85%, 79%, and 73%. CONCLUSIONS In patients with tetralogy of Fallot treated with CRT consistent improvement in QRS duration, left ventricular ejection fraction, New York Heart Association functional class, and reasonable long-term survival were observed. The findings from this multicenter study support the consideration of CRT in this unique population.
Collapse
Affiliation(s)
- Nawin L Ramdat Misier
- Department of Cardiology, Erasmus Medical Center, Rotterdam , The Netherlands (N.L.R.M., N.M.S.d.G.)
| | - Jeremy P Moore
- Ahmanson/University of California Los Angeles Adult Congenital Heart Disease Center, Los Angeles, CA (J.P.M., K.S.)
| | - Hoang H Nguyen
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX (H.H.N.)
| | - Michael S Lloyd
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (M.S.L.)
| | - Anne M Dubin
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto CA (A.M.D.)
| | - Douglas Y Mah
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston MA (D.Y.M., E.T.O.)
| | - Richard J Czosek
- Division of Pediatric Cardiology, Department of Pediatrics, The Heart Institute at Cincinnati Children's Hospital Medical Center, Cincinnati OH (R.J.C.)
| | - Paul Khairy
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal Quebec, Canada (P.K.)
| | - Philip M Chang
- Congenital Heart Center, University of Florida Health, Gainesville, FL (P.M.C.)
| | - Jens C Nielsen
- Department of Clinical Medicine, Aarhus University, Aarhus Denmark (J.C.N.)
- Department of Cardiology, Aarhus University Hospital, Aarhus Denmark (J.C.N.)
| | - Alper Aydin
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario Canada (A.A.)
| | - Thomas A Pilcher
- Division of Pediatric Cardiology, Department of Internal Medicine, University of Utah, Salt Lake City UT (T.A.P.)
| | - Edward T O'Leary
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston MA (D.Y.M., E.T.O.)
| | - Kalyanam Shivkumar
- Ahmanson/University of California Los Angeles Adult Congenital Heart Disease Center, Los Angeles, CA (J.P.M., K.S.)
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus Medical Center, Rotterdam , The Netherlands (N.L.R.M., N.M.S.d.G.)
| |
Collapse
|
2
|
Sykora M, Andelova K, Szeiffova Bacova B, Egan Benova T, Martiskova A, Knezl V, Tribulova N. Hypertension Induces Pro-arrhythmic Cardiac Connexome Disorders: Protective Effects of Treatment. Biomolecules 2023; 13:biom13020330. [PMID: 36830700 PMCID: PMC9953310 DOI: 10.3390/biom13020330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/16/2023] [Accepted: 01/21/2023] [Indexed: 02/11/2023] Open
Abstract
Prolonged population aging and unhealthy lifestyles contribute to the progressive prevalence of arterial hypertension. This is accompanied by low-grade inflammation and over time results in heart dysfunction and failure. Hypertension-induced myocardial structural and ion channel remodeling facilitates the development of both atrial and ventricular fibrillation, and these increase the risk of stroke and sudden death. Herein, we elucidate hypertension-induced impairment of "connexome" cardiomyocyte junctions. This complex ensures cell-to-cell adhesion and coupling for electrical and molecular signal propagation. Connexome dysfunction can be a key factor in promoting the occurrence of both cardiac arrhythmias and heart failure. However, the available literature indicates that arterial hypertension treatment can hamper myocardial structural remodeling, hypertrophy and/or fibrosis, and preserve connexome function. This suggests the pleiotropic effects of antihypertensive agents, including anti-inflammatory. Therefore, further research is required to identify specific molecular targets and pathways that will protect connexomes, and it is also necessary to develop new approaches to maintain heart function in patients suffering from primary or pulmonary arterial hypertension.
Collapse
|
3
|
Odeigah OO, Valdez-Jasso D, Wall ST, Sundnes J. Computational models of ventricular mechanics and adaptation in response to right-ventricular pressure overload. Front Physiol 2022; 13:948936. [PMID: 36091369 PMCID: PMC9449365 DOI: 10.3389/fphys.2022.948936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/03/2022] [Indexed: 12/13/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is associated with substantial remodeling of the right ventricle (RV), which may at first be compensatory but at a later stage becomes detrimental to RV function and patient survival. Unlike the left ventricle (LV), the RV remains understudied, and with its thin-walled crescent shape, it is often modeled simply as an appendage of the LV. Furthermore, PAH diagnosis is challenging because it often leaves the LV and systemic circulation largely unaffected. Several treatment strategies such as atrial septostomy, right ventricular assist devices (RVADs) or RV resynchronization therapy have been shown to improve RV function and the quality of life in patients with PAH. However, evidence of their long-term efficacy is limited and lung transplantation is still the most effective and curative treatment option. As such, the clinical need for improved diagnosis and treatment of PAH drives a strong need for increased understanding of drivers and mechanisms of RV growth and remodeling (G&R), and more generally for targeted research into RV mechanics pathology. Computational models stand out as a valuable supplement to experimental research, offering detailed analysis of the drivers and consequences of G&R, as well as a virtual test bench for exploring and refining hypotheses of growth mechanisms. In this review we summarize the current efforts towards understanding RV G&R processes using computational approaches such as reduced-order models, three dimensional (3D) finite element (FE) models, and G&R models. In addition to an overview of the relevant literature of RV computational models, we discuss how the models have contributed to increased scientific understanding and to potential clinical treatment of PAH patients.
Collapse
Affiliation(s)
| | - Daniela Valdez-Jasso
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States
| | | | | |
Collapse
|
4
|
Bi X, Zhang S, Jiang H, Wei Z. A Multi-Scale Computational Model for the Rat Ventricle: Construction, Parallelization, and Applications. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 208:106289. [PMID: 34303152 DOI: 10.1016/j.cmpb.2021.106289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/10/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Cardiovascular diseases are the top killer of human beings. The ventricular arrhythmia, as a type of malignant cardiac arrhythmias, typically leads to death if not treated within minutes. The multi-scale virtual heart provides an idealized tool for exploring the underlying mechanisms, by means of incorporating abundant experimental data at the level of ion channels and analyzing the subsequent pathological changes at organ levels. However, there are few studies on building a virtual heart model for rats-a species most widely used in experiments. OBJECTIVE To build a multi-scale computational model for rats, with detailed methodology for the model construction, computational optimization, and its applications. METHODS First, approaches for building multi-scale models ranging from cellular to 3-D organ levels are introduced, with detailed descriptions of handling the ventricular myocardium heterogeneity, geometry processing, and boundary conditions, etc. Next, for dealing with the expensive computational costs of 3-D models, optimization approaches including an optimized representation and a GPU-based parallelization method are introduced. Finally, methods for reproducing of some key phenomenon (e.g., electrocardiograph, spiral/scroll waves) are demonstrated. RESULTS Three types of heterogeneity, including the transmural heterogeneity, the interventricular heterogeneity, and the base-apex heterogeneity are incorporated into the model. The normal and reentrant excitation waves, as well as the corresponding pseudo-ECGs are reproduced by the constructed ventricle model. In addition, the temporal and spatial vulnerability to reentry arrhythmias are quantified based on the evaluation experiments of vulnerable window and the critical length. CONCLUSIONS The constructed multi-scale rat ventricle model is able to reproduce both the physiological and the pathological phenomenon in different scales. Evaluation experiments suggest that the apex is the most susceptible area to arrhythmias. The model can be a promising tool for the investigation of arrhythmogenesis and the screening of anti-arrhythmic drugs.
Collapse
Affiliation(s)
- Xiangpeng Bi
- College of Computer Science and Technology, Ocean University of China, Qingdao 266100, China
| | - Shugang Zhang
- College of Computer Science and Technology, Ocean University of China, Qingdao 266100, China; High Performance Computing Center, Pilot National Laboratory for Marine Science and Technology (Qingdao), Qingdao 266237, China.
| | - Huasen Jiang
- College of Computer Science and Technology, Ocean University of China, Qingdao 266100, China
| | - Zhiqiang Wei
- College of Computer Science and Technology, Ocean University of China, Qingdao 266100, China; High Performance Computing Center, Pilot National Laboratory for Marine Science and Technology (Qingdao), Qingdao 266237, China
| |
Collapse
|
5
|
Hwang HV, Sandeep N, Nair RV, Hu D, Zhao M, Lan IS, Fajardo G, Matkovich SJ, Bernstein D, Reddy S. Transcriptomic and Functional Analyses of Mitochondrial Dysfunction in Pressure Overload-Induced Right Ventricular Failure. J Am Heart Assoc 2021; 10:e017835. [PMID: 33522250 PMCID: PMC7955345 DOI: 10.1161/jaha.120.017835] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 11/16/2020] [Indexed: 12/17/2022]
Abstract
Background In complex congenital heart disease patients such as those with tetralogy of Fallot, the right ventricle (RV) is subject to pressure overload, leading to RV hypertrophy and eventually RV failure. The mechanisms that promote the transition from stable RV hypertrophy to RV failure are unknown. We evaluated the role of mitochondrial bioenergetics in the development of RV failure. Methods and Results We created a murine model of RV pressure overload by pulmonary artery banding and compared with sham-operated controls. Gene expression by RNA-sequencing, oxidative stress, mitochondrial respiration, dynamics, and structure were assessed in pressure overload-induced RV failure. RV failure was characterized by decreased expression of electron transport chain genes and mitochondrial antioxidant genes (aldehyde dehydrogenase 2 and superoxide dismutase 2) and increased expression of oxidant stress markers (heme oxygenase, 4-hydroxynonenal). The activities of all electron transport chain complexes decreased with RV hypertrophy and further with RV failure (oxidative phosphorylation: sham 552.3±43.07 versus RV hypertrophy 334.3±30.65 versus RV failure 165.4±36.72 pmol/(s×mL), P<0.0001). Mitochondrial fission protein DRP1 (dynamin 1-like) trended toward an increase, while MFF (mitochondrial fission factor) decreased and fusion protein OPA1 (mitochondrial dynamin like GTPase) decreased. In contrast, transcription of electron transport chain genes increased in the left ventricle of RV failure. Conclusions Pressure overload-induced RV failure is characterized by decreased transcription and activity of electron transport chain complexes and increased oxidative stress which are associated with decreased energy generation. An improved understanding of the complex processes of energy generation could aid in developing novel therapies to mitigate mitochondrial dysfunction and delay the onset of RV failure.
