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Shanmuganathan M, Masi A, Burrage MK, Kotronias RA, Borlotti A, Scarsini R, Banerjee A, Terentes-Printzios D, Zhang Q, Hann E, Tunnicliffe E, Lucking A, Langrish J, Kharbanda R, De Maria GL, Banning AP, Choudhury RP, Channon KM, Piechnik SK, Ferreira VM. Acute Response in the Noninfarcted Myocardium Predicts Long-Term Major Adverse Cardiac Events After STEMI. JACC Cardiovasc Imaging 2023; 16:46-59. [PMID: 36599569 PMCID: PMC9834063 DOI: 10.1016/j.jcmg.2022.09.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Acute ST-segment elevation myocardial infarction (STEMI) has effects on the myocardium beyond the immediate infarcted territory. However, pathophysiologic changes in the noninfarcted myocardium and their prognostic implications remain unclear. OBJECTIVES The purpose of this study was to evaluate the long-term prognostic value of acute changes in both infarcted and noninfarcted myocardium post-STEMI. METHODS Patients with acute STEMI undergoing primary percutaneous coronary intervention underwent evaluation with blood biomarkers and cardiac magnetic resonance (CMR) at 2 days and 6 months, with long-term follow-up for major adverse cardiac events (MACE). A comprehensive CMR protocol included cine, T2-weighted, T2∗, T1-mapping, and late gadolinium enhancement (LGE) imaging. Areas without LGE were defined as noninfarcted myocardium. MACE was a composite of cardiac death, sustained ventricular arrhythmia, and new-onset heart failure. RESULTS Twenty-two of 219 patients (10%) experienced an MACE at a median of 4 years (IQR: 2.5-6.0 years); 152 patients returned for the 6-month visit. High T1 (>1250 ms) in the noninfarcted myocardium was associated with lower left ventricular ejection fraction (LVEF) (51% ± 8% vs 55% ± 9%; P = 0.002) and higher NT-pro-BNP levels (290 pg/L [IQR: 103-523 pg/L] vs 170 pg/L [IQR: 61-312 pg/L]; P = 0.008) at 6 months and a 2.5-fold (IQR: 1.03-6.20) increased risk of MACE (2.53 [IQR: 1.03-6.22]), compared with patients with normal T1 in the noninfarcted myocardium (P = 0.042). A lower T1 (<1,300 ms) in the infarcted myocardium was associated with increased MACE (3.11 [IQR: 1.19-8.13]; P = 0.020). Both noninfarct and infarct T1 were independent predictors of MACE (both P = 0.001) and significantly improved risk prediction beyond LVEF, infarct size, and microvascular obstruction (C-statistic: 0.67 ± 0.07 vs 0.76 ± 0.06, net-reclassification index: 40% [IQR: 12%-64%]; P = 0.007). CONCLUSIONS The acute responses post-STEMI in both infarcted and noninfarcted myocardium are independent incremental predictors of long-term MACE. These insights may provide new opportunities for treatment and risk stratification in STEMI.
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Affiliation(s)
- Mayooran Shanmuganathan
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom,Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom,Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Ambra Masi
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Matthew K. Burrage
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom,Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Rafail A. Kotronias
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom,Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Alessandra Borlotti
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Roberto Scarsini
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom,Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Abhirup Banerjee
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Dimitrios Terentes-Printzios
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom,Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Qiang Zhang
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Evan Hann
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Elizabeth Tunnicliffe
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Andrew Lucking
- Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Jeremy Langrish
- Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Rajesh Kharbanda
- Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Giovanni Luigi De Maria
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom,Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Adrian P. Banning
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom,Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Robin P. Choudhury
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom,Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Keith M. Channon
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom,Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom,Address for correspondence: Prof Keith Channon, Level 2–Oxford Heart Centre, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom.
