The less familiar face of heart failure

Humanizing the mdx mouse model of DMD: the long and the short of it

Duchenne muscular dystrophy (DMD) is a common fatal heritable myopathy, with cardiorespiratory failure occurring by the third decade of life. There is no specific treatment for DMD cardiomyopathy, in large part due to a lack of understanding of the mechanisms underlying the cardiac failure. Mdx mice, which have the same dystrophin mutation as human patients, are of limited use, as they do not develop early dilated cardiomyopathy as seen in patients. Here we summarize the usefulness of the various commonly used DMD mouse models, highlight a model with shortened telomeres like humans, and identify directions that warrant further investigation.

Intraventricular Dyssynchrony Assessment by Real-Time Three-Dimensional Echocardiography

Heart failure is exceedingly prevalent in the United States and in other developed countries. Treatment regimens are complex and now include electrical therapy. Methods for evaluating left ventricular dyssynchrony using echocardiography rather than QRS duration have been developed, with tissue Doppler velocity parameters being the most popular. Real-time three-dimensional echocardiography is another novel method for dyssynchrony evaluation that has potential advantages over existing techniques. The authors describe their experience with three-dimensional echocardiography dyssynchrony evaluation and offer insights into the direction that this technology must move to improve results.

Resynchronization therapy is an important advance in the management of congestive heart failure: view of an antagonist

The antagonist portion of the debate acknowledges that cardiac resynchronization therapy (CRT) is an important advance in the management of congestive heart failure, but the eligible treatment population currently is small relative to the whole. The impact of CRT on mortality without an implantable cardioverter defibrillator (ICD) probably is not significant, although a beneficial effect on morbidity associated with heart failure has clearly been achieved. The costs of CRT are not negligible. The morbidity and mortality of the procedure to implant these devices must be considered in future trial design.

Cytokines and immune activation in systolic heart failure: the role of Type D personality

The proinflammatory cytokine tumor necrosis factor-alpha (TNF-alpha) and its soluble receptors 1 (sTNFR1) and 2 (sTNFR2) are predictors of mortality in chronic heart failure (CHF) but the determinants of these increased levels of disease-promoting cytokines are largely unknown. Type D personality refers to the combination of the tendency to experience negative emotions (negative affectivity) and the tendency to inhibit the expression of emotions in social interaction (social inhibition). Type D is an independent predictor of cardiac events in coronary patients who are at risk for CHF. The present study examined the effect of Type D personality on TNF-alpha, sTNFR1, and sTNFR2 in 42 men with CHF (meanage=57.9+/-10.5 years). There was a significant multivariate effect of Type D on TNF-alpha measures (p=.006); i.e., circulating levels of TNF-alpha (4.8+/-0.9 versus 2.5+/-0.2 pg/ml, p=.003), sTNFR1 (1814+/-314 versus 1134+/-78 pg/ml, p=.014), and sTNFR2 (2465+/-243 versus 1874+/-118 pg/ml, p=.019) were significantly higher in Type D patients as compared to non-Type D patients. The effect size (ES) of Type D personality ranged from rather large (sTNFR1, ES=0.77; sTNFR2, ES= 0.73) to large (TNF-alpha, ES=0.90). After controlling for ischemic etiology and severity of heart failure, Type D personality emerged as an independent predictor of increased circulating levels of both TNF-alpha (OR=9.5, 95% CI 2.1-43.8, p=.004) and TNF-alpha receptors (OR= 6.1, 95% CI 1.4-25.8, p=.014). These findings are consistent with the prognostic power of Type D personality regarding long-term morbidity and mortality in patients with established coronary heart disease. This study suggests that individual differences in personality contribute to the psychoneuroimmunological aspects of heart failure.