Collapse
Affiliation(s)
- HyunTae V. Hwang
- Department of Pediatrics (Cardiology)Stanford UniversityPalo AltoCA
| | - Nefthi Sandeep
- Department of Pediatrics (Cardiology)Stanford UniversityPalo AltoCA
| | - Ramesh V. Nair
- Stanford Center for Genomics and Personalized MedicinePalo AltoCA
| | - Dong‐Qing Hu
- Department of Pediatrics (Cardiology)Stanford UniversityPalo AltoCA
| | - Mingming Zhao
- Department of Pediatrics (Cardiology)Stanford UniversityPalo AltoCA
| | - Ingrid S. Lan
- Department of BioengineeringStanford UniversityPalo AltoCA
| | - Giovanni Fajardo
- Department of Pediatrics (Cardiology)Stanford UniversityPalo AltoCA
| | - Scot J. Matkovich
- Department of Internal MedicineCenter for PharmacogenomicsWashington University School of MedicineSt. LouisMO
| | - Daniel Bernstein
- Department of Pediatrics (Cardiology)Stanford UniversityPalo AltoCA
| | - Sushma Reddy
- Department of Pediatrics (Cardiology)Stanford UniversityPalo AltoCA
| |
Collapse
|
6
|
Boengler K, Rohrbach S, Weissmann N, Schulz R. Importance of Cx43 for Right Ventricular Function. Int J Mol Sci 2021; 22:ijms22030987. [PMID: 33498172 PMCID: PMC7863922 DOI: 10.3390/ijms22030987] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/13/2021] [Accepted: 01/18/2021] [Indexed: 11/16/2022] Open
Abstract
In the heart, connexins form gap junctions, hemichannels, and are also present within mitochondria, with connexin 43 (Cx43) being the most prominent connexin in the ventricles. Whereas the role of Cx43 is well established for the healthy and diseased left ventricle, less is known about the importance of Cx43 for the development of right ventricular (RV) dysfunction. The present article focusses on the importance of Cx43 for the developing heart. Furthermore, we discuss the expression and localization of Cx43 in the diseased RV, i.e., in the tetralogy of Fallot and in pulmonary hypertension, in which the RV is affected, and RV hypertrophy and failure occur. We will also introduce other Cx molecules that are expressed in RV and surrounding tissues and have been reported to be involved in RV pathophysiology. Finally, we highlight therapeutic strategies aiming to improve RV function in pulmonary hypertension that are associated with alterations of Cx43 expression and function.
Collapse
|
7
|
Exercise preconditioning prevents left ventricular dysfunction and remodeling in monocrotaline-induced pulmonary hypertension. Porto Biomed J 2020; 5:e081. [PMID: 33195871 PMCID: PMC7657575 DOI: 10.1097/j.pbj.0000000000000081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/25/2020] [Accepted: 06/29/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Despite pulmonary arterial hypertension (PAH) directly affects the right ventricle (RV), important structural, functional, and molecular changes also occur in left ventricle (LV). The objective of our study was to analyze the hypothetical cardioprotective effects of exercise preconditioning on LV in rats with monocrotaline (MCT)-induced PAH. Methods: Forty male Wistar rats were randomly separated in sedentary (SED) and trained group (EX; running sessions of 60 min/day, 5 days/wk, at 25 m/min, for 4 weeks). After 4 weeks, animals were injected with MCT (60 mg/kg; SED + MCT; EX + MCT) or vehicle (SED + V). Following an additional period of 4 weeks where all animals remained sedentary, we completed LV hemodynamic evaluation in baseline and isovolumic conditions and collected LV samples for histological and molecular analysis. Results: Preconditioning with exercise was capable to restore LV systolic and diastolic dysfunction in both baseline and isovolumic conditions (P < .05). This improved was paralleled with prevention of LV cardiomyocytes atrophy, fibrosis, and endothelin 1 mRNA levels (P < .05). Conclusions: Our findings suggest that exercise preconditioning can prevent LV dysfunction secondary to MCT-induced PAH, which is of particular interest for the familial form of the disease that is manifested by greater severity or earlier onset.
Collapse
|
8
|
Bouvard C, Genet N, Phan C, Rode B, Thuillet R, Tu L, Robillard P, Campagnac M, Soleti R, Dumas De La Roque E, Delcambre F, Cronier L, Parpaite T, Maurat E, Berger P, Savineau JP, Marthan R, Guignabert C, Freund-Michel V, Guibert C. Connexin-43 is a promising target for pulmonary hypertension due to hypoxaemic lung disease. Eur Respir J 2020; 55:13993003.00169-2019. [PMID: 31862763 DOI: 10.1183/13993003.00169-2019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 11/27/2019] [Indexed: 02/06/2023]
Abstract
The mechanisms underlying pulmonary hypertension (PH) are complex and multifactorial, and involve different cell types that are interconnected through gap junctional channels. Although connexin (Cx)-43 is the most abundant gap junction protein in the heart and lungs, and critically governs intercellular signalling communication, its contribution to PH remains unknown. The focus of the present study is thus to evaluate Cx43 as a potential new target in PH.Expressions of Cx37, Cx40 and Cx43 were studied in lung specimens from patients with idiopathic pulmonary arterial hypertension (IPAH) or PH associated with chronic hypoxaemic lung diseases (chronic hypoxia-induced pulmonary hypertension (CH-PH)). Heterozygous Cx43 knockdown CD1 (Cx43+/-) and wild-type littermate (Cx43+/+) mice at 12 weeks of age were randomly divided into two groups, one of which was maintained in room air and the other exposed to hypoxia (10% oxygen) for 3 weeks. We evaluated pulmonary haemodynamics, remodelling processes in cardiac tissues and pulmonary arteries (PAs), lung inflammation and PA vasoreactivity.Cx43 levels were increased in PAs from CH-PH patients and decreased in PAs from IPAH patients; however, no difference in Cx37 or Cx40 levels was noted. Upon hypoxia treatment, the Cx43+/- mice were partially protected against CH-PH when compared to Cx43+/+ mice, with reduced pulmonary arterial muscularisation and inflammatory infiltration. Interestingly, the adaptive changes in cardiac remodelling in Cx43+/- mice were not affected. PA contraction due to endothelin-1 (ET-1) was increased in Cx43+/- mice under normoxic and hypoxic conditions.Taken together, these results indicate that targeting Cx43 may have beneficial therapeutic effects in PH without affecting compensatory cardiac hypertrophy.
Collapse
Affiliation(s)
- Claire Bouvard
- INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Pessac, France.,Univ-Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France
| | - Nafiisha Genet
- INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Pessac, France.,Univ-Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France
| | - Carole Phan
- INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France.,Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Baptiste Rode
- INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Pessac, France.,Univ-Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France
| | - Raphaël Thuillet
- INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France.,Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Ly Tu
- INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France.,Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Paul Robillard
- INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Pessac, France.,Univ-Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France
| | - Marilyne Campagnac
- INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Pessac, France.,Univ-Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France
| | | | - Eric Dumas De La Roque
- INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Pessac, France.,CHU de Bordeaux, Pessac, France
| | | | - Laurent Cronier
- Laboratoire Signalisation et Transports Ioniques Membranaires, CNRS ERL 7003, Université de Poitiers, Poitiers, France
| | - Thibaud Parpaite
- INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Pessac, France.,Univ-Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France
| | - Elise Maurat
- INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Pessac, France.,Univ-Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France
| | - Patrick Berger
- INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Pessac, France.,Univ-Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France.,CHU de Bordeaux, Pessac, France
| | - Jean-Pierre Savineau
- INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Pessac, France.,Univ-Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France
| | - Roger Marthan
- INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Pessac, France.,Univ-Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France.,CHU de Bordeaux, Pessac, France
| | - Christophe Guignabert
- INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France.,Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Véronique Freund-Michel
- INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Pessac, France.,Univ-Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France
| | - Christelle Guibert
- INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Pessac, France .,Univ-Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France
| |
Collapse
|
9
|
Effect of left ventricular diastolic dysfunction on development of primary graft dysfunction after lung transplant. Curr Opin Anaesthesiol 2019; 33:10-16. [PMID: 31789901 DOI: 10.1097/aco.0000000000000811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Primary graft dysfunction (PGD) is one of the most common complications after lung transplant and is associated with significant early and late morbidity and mortality. The cause of primary graft dysfunction is often multifactorial involving patient, donor, and operational factors. Diastolic dysfunction is increasingly recognized as an important risk factor for development of PGD after lung transplant and here we examine recent evidence on the topic. RECENT FINDINGS Patients with end-stage lung disease are more likely to suffer from cardiovascular disease including diastolic dysfunction. PGD as result of ischemia-reperfusion injury after lung transplant is exacerbated by increased left atrial pressure and pulmonary venous congestion impacted by diastolic dysfunction. Recent studies on relationship between diastolic dysfunction and PGD after lung transplant show that patients with diastolic dysfunction are more likely to develop PGD with worse survival outcome and complicated hospital course. SUMMARY Patients with diastolic dysfunction is more likely to suffer from PGD after lung transplant. From the lung transplant candidate selection to perioperative and posttransplant care, thorough evaluation and documentation diastolic dysfunction to guide patient care are imperative.
Collapse
|
10
|
Dubes V, Benoist D, Roubertie F, Gilbert SH, Constantin M, Charron S, Elbes D, Vieillot D, Quesson B, Cochet H, Haïssaguerre M, Rooryck C, Bordachar P, Thambo JB, Bernus O. Arrhythmogenic Remodeling of the Left Ventricle in a Porcine Model of Repaired Tetralogy of Fallot. Circ Arrhythm Electrophysiol 2019; 11:e006059. [PMID: 30354410 PMCID: PMC6553519 DOI: 10.1161/circep.117.006059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Supplemental Digital Content is available in the text. Background Ventricular arrhythmias are frequent in patients with repaired tetralogy of Fallot (rTOF), but their origin and underlying mechanisms remain unclear. In this study, the involvement of left ventricular (LV) electrical and structural remodeling was assessed in an animal model mimicking rTOF sequelae. Methods Piglets underwent a tetralogy of Fallot repair–like surgery (n=6) or were sham operated (Sham, n=5). Twenty-three weeks post-surgery, cardiac function was assessed in vivo by magnetic resonance imaging. Electrophysiological properties were characterized by optical mapping. LV fibrosis and connexin-43 localization were assessed on histological sections and protein expression assessed by Western Blot. Results Right ventricular dysfunction was evident, whereas LV function remained unaltered in rTOF pigs. Optical mapping showed longer action potential duration on the rTOF LV epicardium and endocardium. Epicardial conduction velocity was significantly reduced in the longitudinal direction in rTOF LVs but not in the transverse direction compared with Sham. An elevated collagen content was found in LV basal and apical sections from rTOF pigs. Moreover, a trend for connexin-43 lateralization with no change in protein expression was found in the LV of rTOFs. Finally, rTOF LVs had a lower threshold for arrhythmia induction using incremental pacing protocols. Conclusions We found an arrhythmogenic substrate with prolonged heterogeneous action potential duration and reduced conduction velocity in the LV of rTOF pigs. This remodeling precedes LV dysfunction and is likely to contribute to ventricular arrhythmias and sudden cardiac death in patients with rTOF.