| | - Stefan K. Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Vanessa M. Ferreira
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom,Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom,Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
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Sánchez G, Chalmers S, Ahumada X, Montecinos L, Olmedo I, Eisner V, Riveros A, Kogan MJ, Lavandero S, Pedrozo Z, Donoso P. Inhibition of chymotrypsin-like activity of the proteasome by ixazomib prevents mitochondrial dysfunction during myocardial ischemia. PLoS One 2020; 15:e0233591. [PMID: 32453773 PMCID: PMC7250417 DOI: 10.1371/journal.pone.0233591] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 05/10/2020] [Indexed: 01/02/2023] Open
Abstract
The heart is critically dependent on mitochondrial respiration for energy supply. Ischemia decreases oxygen availability, with catastrophic consequences for cellular energy systems. After a few minutes of ischemia, the mitochondrial respiratory chain halts, ATP levels drop and ion gradients across cell membranes collapse. Activation of cellular proteases and generation of reactive oxygen species by mitochondria during ischemia alter mitochondrial membrane permeability, causing mitochondrial swelling and fragmentation and eventually cell death. The mitochondria, therefore, are important targets of cardioprotection against ischemic injury. We have previously shown that ixazomib (IXA), a proteasome inhibitor used for treating multiple myeloma, effectively reduced the size of the infarct produced by global ischemia in isolated rat hearts and prevented degradation of the sarcoplasmic reticulum calcium release channel RyR2. The aim of this work was to further characterize the protective effect of IXA by determining its effect on mitochondrial morphology and function after ischemia. We also quantified the effect of IXA on levels of mitofusin-2, a protein involved in maintaining mitochondrial morphology and mitochondria-SR communication. We found that mitochondria were significantly preserved and functional parameters such as oxygen consumption, the ability to generate a membrane potential, and glutathione content were improved in mitochondria isolated from hearts perfused with IXA prior to ischemia. IXA also blocked the release of cytochrome c observed in ischemia and significantly preserved mitofusin-2 integrity. These beneficial effects resulted in a significant decrease in the left ventricular end diastolic pressure upon reperfusion and a smaller infarct in isolated hearts.
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Affiliation(s)
- Gina Sánchez
- Programa de Fisiopatología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Centro de Estudios en Ejercicio, Metabolismo y Cáncer, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- * E-mail: (GS); (PD)
| | - Stefanie Chalmers
- Programa de Fisiopatología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Xavier Ahumada
- Programa de Fisiopatología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Luis Montecinos
- Programa de Fisiología y Biofísica, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Ivonne Olmedo
- Programa de Fisiopatología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Veronica Eisner
- Departamento de Biología Celular y Molecular, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ana Riveros
- Departamento de Química Farmacológica y Toxicológica, Facultad Ciencias Químicas y Farmacéuticas Universidad de Chile, Santiago, Chile
| | - Marcelo J. Kogan
- Departamento de Química Farmacológica y Toxicológica, Facultad Ciencias Químicas y Farmacéuticas Universidad de Chile, Santiago, Chile
| | - Sergio Lavandero
- Centro de Estudios en Ejercicio, Metabolismo y Cáncer, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Departamento de Bioquímica y Biología Molecular, Facultad Ciencias Químicas y Farmacéuticas, Universidad de Chile, Santiago, Chile
- Advanced Center for Chronic Diseases (ACCDiS), Santiago, Chile
| | - Zully Pedrozo
- Centro de Estudios en Ejercicio, Metabolismo y Cáncer, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Programa de Fisiología y Biofísica, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Advanced Center for Chronic Diseases (ACCDiS), Santiago, Chile
| | - Paulina Donoso
- Programa de Fisiología y Biofísica, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- * E-mail: (GS); (PD)
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Figueroa H, Lozano M, Suazo C, Eixarch E, Illanes SE, Carreño JE, Villanueva S, Hernández-Andrade E, Gratacós E, Irarrazabal CE. Intrauterine growth restriction modifies the normal gene expression in kidney from rabbit fetuses. Early Hum Dev 2012; 88:899-904. [PMID: 22944138 DOI: 10.1016/j.earlhumdev.2012.07.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 06/30/2012] [Accepted: 07/08/2012] [Indexed: 01/17/2023]
Abstract
The aim of this work was to study the effect of intrauterine growth restriction (IUGR) on fetal kidneys. The IUGR was induced by uteroplacental vessels ligature in a model of pregnant rabbit. We centralized the study in the gene expression of essential proteins for fetal kidney development and kidney protection against hypoxia, osmotic stress, and kidney injury. The gene expression of HIF-1α, NFAT5, IL-1β, NGAL, and ATM were studied by qRT-PCR and Western blot in kidneys from control and IUGR fetuses. Experimental IUGR fetuses were significantly smaller than the control animals (39 vs. 48 g, p<0.05). The number of glomeruli was decreased in IUGR kidneys, without morphological alterations. IUGR increased the gene expression of HIF-1α, NFAT5, IL-1β, NGAL, and ATM (p<0.05) in kidneys of fetuses undergoing IUGR, suggesting that fetal blood flow restriction produce alterations in gene expression in fetal kidneys.