Collapse
Affiliation(s)
- Virginie Dubes
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Pessac, France (V.D., D.B., F.R., S.H.G., M.C., S.C., D.E., B.Q., H.C., M.H., C.R., P.B., J.-B.T., O.B.).,Inserm U1045, Centre de Recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, France. (V.D., D.B., F.R., S.H.G., M.C., S.C., D.E., B.Q., H.C., M.H., P.B., J.-B.T., O.B.)
| | - David Benoist
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Pessac, France (V.D., D.B., F.R., S.H.G., M.C., S.C., D.E., B.Q., H.C., M.H., C.R., P.B., J.-B.T., O.B.).,Inserm U1045, Centre de Recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, France. (V.D., D.B., F.R., S.H.G., M.C., S.C., D.E., B.Q., H.C., M.H., P.B., J.-B.T., O.B.)
| | - François Roubertie
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Pessac, France (V.D., D.B., F.R., S.H.G., M.C., S.C., D.E., B.Q., H.C., M.H., C.R., P.B., J.-B.T., O.B.).,Inserm U1045, Centre de Recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, France. (V.D., D.B., F.R., S.H.G., M.C., S.C., D.E., B.Q., H.C., M.H., P.B., J.-B.T., O.B.).,Centre Hospitalier Universitaire de Bordeaux, Hôpital Cardiologique du Haut-Lévêque, Pessac, France (F.R., H.C., M.H., C.R., P.B., J.-B.T.)
| | - Stephen H Gilbert
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Pessac, France (V.D., D.B., F.R., S.H.G., M.C., S.C., D.E., B.Q., H.C., M.H., C.R., P.B., J.-B.T., O.B.).,Inserm U1045, Centre de Recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, France. (V.D., D.B., F.R., S.H.G., M.C., S.C., D.E., B.Q., H.C., M.H., P.B., J.-B.T., O.B.).,Max Delbröck Center for Molecular Medicine, Berlin, Germany (S.H.G.)
| | - Marion Constantin
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Pessac, France (V.D., D.B., F.R., S.H.G., M.C., S.C., D.E., B.Q., H.C., M.H., C.R., P.B., J.-B.T., O.B.).,Inserm U1045, Centre de Recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, France. (V.D., D.B., F.R., S.H.G., M.C., S.C., D.E., B.Q., H.C., M.H., P.B., J.-B.T., O.B.)
| | - Sabine Charron
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Pessac, France (V.D., D.B., F.R., S.H.G., M.C., S.C., D.E., B.Q., H.C., M.H., C.R., P.B., J.-B.T., O.B.).,Inserm U1045, Centre de Recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, France. (V.D., D.B., F.R., S.H.G., M.C., S.C., D.E., B.Q., H.C., M.H., P.B., J.-B.T., O.B.)
| | - Delphine Elbes
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Pessac, France (V.D., D.B., F.R., S.H.G., M.C., S.C., D.E., B.Q., H.C., M.H., C.R., P.B., J.-B.T., O.B.).,Inserm U1045, Centre de Recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, France. (V.D., D.B., F.R., S.H.G., M.C., S.C., D.E., B.Q., H.C., M.H., P.B., J.-B.T., O.B.).,Institute of Biomedical Engineering, University of Oxford, United Kingdom (D.E.)
| | - Delphine Vieillot
- Plateforme Technologique d'Innovation Biomédicale, Université de Bordeaux, France. (D.V.)
| | - Bruno Quesson
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Pessac, France (V.D., D.B., F.R., S.H.G., M.C., S.C., D.E., B.Q., H.C., M.H., C.R., P.B., J.-B.T., O.B.).,Inserm U1045, Centre de Recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, France. (V.D., D.B., F.R., S.H.G., M.C., S.C., D.E., B.Q., H.C., M.H., P.B., J.-B.T., O.B.)
| | - Hubert Cochet
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Pessac, France (V.D., D.B., F.R., S.H.G., M.C., S.C., D.E., B.Q., H.C., M.H., C.R., P.B., J.-B.T., O.B.).,Inserm U1045, Centre de Recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, France. (V.D., D.B., F.R., S.H.G., M.C., S.C., D.E., B.Q., H.C., M.H., P.B., J.-B.T., O.B.).,Centre Hospitalier Universitaire de Bordeaux, Hôpital Cardiologique du Haut-Lévêque, Pessac, France (F.R., H.C., M.H., C.R., P.B., J.-B.T.)
| | - Michel Haïssaguerre
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Pessac, France (V.D., D.B., F.R., S.H.G., M.C., S.C., D.E., B.Q., H.C., M.H., C.R., P.B., J.-B.T., O.B.).,Inserm U1045, Centre de Recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, France. (V.D., D.B., F.R., S.H.G., M.C., S.C., D.E., B.Q., H.C., M.H., P.B., J.-B.T., O.B.).,Centre Hospitalier Universitaire de Bordeaux, Hôpital Cardiologique du Haut-Lévêque, Pessac, France (F.R., H.C., M.H., C.R., P.B., J.-B.T.)
| | - Caroline Rooryck
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Pessac, France (V.D., D.B., F.R., S.H.G., M.C., S.C., D.E., B.Q., H.C., M.H., C.R., P.B., J.-B.T., O.B.).,Inserm U1211, Maladies Rares: Génétique et Métabolisme, Université de Bordeaux, France. (C.R.).,Centre Hospitalier Universitaire de Bordeaux, Hôpital Cardiologique du Haut-Lévêque, Pessac, France (F.R., H.C., M.H., C.R., P.B., J.-B.T.)
| | - Pierre Bordachar
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Pessac, France (V.D., D.B., F.R., S.H.G., M.C., S.C., D.E., B.Q., H.C., M.H., C.R., P.B., J.-B.T., O.B.).,Inserm U1045, Centre de Recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, France. (V.D., D.B., F.R., S.H.G., M.C., S.C., D.E., B.Q., H.C., M.H., P.B., J.-B.T., O.B.).,Centre Hospitalier Universitaire de Bordeaux, Hôpital Cardiologique du Haut-Lévêque, Pessac, France (F.R., H.C., M.H., C.R., P.B., J.-B.T.)
| | - Jean-Benoit Thambo
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Pessac, France (V.D., D.B., F.R., S.H.G., M.C., S.C., D.E., B.Q., H.C., M.H., C.R., P.B., J.-B.T., O.B.).,Inserm U1045, Centre de Recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, France. (V.D., D.B., F.R., S.H.G., M.C., S.C., D.E., B.Q., H.C., M.H., P.B., J.-B.T., O.B.).,Centre Hospitalier Universitaire de Bordeaux, Hôpital Cardiologique du Haut-Lévêque, Pessac, France (F.R., H.C., M.H., C.R., P.B., J.-B.T.)
| | - Olivier Bernus
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Pessac, France (V.D., D.B., F.R., S.H.G., M.C., S.C., D.E., B.Q., H.C., M.H., C.R., P.B., J.-B.T., O.B.).,Inserm U1045, Centre de Recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, France. (V.D., D.B., F.R., S.H.G., M.C., S.C., D.E., B.Q., H.C., M.H., P.B., J.-B.T., O.B.)
| |
Collapse
|
11
|
Andrade AC, Jerosch‐Herold M, Wegner P, Gabbert DD, Voges I, Pham M, Shah R, Hedderich J, Kramer H, Rickers C. Determinants of Left Ventricular Dysfunction and Remodeling in Patients With Corrected Tetralogy of Fallot. J Am Heart Assoc 2019; 8:e009618. [PMID: 31474177 PMCID: PMC6755839 DOI: 10.1161/jaha.118.009618] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background The aim of this study was to identify in asymptomatic patients with repaired tetralogy of Fallot the prevalence and determinants of impaired left‐sided cardiac function and adverse ventricular remodeling and the relation of left ventricular (LV) dysfunction and remodeling with cardiopulmonary exercise capacity. Methods and Results In a cross‐sectional study, 103 patients with tetralogy of Fallot (median age, 16.3 years) in New York Heart Association class 1, with surgical repair at a median age of 1.1 years, and 63 age‐matched controls were studied. LV, right ventricular function and geometry, LV myocardial extracellular volume (n=57), and left atrial function were quantified with cardiac magnetic resonance. Peak oxygen consumption was measured by a standardized cardiopulmonary exercise test (n=70). Patients with tetralogy of Fallot had lower LV ejection fraction (P=0.001; 49% below age‐adjusted fifth percentile for controls), lower LV mass index (P=0.003), lower LV mass/volume ratio (P<0.01), and impaired left atrial function. Right ventricular mass/volume ratio was the best predictor for LV systolic dysfunction and for a lower LV mass/volume ratio. Compared with controls, LV extracellular volume was higher (P<0.001), particularly in female patients, and associated with subnormal peak oxygen consumption (P=0.037). A peak oxygen consumption below the third percentile reference level was more likely with decreasing LV ejection fraction (P=0.008), and lower LV mass index (P=0.024), but independent of right ventricular ejection fraction. Conclusions In New York Heart Association class 1 patients with tetralogy of Fallot, frequent impaired systolic and diastolic LV function, LV adverse remodeling with LV atrophy, a decreased mass/volume ratio, and extracellular matrix expansion suggest cardiomyopathic changes. The best predictor for LV systolic dysfunction was the right ventricular mass/volume ratio. The subnormal peak oxygen consumption indicates that monitoring of LV status may be important for long‐term prognosis.
Collapse
Affiliation(s)
- Ana Cristina Andrade
- Heart InstituteMedical School of São Paulo UniversitySão PauloBrazil
- Department of Congenital Heart Disease and Pediatric CardiologyUniversity Hospital of Schleswig‐HolsteinKielGermany
| | | | - Philip Wegner
- Department of Congenital Heart Disease and Pediatric CardiologyUniversity Hospital of Schleswig‐HolsteinKielGermany
| | - Dominik Daniel Gabbert
- Department of Congenital Heart Disease and Pediatric CardiologyUniversity Hospital of Schleswig‐HolsteinKielGermany
| | - Inga Voges
- Department of Congenital Heart Disease and Pediatric CardiologyUniversity Hospital of Schleswig‐HolsteinKielGermany
| | - Minh Pham
- Department of Congenital Heart Disease and Pediatric CardiologyUniversity Hospital of Schleswig‐HolsteinKielGermany
| | - Ravi Shah
- Department of RadiologyBrigham & Women's Hospital and Harvard Medical SchoolBostonMA
| | - Jürgen Hedderich
- Department for Medical Informatics and StatisticsUniversity Hospital of Schleswig‐HolsteinKielGermany
| | - Hans‐Heiner Kramer
- Department of Congenital Heart Disease and Pediatric CardiologyUniversity Hospital of Schleswig‐HolsteinKielGermany
| | - Carsten Rickers
- University Heart CenterAdult with Congenital Heart Disease UnitUniversity Hospital Hamburg‐EppendorfHamburgGermany
| |
Collapse
|
12
|
Clinical Risk Factors and Prognostic Model for Primary Graft Dysfunction after Lung Transplantation in Patients with Pulmonary Hypertension. Ann Am Thorac Soc 2018; 14:1514-1522. [PMID: 28719755 DOI: 10.1513/annalsats.201610-810oc] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RATIONALE Pulmonary hypertension from pulmonary arterial hypertension or parenchymal lung disease is associated with an increased risk for primary graft dysfunction after lung transplantation. OBJECTIVE We evaluated the clinical determinants of severe primary graft dysfunction in pulmonary hypertension and developed and validated a prognostic model. METHODS We conducted a retrospective cohort study of patients in the multicenter Lung Transplant Outcomes Group with pulmonary hypertension at transplant listing. Severe primary graft dysfunction was defined as PaO2/FiO2 ≤200 with allograft infiltrates at 48 or 72 hours after transplantation. Donor, recipient, and operative characteristics were evaluated in a multivariable explanatory model. A prognostic model derived using donor and recipient characteristics was then validated in a separate cohort. RESULTS In the explanatory model of 826 patients with pulmonary hypertension, donor tobacco smoke exposure, higher recipient body mass index, female sex, listing mean pulmonary artery pressure, right atrial pressure and creatinine at transplant, cardiopulmonary bypass use, transfusion volume, and reperfusion fraction of inspired oxygen were associated with primary graft dysfunction. Donor obesity was associated with a lower risk for primary graft dysfunction. Using a 20% threshold for elevated risk, the prognostic model had good negative predictive value in both derivation and validation cohorts (89.1% [95% confidence interval, 85.3-92.8] and 83.3% [95% confidence interval, 78.5-88.2], respectively), but low positive predictive value. CONCLUSIONS Several recipient, donor, and operative characteristics were associated with severe primary graft dysfunction in patients with pulmonary hypertension, including several risk factors not identified in the overall transplant population. A prognostic model with donor and recipient clinical risk factors alone had low positive predictive value, but high negative predictive value, to rule out high risk for primary graft dysfunction.
Collapse
|
13
|
Pham T, Nisbet L, Taberner A, Loiselle D, Han JC. Pulmonary arterial hypertension reduces energy efficiency of right, but not left, rat ventricular trabeculae. J Physiol 2018; 596:1153-1166. [PMID: 29363144 DOI: 10.1113/jp275578] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/17/2018] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Pulmonary arterial hypertension (PAH) triggers right ventricle (RV) hypertrophy and left ventricle (LV) atrophy, which progressively leads to heart failure. We designed experiments under conditions mimicking those encountered by the heart in vivo that allowed us to investigate whether consequent structural and functional remodelling of the ventricles affects their respective energy efficiencies. We found that peak work output was lower in RV trabeculae from PAH rats due to reduced extent and velocity of shortening. However, their suprabasal enthalpy was unaffected due to increased activation heat, resulting in reduced suprabasal efficiency. There was no effect of PAH on LV suprabasal efficiency. We conclude that the mechanism underlying the reduced energy efficiency of hypertrophied RV tissues is attributable to the increased energy cost of Ca2+ cycling, whereas atrophied LV tissues still maintain normal mechano-energetic performance. ABSTRACT Pulmonary arterial hypertension (PAH) greatly increases the afterload on the right ventricle (RV), triggering RV hypertrophy, which progressively leads to RV failure. In contrast, the disease reduces the passive filling pressure of the left ventricle (LV), resulting in LV atrophy. We investigated whether these distinct structural and functional consequences to the ventricles affect their respective energy efficiencies. We studied trabeculae isolated from both ventricles of Wistar rats with monocrotaline-induced PAH and their respective Control groups. Trabeculae were mounted in a calorimeter at 37°C. While contracting at 5 Hz, they were subjected to stress-length work-loops over a wide range of afterloads. They were subsequently required to undergo a series of isometric contractions at various muscle lengths. In both protocols, stress production, length change and suprabasal heat output were simultaneously measured. We found that RV trabeculae from PAH rats generated higher activation heat, but developed normal active stress. Their peak external work output was lower due to reduced extent and velocity of shortening. Despite lower peak work output, suprabasal enthalpy was unaffected, thereby rendering suprabasal efficiency lower. Crossbridge efficiency, however, was unaffected. In contrast, LV trabeculae from PAH rats maintained normal mechano-energetic performance. Pulmonary arterial hypertension reduces the suprabasal energy efficiency of hypertrophied right ventricular tissues as a consequence of the increased energy cost of Ca2+ cycling.
Collapse
Affiliation(s)
- Toan Pham
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand.,Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Linley Nisbet
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand.,Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Andrew Taberner
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand.,Department of Engineering Science, The University of Auckland, Auckland, New Zealand
| | - Denis Loiselle
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand.,Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - June-Chiew Han
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
14
|
Han JC, Guild SJ, Pham T, Nisbet L, Tran K, Taberner AJ, Loiselle DS. Left-Ventricular Energetics in Pulmonary Arterial Hypertension-Induced Right-Ventricular Hypertrophic Failure. Front Physiol 2018; 8:1115. [PMID: 29375394 PMCID: PMC5767264 DOI: 10.3389/fphys.2017.01115] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/15/2017] [Indexed: 11/18/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) alters the geometries of both ventricles of the heart. While the right ventricle (RV) hypertrophies, the left ventricle (LV) atrophies. Multiple lines of clinical and experimental evidence lead us to hypothesize that the impaired stroke volume and systolic pressure of the LV are a direct consequence of the effect of pressure overload in the RV, and that atrophy in the LV plays only a minor role. In this study, we tested this hypothesis by examining the mechanoenergetic response of the atrophied LV to RV hypertrophy in rats treated with monocrotaline. Experiments were performed across multiple-scales: the whole-heart in vivo and ex vivo, and its trabeculae in vitro. Under the in vivo state where the RV was pressure-overloaded, we measured reduced systemic blood pressure and LV ventricular pressure. In contrast, under both ex vivo and in vitro conditions, where the effect of RV pressure overload was circumvented, we found that LV was capable of developing normal systolic pressure and stress. Nevertheless, LV atrophy played a minor role in that LV stroke volume remained lower, thereby contributing to lower LV mechanical work output. Concomitantly lower oxygen consumption and change of enthalpy were observed, and hence LV energy efficiency was unchanged. Our internally consistent findings between working-heart and trabecula experiments explain the rapid improvement of LV systolic function observed in patients with chronic pulmonary hypertension following surgical relief of RV pressure overload.
Collapse
Affiliation(s)
- June-Chiew Han
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Sarah-Jane Guild
- Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Toan Pham
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand.,Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Linley Nisbet
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand.,Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Kenneth Tran
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Andrew J Taberner
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand.,Department of Engineering Science, The University of Auckland, Auckland, New Zealand
| | - Denis S Loiselle
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand.,Department of Physiology, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
15
|
Jackman CP, Ganapathi AM, Asfour H, Qian Y, Allen BW, Li Y, Bursac N. Engineered cardiac tissue patch maintains structural and electrical properties after epicardial implantation. Biomaterials 2018; 159:48-58. [PMID: 29309993 DOI: 10.1016/j.biomaterials.2018.01.002] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/17/2017] [Accepted: 01/01/2018] [Indexed: 12/22/2022]
Abstract
Functional cardiac tissue engineering holds promise as a candidate therapy for myocardial infarction and heart failure. Generation of "strong-contracting and fast-conducting" cardiac tissue patches capable of electromechanical coupling with host myocardium could allow efficient improvement of heart function without increased arrhythmogenic risks. Towards that goal, we engineered highly functional 1 cm × 1 cm cardiac tissue patches made of neonatal rat ventricular cells which after 2 weeks of culture exhibited force of contraction of 18.0 ± 1.4 mN, conduction velocity (CV) of 32.3 ± 1.8 cm/s, and sustained chronic activation when paced at rates as high as 8.7 ± 0.8 Hz. Patches transduced with genetically-encoded calcium indicator (GCaMP6) were implanted onto adult rat ventricles and after 4-6 weeks assessed for action potential conduction and electrical integration by two-camera optical mapping of GCaMP6-reported Ca2+ transients in the patch and RH237-reported action potentials in the recipient heart. Of the 13 implanted patches, 11 (85%) engrafted, maintained structural integrity, and conducted action potentials with average CVs and Ca2+ transient durations comparable to those before implantation. Despite preserved graft electrical properties, no anterograde or retrograde conduction could be induced between the patch and host cardiomyocytes, indicating lack of electrical integration. Electrical properties of the underlying myocardium were not changed by the engrafted patch. From immunostaining analyses, implanted patches were highly vascularized and expressed abundant electromechanical junctions, but remained separated from the epicardium by a non-myocyte layer. In summary, our studies demonstrate generation of highly functional cardiac tissue patches that can robustly engraft on the epicardial surface, vascularize, and maintain electrical function, but do not couple with host tissue. The lack of graft-host electrical integration is therefore a critical obstacle to development of efficient tissue engineering therapies for heart repair.
Collapse
Affiliation(s)
| | - Asvin M Ganapathi
- Duke University Medical Center, Department of General Surgery, Durham, NC, USA
| | - Huda Asfour
- Duke University, Department of Biomedical Engineering, Durham, NC, USA
| | - Ying Qian
- Duke University, Department of Biomedical Engineering, Durham, NC, USA
| | - Brian W Allen
- Duke University, Department of Biomedical Engineering, Durham, NC, USA
| | - Yanzhen Li
- Duke University, Department of Biomedical Engineering, Durham, NC, USA
| | - Nenad Bursac
- Duke University, Department of Biomedical Engineering, Durham, NC, USA.
| |
Collapse
|
16
|
Xi C, Latnie C, Zhao X, Tan JL, Wall ST, Genet M, Zhong L, Lee LC. Patient-Specific Computational Analysis of Ventricular Mechanics in Pulmonary Arterial Hypertension. J Biomech Eng 2017; 138:2551745. [PMID: 27589906 DOI: 10.1115/1.4034559] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Indexed: 11/08/2022]
Abstract
Patient-specific biventricular computational models associated with a normal subject and a pulmonary arterial hypertension (PAH) patient were developed to investigate the disease effects on ventricular mechanics. These models were developed using geometry reconstructed from magnetic resonance (MR) images, and constitutive descriptors of passive and active mechanics in cardiac tissues. Model parameter values associated with ventricular mechanical properties and myofiber architecture were obtained by fitting the models with measured pressure-volume loops and circumferential strain calculated from MR images using a hyperelastic warping method. Results show that the peak right ventricle (RV) pressure was substantially higher in the PAH patient (65 mmHg versus 20 mmHg), who also has a significantly reduced ejection fraction (EF) in both ventricles (left ventricle (LV): 39% versus 66% and RV: 18% versus 64%). Peak systolic circumferential strain was comparatively lower in both the left ventricle (LV) and RV free wall (RVFW) of the PAH patient (LV: -6.8% versus -13.2% and RVFW: -2.1% versus -9.4%). Passive stiffness, contractility, and myofiber stress in the PAH patient were all found to be substantially increased in both ventricles, whereas septum wall in the PAH patient possessed a smaller curvature than that in the LV free wall. Simulations using the PAH model revealed an approximately linear relationship between the septum curvature and the transseptal pressure gradient at both early-diastole and end-systole. These findings suggest that PAH can induce LV remodeling, and septum curvature measurements may be useful in quantifying transseptal pressure gradient in PAH patients.