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Affiliation(s)
- Horacio Figueroa
- Department of Obstetrics & Gynecology, Faculty of Medicine, Universidad de los Andes, Santiago, Chile
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Guerra M, Amorim MJ, Brás-Silva C, Leite-Moreira AF. Intraventricular pressure gradients throughout the cardiac cycle: effects of ischaemia and modulation by afterload. Exp Physiol 2012; 98:149-60. [DOI: 10.1113/expphysiol.2012.066324] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Goswami SK, Das DK. Oxygen Sensing, Cardiac Ischemia, HIF-1α and Some Emerging Concepts. Curr Cardiol Rev 2011; 6:265-73. [PMID: 22043202 PMCID: PMC3083807 DOI: 10.2174/157340310793566136] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Revised: 09/03/2010] [Accepted: 09/15/2010] [Indexed: 11/22/2022] Open
Abstract
Oxygen plays a critical role in the perpetuation and propagation of almost all forms of life. The primary site of cellular oxygen consumption is the mitochondrial electron transport chain and in addition, oxygen is also used as a substrate for various enzymes involved in cellular homeostasis. Although our knowledge of the biochemistry and physiology of oxygen transport is century old, recent development of sophisticated tools of biophysical chemistry revealed that tissue oxygenation and oxygen sensing is a highly evolved process, especially in mammals. Perturbation of normal oxygen supply is associated with diseases like tumorigenesis, myocardial infarction and stroke. Available information suggests that when tissue oxygen supply is limited, mitochondria emanate signals involving reactive oxygen species generation which in turn stabilizes oxygen sensing transcription factor HIF-1. Upon stabilization, HIF-1 elicits necessary genetic response to cope with the diminished oxygen level. In view of such critical role of HIF-1 in cellular oxygen sensing, recently there has been a heightened interest in understanding the biology of HIF-1 in the context of cardiovascular system. The following review describes some of the recent advances in this regard.
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Affiliation(s)
- Shyamal K Goswami
- Cardiovascular Research Center, University of Connecticut School of Medicine, Farmington, Connecticut, CT 06030- 1110, USA
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Xia WJ, Huang YY, Chen YL, Chen SL, He JG. Acute myocardial ischemia directly modulates the expression of brain natriuretic peptide at the transcriptional and translational levels via inflammatory cytokines. Eur J Pharmacol 2011; 670:7-12. [DOI: 10.1016/j.ejphar.2011.09.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 09/03/2011] [Accepted: 09/11/2011] [Indexed: 10/17/2022]
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Moreira-Gonçalves D, Henriques-Coelho T, Fonseca H, Ferreira RM, Amado F, Leite-Moreira A, Duarte JA. Moderate exercise training provides left ventricular tolerance to acute pressure overload. Am J Physiol Heart Circ Physiol 2010; 300:H1044-52. [PMID: 21186273 DOI: 10.1152/ajpheart.01008.2010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The present study evaluated the impact of moderate exercise training on the cardiac tolerance to acute pressure overload. Male Wistar rats were randomly submitted to exercise training or sedentary lifestyle for 14 wk. At the end of this period, the animals were anaesthetized, mechanically ventilated, and submitted to hemodynamic evaluation with biventricular tip pressure manometers. Acute pressure overload was induced by banding the descending aorta to induce a 60% increase of peak systolic left ventricular pressure during 120 min. This resulted in the following experimental groups: 1) sedentary without banding (SED + Sham), 2) sedentary with banding (SED + Band), and 3) exercise trained with banding (EX + Band). In response to aortic banding, SED + Band animals could not sustain the 60% increase of peak systolic pressure for 120 min, even with additional narrowing of the banding. This was accompanied by a reduction of dP/dt(max) and dP/dt(min) and a prolongation of the time constant tau, indicating impaired systolic and diastolic function. This impairment was not observed in EX + Band (P < 0.05 vs. SED + Band). Additionally, compared with SED + Band, EX + Band presented less myocardial damage, exhibited attenuated protein expression of active caspase-3 and NF-κB (P < 0.016), and showed less protein carbonylation and nitration (P < 0.05). These findings support our hypothesis that exercise training has a protective role in the modulation of the early cardiac response to pressure overload.
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Affiliation(s)
- Daniel Moreira-Gonçalves
- Faculty of Medicine, Department of Physiology, Department of Sport Biology, Research Center in Physical Activity and Health, University of Porto, Porto, Portugal.
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Hein M, Roehl AB, Baumert JH, Bleilevens C, Fischer S, Steendijk P, Rossaint R. Xenon and isoflurane improved biventricular function during right ventricular ischemia and reperfusion. Acta Anaesthesiol Scand 2010; 54:470-8. [PMID: 19839950 DOI: 10.1111/j.1399-6576.2009.02116.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although anesthetics have some cardioprotective properties, these benefits are often counterbalanced by their negative inotropic effects. Xenon, on the other hand, does not influence myocardial contractility. Thus, xenon may be a superior treatment for the maintenance of global hemodynamics, especially during right ventricular ischemia, which is generally characterized by a high acute complication rate. METHODS The effects of 70 vol% xenon and 0.9 vol% isoflurane on biventricular function were assessed in a porcine model (n=36) using the conductance catheter technique, and the expression of the type B natriuretic peptide (BNP) gene was measured. The animals underwent 90 min of right ventricular ischemia followed by 120 min of reperfusion. A barbiturate-anesthetized group was included as a control. RESULTS Cardiac output was compromised in unprotected animals during ischemia by 33+/-18% and during reperfusion by 53+/-17%. This was mainly due to impaired contractility in the left ventricle (LV) and increased stiffness. Isoflurane attenuated the increase in stiffness and resulted in a higher preload. In contrast, xenon increased the right ventricular afterload, which was compensated by an increase in contractility. Its effects on diastolic function were less pronounced. Upregulation of BNP mRNA expression was impeded in the remote area of the LV by both isoflurane and xenon. CONCLUSIONS Xenon and isoflurane demonstrated equipotent effects in preventing the hemodynamic compromise that is induced by right ventricular ischemia and reperfusion, although they acted through somewhat differential inotropic and vasodilatory effects.
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Affiliation(s)
- M Hein
- Department of Anesthesiology, University Hospital of Aachen, Aachen, Germany.