Collapse
Affiliation(s)
- Ce Xi
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI 48824-1226
| | - Candace Latnie
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI 48824-1226
| | - Xiaodan Zhao
- National Heart Center Singapore, Singapore, Singapore 169609
| | - Ju Le Tan
- National Heart Center Singapore, Singapore, Singapore 169609
| | | | - Martin Genet
- LMS, École Polytechnique, CNRS, Université Paris-Saclay; Inria, Université Paris-Saclay, Palaiseau 91128, France
| | - Liang Zhong
- National Heart Center Singapore, Singapore, Singapore 169609;Duke-NUS Medical School, Singapore, Singapore 169857
| | - Lik Chuan Lee
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI 48824-1226 e-mail:
| |
Collapse
|
17
|
Naeije R, Badagliacca R. The overloaded right heart and ventricular interdependence. Cardiovasc Res 2017; 113:1474-1485. [DOI: 10.1093/cvr/cvx160] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 08/10/2017] [Indexed: 02/04/2023] Open
|
18
|
Kharin SN, Krandycheva VV, Tsvetkova AS, Shumikhin KV. Remodeling of ventricular repolarization in experimental right ventricular hypertrophy. J Electrocardiol 2017; 50:626-633. [PMID: 28554514 DOI: 10.1016/j.jelectrocard.2017.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND To understand electrophysiological mechanisms that underlie the progression of compensated right ventricular hypertrophy (RVH) to heart failure, the purpose of the study was to evaluate remodeling of ventricular repolarization in connection with hemodynamic abnormalities and vulnerability of the heart ventricles to arrhythmias in RVH rats with pulmonary arterial hypertension (PAH) and heart failure. METHODS PAH followed by heart failure was induced by monocrotaline in adult female Wistar rats. Unipolar epicardial electrograms and cardiac hemodynamic parameters were recorded in situ. Vulnerability to ventricular arrhythmias was measured as the threshold dose of aconitine required to produce sustained ventricular tachycardia. Histological examination of the heart ventricles was performed. Activation-recovery intervals (ARIs) and ARI dispersions were used as indices of durations and heterogeneity of repolarization respectively to assess ventricular repolarization. RESULTS AND CONCLUSIONS The development of compensated RVH was characterized by the dramatic prolongation of repolarization against the less expressed increase in repolarization heterogeneity, whereas the dramatic increase in repolarization heterogeneity against the less expressed but inhomogeneous prolongation of repolarization occurred in the progression of compensated RVH to heart failure. These changes increased vulnerability of the failing heart but not the compensated heart to aconitine-induced ventricular arrhythmias.
Collapse
Affiliation(s)
- S N Kharin
- Laboratory of Cardiac Physiology, Institute of Physiology of the Komi Scientific Centre of the Ural Branch of the Russian Academy of Sciences, 50 Pervomayskaya Street, GSP-2, Syktyvkar, Komi Republic, Russian Federation; Department of Physiology, Medical Institute, Federal State Budget Educational Institution of Higher Education «Syktyvkar State University named after Pitirim Sorokin», 11 Babushkin Street, Syktyvkar, Komi Republic, Russian Federation.
| | - V V Krandycheva
- Laboratory of Cardiac Physiology, Institute of Physiology of the Komi Scientific Centre of the Ural Branch of the Russian Academy of Sciences, 50 Pervomayskaya Street, GSP-2, Syktyvkar, Komi Republic, Russian Federation; Department of Physiology, Medical Institute, Federal State Budget Educational Institution of Higher Education «Syktyvkar State University named after Pitirim Sorokin», 11 Babushkin Street, Syktyvkar, Komi Republic, Russian Federation
| | - A S Tsvetkova
- Laboratory of Cardiac Physiology, Institute of Physiology of the Komi Scientific Centre of the Ural Branch of the Russian Academy of Sciences, 50 Pervomayskaya Street, GSP-2, Syktyvkar, Komi Republic, Russian Federation
| | - K V Shumikhin
- Department of Physiology, Medical Institute, Federal State Budget Educational Institution of Higher Education «Syktyvkar State University named after Pitirim Sorokin», 11 Babushkin Street, Syktyvkar, Komi Republic, Russian Federation
| |
Collapse
|
19
|
Porteous MK, Ky B, Kirkpatrick JN, Shinohara R, Diamond JM, Shah RJ, Lee JC, Christie JD, Kawut SM. Diastolic Dysfunction Increases the Risk of Primary Graft Dysfunction after Lung Transplant. Am J Respir Crit Care Med 2017; 193:1392-400. [PMID: 26745666 DOI: 10.1164/rccm.201508-1522oc] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
RATIONALE Primary graft dysfunction (PGD) is a significant cause of early morbidity and mortality after lung transplant and is characterized by severe hypoxemia and infiltrates in the allograft. The pathogenesis of PGD involves ischemia-reperfusion injury. However, subclinical increases in pulmonary venous pressure due to left ventricular diastolic dysfunction may contribute by exacerbating capillary leak. OBJECTIVES To determine whether a higher ratio of early mitral inflow velocity (E) to early diastolic mitral annular velocity (é), indicative of worse left ventricular diastolic function, is associated with a higher risk of PGD. METHODS We performed a retrospective cohort study of patients in the Lung Transplant Outcomes Group who underwent bilateral lung transplant at our institution between 2004 and 2014 for interstitial lung disease, chronic obstructive pulmonary disease, or pulmonary arterial hypertension. Transthoracic echocardiograms obtained during evaluation for transplant listing were analyzed for E/é and other measures of diastolic function. PGD was defined as PaO2/FiO2 less than or equal to 200 with allograft infiltrates at 48 or 72 hours after reperfusion. The association between E/é and PGD was assessed with multivariable logistic regression. MEASUREMENTS AND MAIN RESULTS After adjustment for recipient age, body mass index, mean pulmonary arterial pressure, and pretransplant diagnosis, higher E/é and E/é greater than 8 were associated with an increased risk of PGD (E/é odds ratio, 1.93; 95% confidence interval, 1.02-3.64; P = 0.04; E/é >8 odds ratio, 5.29; 95% confidence interval, 1.40-20.01; P = 0.01). CONCLUSIONS Differences in left ventricular diastolic function may contribute to the development of PGD. Future trials are needed to determine whether optimization of left ventricular diastolic function reduces the risk of PGD.
Collapse
Affiliation(s)
- Mary K Porteous
- 1 Department of Medicine.,2 Center for Clinical Epidemiology and Biostatistics, and
| | - Bonnie Ky
- 1 Department of Medicine.,2 Center for Clinical Epidemiology and Biostatistics, and.,3 Penn Cardiovascular Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - James N Kirkpatrick
- 4 Department of Medicine, University of Washington, Seattle, Washington; and
| | | | - Joshua M Diamond
- 1 Department of Medicine.,2 Center for Clinical Epidemiology and Biostatistics, and
| | - Rupal J Shah
- 5 Department of Medicine, University of California, San Francisco, San Francisco, California
| | | | - Jason D Christie
- 1 Department of Medicine.,2 Center for Clinical Epidemiology and Biostatistics, and
| | - Steven M Kawut
- 1 Department of Medicine.,2 Center for Clinical Epidemiology and Biostatistics, and.,3 Penn Cardiovascular Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
20
|
Schmidt C, Wiedmann F, Kallenberger SM, Ratte A, Schulte JS, Scholz B, Müller FU, Voigt N, Zafeiriou MP, Ehrlich JR, Tochtermann U, Veres G, Ruhparwar A, Karck M, Katus HA, Thomas D. Stretch-activated two-pore-domain (K 2P) potassium channels in the heart: Focus on atrial fibrillation and heart failure. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2017; 130:233-243. [PMID: 28526353 DOI: 10.1016/j.pbiomolbio.2017.05.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 12/18/2022]
Abstract
Two-pore-domain potassium (K2P) channels modulate cellular excitability. The significance of stretch-activated cardiac K2P channels (K2P2.1, TREK-1, KCNK2; K2P4.1, TRAAK, KCNK4; K2P10.1, TREK-2, KCNK10) in heart disease has not been elucidated in detail. The aim of this work was to assess expression and remodeling of mechanosensitive K2P channels in atrial fibrillation (AF) and heart failure (HF) patients in comparison to murine models. Cardiac K2P channel levels were quantified in atrial (A) and ventricular (V) tissue obtained from patients undergoing open heart surgery. In addition, control mice and mouse models of AF (cAMP-response element modulator (CREM)-IbΔC-X transgenic animals) or HF (cardiac dysfunction induced by transverse aortic constriction, TAC) were employed. Human and murine KCNK2 displayed highest mRNA abundance among mechanosensitive members of the K2P channel family (V > A). Disease-associated K2P2.1 remodeling was studied in detail. In patients with impaired left ventricular function, atrial KCNK2 (K2P2.1) mRNA and protein expression was significantly reduced. In AF subjects, downregulation of atrial and ventricular KCNK2 (K2P2.1) mRNA and protein levels was observed. AF-associated suppression of atrial Kcnk2 (K2P2.1) mRNA and protein was recapitulated in CREM-transgenic mice. Ventricular Kcnk2 expression was not significantly altered in mouse models of disease. In conclusion, mechanosensitive K2P2.1 and K2P10.1 K+ channels are expressed throughout the heart. HF- and AF-associated downregulation of KCNK2 (K2P2.1) mRNA and protein levels suggest a mechanistic contribution to cardiac arrhythmogenesis.
Collapse
Affiliation(s)
- Constanze Schmidt
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg / Mannheim, University of Heidelberg, Germany
| | - Felix Wiedmann
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg / Mannheim, University of Heidelberg, Germany
| | - Stefan M Kallenberger
- Department for Bioinformatics and Functional Genomics, Division of Theoretical Bioinformatics, German Cancer Research Center (DKFZ), Institute for Pharmacy and Molecular Biotechnology (IPMB) and BioQuant, Heidelberg University, Heidelberg, Germany
| | - Antonius Ratte
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Jan S Schulte
- Institute of Pharmacology and Toxicology, University of Münster, Münster, Germany
| | - Beatrix Scholz
- Institute of Pharmacology and Toxicology, University of Münster, Münster, Germany
| | - Frank Ulrich Müller
- Institute of Pharmacology and Toxicology, University of Münster, Münster, Germany
| | - Niels Voigt
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Georg-August University Göttingen, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Germany
| | - Maria-Patapia Zafeiriou
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Georg-August University Göttingen, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Germany
| | - Joachim R Ehrlich
- Department of Cardiology, Internal Medicine III, Goethe University, Frankfurt, Germany; Department of Cardiology, St. Josefs-Hospital, Wiesbaden, Germany
| | - Ursula Tochtermann
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Gábor Veres
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg / Mannheim, University of Heidelberg, Germany
| | - Dierk Thomas
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg / Mannheim, University of Heidelberg, Germany.
| |
Collapse
|
21
|
Left Ventricular Myocardial Fibrosis, Atrophy, and Impaired Contractility in Patients With Pulmonary Arterial Hypertension and a Preserved Left Ventricular Function: A Cardiac Magnetic Resonance Study. J Thorac Imaging 2017; 32:36-42. [PMID: 27861208 DOI: 10.1097/rti.0000000000000248] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE Using a cardiac magnetic resonance (CMR) approach we investigated left ventricular (LV) myocardial changes associated with pulmonary arterial hypertension (PAH) by strain analysis and mapping techniques. MATERIALS AND METHODS Seventeen patients with PAH (9 men; mean age, 64.2±13.6 y) and 20 controls (10 men, 63.2±10.5 y) were examined using CMR at 1.5 T. Native LV T1-relaxation times (T1) and extracellular volume fraction (ECV) were assessed using a MOLLI sequence, T2-relaxation times (T2) by means of a gradient spin-echo sequence, and LV longitudinal strain (LVS) and right ventricular (RV) longitudinal strain (RVS) by means of CMR feature tracking. The hematocrit and serum levels of pro-Brain Natriuretic Peptide were determined on the day of the CMR examination. Pulmonary arterial pressure and 6-minute walking distance were assessed as part of the clinical evaluation. RESULTS T1 and ECV were higher (1048.5±46.6 vs. 968.3±22.9 ms and 32.4%±5.7% vs. 28.4%±3.8%; P<0.05) and LVS was lower in patients with PAH (-18.0±5.6 vs. -23.0±2.9; P<0.01) compared with controls. LV mass and interventricular septal thickness were lower in PAH patients (65.7±18.0 vs. 86.7±26.9 g and 7.6±1.9 vs. 10±2.4 mm; P<0.05); there were no differences in LV ejection fraction (61.2%±6.9% vs. 61.9%±6.7%; P=0.86). T1-derived parameters correlated significantly with RVS, LVS, the 6-minute walking distance, RV ejection fraction, pro-Brain Natriuretic Peptide, and baseline mean pulmonary arterial pressure. There were no significant differences in T2. CONCLUSIONS In patients with PAH, changes in T1 and ECV support the hypothesis of LV myocardial fibrosis and atrophy with a consecutively impaired contractility despite a preserved LV function, possibly due to longstanding PAH-associated LV underfilling.
Collapse
|
22
|
Suslonova OV, Smirnova SL, Roshchevskaya IM. Cardiac Body Surface Potentials in Rats with Experimental Pulmonary Hypertension during Ventricular Depolarization. Bull Exp Biol Med 2016; 162:7-10. [PMID: 27878490 DOI: 10.1007/s10517-016-3531-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Indexed: 10/20/2022]
Abstract
The spatial and the amplitude-temporal parameters of cardiac body surface potentials were examined in female Wistar rats with experimental pulmonary hypertension during ventricular depolarization. The cardiac body surface potentials have been led from 64 subcutaneous electrodes evenly distributed across the chest surface prior to and 4 weeks after subcutaneous injection of a single dose of monocrotaline (60 mg/kg). Right ventricular hypertrophy and electrophysiological remodeling of the heart developed in rats with experimental pulmonary hypertension in 4 weeks after monocrotaline injection; these changes led to a significant increase in amplitude and temporal characteristics of the cardioelectric field on the body surface in comparison with the initial state.
Collapse
Affiliation(s)
- O V Suslonova
- Department of Comparative Cardiology, Komi Scientific Center, Ural Division of Russian Academy of Sciences, Syktyvkar, Russia.
| | - S L Smirnova
- Department of Comparative Cardiology, Komi Scientific Center, Ural Division of Russian Academy of Sciences, Syktyvkar, Russia
| | - I M Roshchevskaya
- Department of Comparative Cardiology, Komi Scientific Center, Ural Division of Russian Academy of Sciences, Syktyvkar, Russia
| |
Collapse
|
23
|
Ortega A, Tarazón E, Roselló-Lletí E, Gil-Cayuela C, Lago F, González-Juanatey JR, Cinca J, Jorge E, Martínez-Dolz L, Portolés M, Rivera M. Patients with Dilated Cardiomyopathy and Sustained Monomorphic Ventricular Tachycardia Show Up-Regulation of KCNN3 and KCNJ2 Genes and CACNG8-Linked Left Ventricular Dysfunction. PLoS One 2015; 10:e0145518. [PMID: 26710323 PMCID: PMC4692400 DOI: 10.1371/journal.pone.0145518] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 12/05/2015] [Indexed: 01/26/2023] Open
Abstract
AIMS Disruptions in cardiac ion channels have shown to influence the impaired cardiac contraction in heart failure. We sought to determine the altered gene expression profile of this category in dilated cardiomyopathy (DCM) patients and relate the altered gene expression with the clinical signs present in our patients, such as ventricular dysfunction and sustained monomorphic ventricular tachycardia (SMVT). METHODS AND RESULTS Left ventricular (LV) tissue samples were used in RNA-sequencing technique to elucidate the transcriptomic changes of 13 DCM patients compared to controls (n = 10). We analyzed the differential gene expression of cardiac ion channels, and we found a total of 34 altered genes. We found that the calcium channel CACNG8 mRNA and protein levels were down-regulated and highly and inversely related with LV ejection fraction (LVEF) (r = -0.78, P<0.01). Furthermore, the potassium channels KCNN3 and KCNJ2 mRNA and protein levels were up-regulated and showed also a significant and inverse correlation with LVEF (r = -0.61, P<0.05; r = -0.60, P<0.05) in patients with SMVT. CONCLUSION A broad set of deregulated genes have been identified by RNA-sequencing technique. The relationship of CACNG8, KCNN3 and KCNJ2 with LVEF, and the up-regulation of KCNN3 and KCNJ2 in all patients with SMVT, irrespective of CACNG8 expression, suggest a significant role for these three ion flux related genes in the LV dysfunction present in this cardiomyopathy and an important relationship between KCNN3 and KCNJ2 up-regulation and the presence of SMVT.
Collapse
Affiliation(s)
- Ana Ortega
- Cardiocirculatory Unit, Health Research Institute of La Fe University Hospital (IIS La Fe), Valencia, Spain
| | - Estefanía Tarazón
- Cardiocirculatory Unit, Health Research Institute of La Fe University Hospital (IIS La Fe), Valencia, Spain
| | - Esther Roselló-Lletí
- Cardiocirculatory Unit, Health Research Institute of La Fe University Hospital (IIS La Fe), Valencia, Spain
| | - Carolina Gil-Cayuela
- Cardiocirculatory Unit, Health Research Institute of La Fe University Hospital (IIS La Fe), Valencia, Spain
| | - Francisca Lago
- Cellular and Molecular Cardiology Research Unit, Department of Cardiology and Institute of Biomedical Research, University Clinical Hospital, Santiago de Compostela, Spain
| | - Jose-Ramón González-Juanatey
- Cellular and Molecular Cardiology Research Unit, Department of Cardiology and Institute of Biomedical Research, University Clinical Hospital, Santiago de Compostela, Spain
| | - Juan Cinca
- Cardiology Service of Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | - Esther Jorge
- Cardiology Service of Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | - Luis Martínez-Dolz
- Heart Failure and Transplantation Unit, Cardiology Department, La Fe University Hospital, Valencia, Spain
| | - Manuel Portolés
- Cardiocirculatory Unit, Health Research Institute of La Fe University Hospital (IIS La Fe), Valencia, Spain
| | - Miguel Rivera
- Cardiocirculatory Unit, Health Research Institute of La Fe University Hospital (IIS La Fe), Valencia, Spain
- * E-mail:
| |
Collapse
|
24
|
Lookin O, Balakin A, Kuznetsov D, Protsenko Y. The length-dependent activation of contraction is equally impaired in impuberal male and female rats in monocrotaline-induced right ventricular failure. Clin Exp Pharmacol Physiol 2015; 42:1198-206. [DOI: 10.1111/1440-1681.12471] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 07/23/2015] [Accepted: 07/27/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Oleg Lookin
- Laboratory of Biological Motility; Institute of Immunology and Physiology; Ural Branch of Russian Academy of Sciences; Yekaterinburg Russian Federation
| | - Alexander Balakin
- Laboratory of Biological Motility; Institute of Immunology and Physiology; Ural Branch of Russian Academy of Sciences; Yekaterinburg Russian Federation
| | - Daniil Kuznetsov
- Laboratory of Biological Motility; Institute of Immunology and Physiology; Ural Branch of Russian Academy of Sciences; Yekaterinburg Russian Federation
| | - Yuri Protsenko
- Laboratory of Biological Motility; Institute of Immunology and Physiology; Ural Branch of Russian Academy of Sciences; Yekaterinburg Russian Federation
| |
Collapse
|
25
|
Myocardial inflammation in experimental acute right ventricular failure: Effects of prostacyclin therapy. J Heart Lung Transplant 2015; 34:1334-45. [DOI: 10.1016/j.healun.2015.05.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 03/27/2015] [Accepted: 05/01/2015] [Indexed: 01/24/2023] Open
|
26
|
Maarman G, Blackhurst D, Thienemann F, Blauwet L, Butrous G, Davies N, Sliwa K, Lecour S. Melatonin as a preventive and curative therapy against pulmonary hypertension. J Pineal Res 2015. [PMID: 26201290 DOI: 10.1111/jpi.12263] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Pulmonary hypertension (PH) is characterized by elevated pulmonary arterial pressure, which leads to right ventricular (RV) hypertrophy and failure. The pathophysiological mechanisms of PH remain unclear but oxidative stress is believed to contribute to RV dysfunction. Melatonin is a powerful antioxidant and is cardioprotective against ischemia-reperfusion injury and hypertension. Therefore, we hypothesized that a chronic treatment with melatonin, given as a curative or preventive therapy, may confer cardiovascular benefits in PH. PH was induced in Long Evans rats (n ≥ 6 per group), with a single subcutaneous injection of monocrotaline (MCT, 80 mg/kg). Melatonin was given daily in the drinking water, with the treatment starting either on the day of the injection of MCT (dose testing: melatonin 75 ng/L and 6 mg/kg), 14 days after the injection of MCT (curative treatment: 6 mg/kg), or 5 days before the injection (preventive treatment: 6 mg/kg). The development of PH was assessed by measuring RV hypertrophy, RV function, cardiac interstitial fibrosis, and plasma oxidative stress. Compared with controls, MCT-treated rats displayed RV hypertrophy and dysfunction, increased interstitial fibrosis, and elevated plasma oxidative stress. A chronic melatonin treatment (75 ng/L or 6 mg/kg) reduced RV hypertrophy, improved RV function and reduced plasma oxidative stress. Curative and preventive treatment improved RV functional and plasma oxidative stress parameters and reduced cardiac interstitial fibrosis. Our data demonstrate that melatonin confers cardioprotection in this model of PH. As melatonin is an inexpensive and safe drug, we propose that clinical investigation of the effects of melatonin on RV function in patients with PH should be considered.
Collapse
MESH Headings
- Animals
- Antioxidants/therapeutic use
- Hypertension, Pulmonary/chemically induced
- Hypertension, Pulmonary/drug therapy
- Hypertension, Pulmonary/prevention & control
- Hypertrophy, Right Ventricular/chemically induced
- Hypertrophy, Right Ventricular/drug therapy
- Hypertrophy, Right Ventricular/prevention & control
- Male
- Melatonin/therapeutic use
- Monocrotaline/toxicity
- Rats
- Rats, Long-Evans
- Ventricular Dysfunction, Right/chemically induced
- Ventricular Dysfunction, Right/drug therapy
- Ventricular Dysfunction, Right/prevention & control
Collapse
Affiliation(s)
- Gerald Maarman
- Hatter Institute for Cardiovascular Research in Africa and Inter University MRC Cape Heart Group, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Dee Blackhurst
- Division of Chemical Pathology, Department of Clinical Laboratory Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Friedrich Thienemann
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | | | - Neil Davies
- Cardiovascular Research Unit, Chris Barnard Division of Cardiothoracic Surgery, University of Cape Town, Faculty of Health Sciences, Cape Town, South Africa
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa and Inter University MRC Cape Heart Group, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sandrine Lecour
- Hatter Institute for Cardiovascular Research in Africa and Inter University MRC Cape Heart Group, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
27
|
Rasmussen JT, Thenappan T, Benditt DG, Weir EK, Pritzker MR. Is cardiac resynchronization therapy for right ventricular failure in pulmonary arterial hypertension of benefit? Pulm Circ 2015; 4:552-9. [PMID: 25610593 DOI: 10.1086/678470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 05/07/2014] [Indexed: 12/17/2022] Open
Abstract
Pulmonary arterial hypertension is a manifestation of a group of disorders leading to pulmonary vascular remodeling and increased pulmonary pressures. The right ventricular (RV) response to chronic pressure overload consists of myocardial remodeling, which is in many ways similar to that seen in left ventricular (LV) failure. Maladaptive myocardial remodeling often leads to intraventricular and interventricular dyssychrony, an observation that has led to cardiac resynchronization therapy (CRT) for LV failure. CRT has proven to be an effective treatment strategy in subsets of patients with LV failure resulting in improvement in LV function, heart failure symptoms, and survival. Current therapy for pulmonary arterial hypertension is based on decreasing pulmonary vascular resistance, and there is currently no effective therapy targeting the right ventricle or maladaptive ventricular remodeling in these patients. This review focuses on the RV response to chronic pressure overload, its effect on electromechanical coupling and synchrony, and how lessons learned from left ventricular cardiac resynchronization might be applied as therapy for RV dysfunction in the context of pulmonary arterial hypertension.
Collapse
Affiliation(s)
- Jason T Rasmussen
- Department of Medicine, Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Thenappan Thenappan
- Department of Medicine, Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - David G Benditt
- Department of Medicine, Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - E Kenneth Weir
- Department of Medicine, Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Marc R Pritzker
- Department of Medicine, Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
28
|
Kessler EL, Boulaksil M, van Rijen HVM, Vos MA, van Veen TAB. Passive ventricular remodeling in cardiac disease: focus on heterogeneity. Front Physiol 2014; 5:482. [PMID: 25566084 PMCID: PMC4273631 DOI: 10.3389/fphys.2014.00482] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 11/24/2014] [Indexed: 12/20/2022] Open
Abstract
Passive ventricular remodeling is defined by the process of molecular ventricular adaptation to different forms of cardiac pathophysiology. It includes changes in tissue architecture, such as hypertrophy, fiber disarray, alterations in cell size and fibrosis. Besides that, it also includes molecular remodeling of gap junctions, especially those composed by Connexin43 proteins (Cx43) in the ventricles that affect cell-to-cell propagation of the electrical impulse, and changes in the sodium channels that modify excitability. All those alterations appear mainly in a heterogeneous manner, creating irregular and inhomogeneous electrical and mechanical coupling throughout the heart. This can predispose to reentry arrhythmias and adds to a further deterioration into heart failure. In this review, passive ventricular remodeling is described in Hypertrophic Cardiomyopathy (HCM), Dilated Cardiomyopathy (DCM), Ischemic Cardiomyopathy (ICM), and Arrhythmogenic Cardiomyopathy (ACM), with a main focus on the heterogeneity of those alterations mentioned above.
Collapse
Affiliation(s)
- Elise L Kessler
- Division of Heart and Lungs, Department of Medical Physiology, University Medical Center Utrecht Utrecht, Netherlands
| | - Mohamed Boulaksil
- Division of Heart and Lungs, Department of Medical Physiology, University Medical Center Utrecht Utrecht, Netherlands ; Department of Cardiology, Radboud University Medical Center Nijmegen, Netherlands
| | - Harold V M van Rijen
- Division of Heart and Lungs, Department of Medical Physiology, University Medical Center Utrecht Utrecht, Netherlands
| | - Marc A Vos
- Division of Heart and Lungs, Department of Medical Physiology, University Medical Center Utrecht Utrecht, Netherlands
| | - Toon A B van Veen
- Division of Heart and Lungs, Department of Medical Physiology, University Medical Center Utrecht Utrecht, Netherlands
| |
Collapse
|
29
|
Manders E, Bogaard HJ, Handoko ML, van de Veerdonk MC, Keogh A, Westerhof N, Stienen GJM, Dos Remedios CG, Humbert M, Dorfmüller P, Fadel E, Guignabert C, van der Velden J, Vonk-Noordegraaf A, de Man FS, Ottenheijm CAC. Contractile dysfunction of left ventricular cardiomyocytes in patients with pulmonary arterial hypertension. J Am Coll Cardiol 2014; 64:28-37. [PMID: 24998125 DOI: 10.1016/j.jacc.2014.04.031] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 04/16/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND After lung transplantation, increased left ventricular (LV) filling can lead to LV failure, increasing the risk of post-operative complications and mortality. LV dysfunction in pulmonary arterial hypertension (PAH) is characterized by a reduced LV ejection fraction and impaired diastolic function. OBJECTIVES The pathophysiology of LV dysfunction in PAH is incompletely understood. This study sought to assess the contribution of atrophy and contractility of cardiomyocytes to LV dysfunction in PAH patients. METHODS LV function was assessed by cardiac magnetic resonance imaging. In addition, LV biopsies were obtained in 9 PAH patients and 10 donors. The cross-sectional area (CSA) and force-generating capacity of isolated single cardiomyocytes was investigated. RESULTS Magnetic resonance imaging analysis revealed a significant reduction in LV ejection fraction in PAH patients, indicating a reduction in LV contractility. The CSA of LV cardiomyocytes of PAH patients was significantly reduced (~30%), indicating LV cardiomyocyte atrophy. The maximal force-generating capacity, normalized to cardiomyocyte CSA, was significantly reduced (~25%). Also, a reduction in the number of available myosin-based cross-bridges was found to cause the contractile weakness of cardiomyocytes. This finding was supported by protein analyses, which showed an ~30% reduction in the myosin/actin ratio in cardiomyocytes from PAH patients. Finally, the phosphorylation level of sarcomeric proteins was reduced in PAH patients, which was accompanied by increased calcium sensitivity of force generation. CONCLUSIONS The contractile function and the CSA of LV cardiomyocytes is substantially reduced in PAH patients. We propose that these changes contribute to the reduced in vivo contractility of the LV in PAH patients.
Collapse
Affiliation(s)
- Emmy Manders
- Department of Pulmonology, Vrije Universiteit (VU) University Medical Center, Amsterdam, the Netherlands; Department of Physiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Harm-Jan Bogaard
- Department of Pulmonology, Vrije Universiteit (VU) University Medical Center, Amsterdam, the Netherlands
| | - M Louis Handoko
- Department of Physiology, VU University Medical Center, Amsterdam, the Netherlands; Cardiology Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Marielle C van de Veerdonk
- Department of Pulmonology, Vrije Universiteit (VU) University Medical Center, Amsterdam, the Netherlands
| | - Anne Keogh
- Heart Transplant Unit, St. Vincent's Hospital, Sydney, Australia
| | - Nico Westerhof
- Department of Pulmonology, Vrije Universiteit (VU) University Medical Center, Amsterdam, the Netherlands; Department of Physiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Ger J M Stienen
- Department of Physiology, VU University Medical Center, Amsterdam, the Netherlands; Department of Physics and Astronomy, VU University, Amsterdam, the Netherlands
| | | | - Marc Humbert
- University of Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France; Assistance Publique-Hôpitaux de Paris, Service de Pneumologie, Département Hospitalo-Universitaire, Thorax Innovation (DHU TORINO), Hôpital Bicêtre, Le Kremlin-Bicêtre, France; Inserm U999, Laboratoire d'Excellence en Recherche sur le Médicament et l'Innovation Thérapeutique (LabEx LERMIT), Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France
| | - Peter Dorfmüller
- University of Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France; Inserm U999, Laboratoire d'Excellence en Recherche sur le Médicament et l'Innovation Thérapeutique (LabEx LERMIT), Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France; Service d'Anatomie Pathologique, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France
| | - Elie Fadel
- University of Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France; Inserm U999, Laboratoire d'Excellence en Recherche sur le Médicament et l'Innovation Thérapeutique (LabEx LERMIT), Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France; Service de Chirurgie Thoracique, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France
| | - Christophe Guignabert
- University of Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France; Inserm U999, Laboratoire d'Excellence en Recherche sur le Médicament et l'Innovation Thérapeutique (LabEx LERMIT), Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France
| | - Jolanda van der Velden
- Department of Physiology, VU University Medical Center, Amsterdam, the Netherlands; ICIN Netherlands Heart Institute, Utrecht, the Netherlands
| | - Anton Vonk-Noordegraaf
- Department of Pulmonology, Vrije Universiteit (VU) University Medical Center, Amsterdam, the Netherlands
| | - Frances S de Man
- Department of Pulmonology, Vrije Universiteit (VU) University Medical Center, Amsterdam, the Netherlands.
| | - Coen A C Ottenheijm
- Department of Physiology, VU University Medical Center, Amsterdam, the Netherlands.
| |
Collapse
|
30
|
Yasui H, Lee JK, Yoshida A, Yokoyama T, Nakanishi H, Miwa K, Naito AT, Oka T, Akazawa H, Nakai J, Miyagawa S, Sawa Y, Sakata Y, Komuro I. Excitation propagation in three-dimensional engineered hearts using decellularized extracellular matrix. Biomaterials 2014; 35:7839-50. [DOI: 10.1016/j.biomaterials.2014.05.080] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 05/28/2014] [Indexed: 12/20/2022]
|
31
|
Rocchetti M, Sala L, Rizzetto R, Staszewsky LI, Alemanni M, Zambelli V, Russo I, Barile L, Cornaghi L, Altomare C, Ronchi C, Mostacciuolo G, Lucchetti J, Gobbi M, Latini R, Zaza A. Ranolazine prevents INaL enhancement and blunts myocardial remodelling in a model of pulmonary hypertension. Cardiovasc Res 2014; 104:37-48. [DOI: 10.1093/cvr/cvu188] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
32
|
Vonk-Noordegraaf A, Haddad F, Chin KM, Forfia PR, Kawut SM, Lumens J, Naeije R, Newman J, Oudiz RJ, Provencher S, Torbicki A, Voelkel NF, Hassoun PM. Right heart adaptation to pulmonary arterial hypertension: physiology and pathobiology. J Am Coll Cardiol 2014; 62:D22-33. [PMID: 24355638 DOI: 10.1016/j.jacc.2013.10.027] [Citation(s) in RCA: 674] [Impact Index Per Article: 67.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 10/22/2013] [Indexed: 12/22/2022]
Abstract
Survival in patients with pulmonary arterial hypertension (PAH) is closely related to right ventricular (RV) function. Although pulmonary load is an important determinant of RV systolic function in PAH, there remains a significant variability in RV adaptation to pulmonary hypertension. In this report, the authors discuss the emerging concepts of right heart pathobiology in PAH. More specifically, the discussion focuses on the following questions. 1) How is right heart failure syndrome best defined? 2) What are the underlying molecular mechanisms of the failing right ventricle in PAH? 3) How are RV contractility and function and their prognostic implications best assessed? 4) What is the role of targeted RV therapy? Throughout the report, the authors highlight differences between right and left heart failure and outline key areas of future investigation.
Collapse
Affiliation(s)
| | - François Haddad
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California
| | - Kelly M Chin
- Department of Internal Medicine, Pulmonary Division, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Paul R Forfia
- Pulmonary Hypertension and Right Heart Failure Program, Temple University Hospital, Philadelphia, Pennsylvania
| | - Steven M Kawut
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joost Lumens
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Robert Naeije
- Department of Pathophysiology, Faculty of Medicine, Free University of Brussels, Brussels, Belgium
| | - John Newman
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Ronald J Oudiz
- The David Geffen School of Medicine at UCLA, Liu Center for Pulmonary Hypertension, Division of Cardiology, Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Steve Provencher
- Pulmonary Hypertension Research Group, Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Chemin Sainte-Foy, Québec, Canada
| | - Adam Torbicki
- Department of Pulmonary Circulation and Thromboembolic Diseases, Centre of Postgraduate Medical Education, ECZ, Otwock, Poland
| | - Norbert F Voelkel
- Division of Pulmonary and Critical Care Medicine and Victoria Johnson Lab for Lung Research, Virginia Commonwealth University, Richmond, Virginia; Johns Hopkins University, Baltimore, Maryland
| | - Paul M Hassoun
- Department of Internal Medicine, Pulmonary Division, University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
33
|
Friedberg MK, Cho MY, Li J, Assad RS, Sun M, Rohailla S, Honjo O, Apitz C, Redington AN. Adverse biventricular remodeling in isolated right ventricular hypertension is mediated by increased transforming growth factor-β1 signaling and is abrogated by angiotensin receptor blockade. Am J Respir Cell Mol Biol 2014; 49:1019-28. [PMID: 23841477 DOI: 10.1165/rcmb.2013-0149oc] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The pressure-loaded right ventricle (RV) adversely affects left ventricular (LV) function. We recently found that these ventricular-ventricular interactions lead to LV myocardial fibrosis through transforming growth factor-β1 (TGF-β1) signaling. We investigated the mechanisms mediating biventricular fibrosis in RV afterload and their potential modification by angiotensin receptor blockade. An adjustable pulmonary artery band (PAB) was placed in rabbits. In sham-operated control rabbits, the band was left uninflated (n = 6). In the RV afterload group, the PAB was sequentially inflated to generate systemic RV pressure at 28 days (n = 8). In a third group, the PAB was inflated to systemic levels, and the angiotensin receptor blocker losartan was added (n = 6). Five weeks after surgery, the animals were killed for assessments of biventricular hypertrophy, fibrosis, apoptosis, and the components of their signaling pathways. PAB animals developed biventricular hypertrophy, fibrosis, and apoptosis, versus sham rabbits, in which these conditions were decreased with losartan. RV and LV TGF-β1, connective tissue growth factor (CTGF) (CCN2), endothelin-1 (ET-1), endothelin receptor B, and matrix metalloproteinase 2/9 mRNA levels were increased in PAB animals versus sham animals, and decreased with losartan. Given the marked biventricular CTGF up-regulation in PAB and down-regulation with losartan, we investigated CTGF signaling. RV and LV Smad 2/3/4 protein levels and LV RhoA mRNA levels were increased with PAB and reduced with losartan. In conclusion, isolated RV afterload induces biventricular fibrosis and apoptosis, which are reduced by angiotensin receptor blockade. Adverse ventricular-ventricular interactions induced by isolated RV afterload appear to be mediated through TGF-β1-CTGF and ET-1 pathways.
Collapse
|
34
|
Becker M, Goetzenich A, Roehl AB, Huebel C, de la Fuente M, Dietz-Laursonn K, Radermacher K, Rossaint R, Hein M. Myocardial effects of local shock wave therapy in a Langendorff model. ULTRASONICS 2014; 54:131-136. [PMID: 23896623 DOI: 10.1016/j.ultras.2013.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 05/08/2013] [Accepted: 07/06/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Applying shock waves to the heart has been reported to stimulate the heart and alter cardiac function. We hypothesized that shock waves could be used to diagnose regional viability. METHOD We used a Langendorff model to investigate the acute effects of shock waves at different energy levels and times related to systole, cycle duration and myocardial function. RESULTS We found only a small time window to use shock waves. Myocardial fibrillation or extrasystolic beats will occur if the shock wave is placed more than 15 ms before or 30 ms after the onset of systole. Increased contractility and augmented relaxation were observed after the second beat, and these effects decreased after prolonging the shock wave delay from 15 ms before to 30 ms after the onset of systole. An energy dependency could be found only after short delays (-15 ms). The involved processes might include post-extrasystolic potentiation and simultaneous pacing. CONCLUSION In summary, we found that low-energy shock waves can be a useful tool to stimulate the myocardium at a distance and influence function.
Collapse
Affiliation(s)
- M Becker
- Medical Clinic of Cardiology and Pulmonology, RWTH Aachen University Hospital, Pauwelstrasse 30, 52074 Aachen, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Coronel R, Wilders R, Verkerk AO, Wiegerinck RF, Benoist D, Bernus O. Electrophysiological changes in heart failure and their implications for arrhythmogenesis. Biochim Biophys Acta Mol Basis Dis 2013; 1832:2432-41. [DOI: 10.1016/j.bbadis.2013.04.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 04/01/2013] [Indexed: 01/07/2023]
|
36
|
Herren AW, Bers DM, Grandi E. Post-translational modifications of the cardiac Na channel: contribution of CaMKII-dependent phosphorylation to acquired arrhythmias. Am J Physiol Heart Circ Physiol 2013; 305:H431-45. [PMID: 23771687 DOI: 10.1152/ajpheart.00306.2013] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The voltage-gated Na channel isoform 1.5 (NaV1.5) is the pore forming α-subunit of the voltage-gated cardiac Na channel, which is responsible for the initiation and propagation of cardiac action potentials. Mutations in the SCN5A gene encoding NaV1.5 have been linked to changes in the Na current leading to a variety of arrhythmogenic phenotypes, and alterations in the NaV1.5 expression level, Na current density, and/or gating have been observed in acquired cardiac disorders, including heart failure. The precise mechanisms underlying these abnormalities have not been fully elucidated. However, several recent studies have made it clear that NaV1.5 forms a macromolecular complex with a number of proteins that modulate its expression levels, localization, and gating and is the target of extensive post-translational modifications, which may also influence all these properties. We review here the molecular aspects of cardiac Na channel regulation and their functional consequences. In particular, we focus on the molecular and functional aspects of Na channel phosphorylation by the Ca/calmodulin-dependent protein kinase II, which is hyperactive in heart failure and has been causally linked to cardiac arrhythmia. Understanding the mechanisms of altered NaV1.5 expression and function is crucial for gaining insight into arrhythmogenesis and developing novel therapeutic strategies.
Collapse
Affiliation(s)
- Anthony W Herren
- Department of Pharmacology, University of California Davis, Davis, California
| | | | | |
Collapse
|
37
|
Ichikawa K, Dohi K, Sugiura E, Sugimoto T, Takamura T, Ogihara Y, Nakajima H, Onishi K, Yamada N, Nakamura M, Nobori T, Ito M. Ventricular Function and Dyssynchrony Quantified by Speckle-Tracking Echocardiography in Patients with Acute and Chronic Right Ventricular Pressure Overload. J Am Soc Echocardiogr 2013; 26:483-92. [PMID: 23528714 DOI: 10.1016/j.echo.2013.02.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Indexed: 10/27/2022]
|
38
|
|