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Time course and mechanisms of left ventricular systolic and diastolic dysfunction in monocrotaline-induced pulmonary hypertension. Basic Res Cardiol 2009; 104:535-45. [PMID: 19288153 DOI: 10.1007/s00395-009-0017-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Revised: 01/27/2009] [Accepted: 02/24/2009] [Indexed: 10/21/2022]
Abstract
Although pulmonary hypertension (PH) selectively overloads the right ventricle (RV), neuroendocrine activation and intrinsic myocardial dysfunction have been described in the left ventricle (LV). In order to establish the timing of LV dysfunction development in PH and to clarify underlying molecular changes, Wistar rats were studied 4 and 6 weeks after subcutaneous injection of monocrotaline (MCT) 60 mg/kg (MCT-4, n = 11; MCT-6, n = 11) or vehicle (Ctrl-4, n = 11; Ctrl-6, n = 11). Acute single beat stepwise increases of systolic pressure were performed from baseline to isovolumetric (LVPiso). This hemodynamic stress was used to detect early changes in LV performance. Neurohumoral activation was evaluated by measuring angiotensin-converting enzyme (ACE) and endothelin-1 (ET-1) LV mRNA levels. Cardiomyocyte apoptosis was evaluated by TUNEL assay. Extracellular matrix composition was evaluated by tenascin-C mRNA levels and interstitial collagen content. Myosin heavy chain (MHC) composition of the LV was studied by protein quantification. MCT treatment increased RV pressures and RV/LV weight ratio, without changing LV end-diastolic pressures or dimensions. Baseline LV dysfunction were present only in MCT-6 rats. Afterload elevations prolonged tau and upward-shifted end-diastolic pressure dimension relations in MCT-4 and even more in MCT-6. MHC-isoform switch, ACE upregulation and cardiomyocyte apoptosis were present in both MCT groups. Rats with severe PH develop LV dysfunction associated with ET-1 and tenascin-C overexpression. Diastolic dysfunction, however, could be elicited at earlier stages in response to hemodynamic stress, when only LV molecular changes, such as MHC isoform switch, ACE upregulation, and myocardial apoptosis were present.
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Günzinger R, Wildhirt SM, Schad H, Heimisch W, Gurdan M, Mendler N, Grammer J, Lange R, Bauernschmitt R. A rat model of cardiopulmonary bypass with cardioplegic arrest and hemodynamic assessment by conductance catheter technique. Basic Res Cardiol 2007; 102:508-17. [PMID: 17668258 DOI: 10.1007/s00395-007-0668-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Revised: 06/13/2007] [Accepted: 06/26/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiopulmonary bypass (CPB) is known to induce systemic inflammation and cardiac dysfunction associated with a significant morbidity. Aim of the study was to develop an in vivo model of rat CPB with hypothermic cardiac arrest and the use of cardioplegia. MATERIAL AND METHODS The CPB circuit consisted of a venous reservoir, membrane oxygenator, heat exchanger, and roller pump. CPB was instituted in adult male Wistar rats (400-500 g) for 60 min at a flow rate of 120 ml x kg(-1) x min(-1), including 15 min cooling to 32 degrees C, 30 min cardiac arrest with the use of cold crystalloid cardioplegia after aortic cross clamping, and 15 min of reperfusion and rewarming to 37 degrees C. Arterial blood pressure (MAP) and heart rate (HR) were monitored, arterial blood samples were analyzed. Left ventricular (LV) function parameters were assessed by intraventricular conductance catheter. Important technical aspects are: ventilation is required during partial bypass; anticoagulation should be performed immediately prior to CPB to reduce blood loss; active suction on venous drainage allows higher pump flows; and the small priming volume of the extracorporeal circuit (8 ml) avoids the need for donor blood. RESULTS MAP remained stable prior to and during CPB.MAP and HR were significantly decreased 60 min after weaning from bypass. Hct was significantly lowered after hemodilution, but remained stable during CPB and 60 min after weaning from bypass. BE and pH remained stable throughout the experiment.Without inotropic support diastolic and systolic LV function parameters were impaired after 30 min of cardioplegic arrest followed by 15 min of reperfusion. Myocardial TNF-alpha mRNA levels were slightly increased (1.28-fold, p = 0.71), and IL-6 mRNA was significantly increased in the cardioplegia group (90.3-fold, p = 0.001). Both IL-6 and TNF-alpha plasma levels were significantly elevated in the cardioplegia group (TNF-alpha: 4.6-fold increase,p < 0.05; IL-6: 426.8-fold increase, p < 0.001). CONCLUSIONS We have developed a rat CPB with mild hypothermic cardioplegic arrest. This rodent model is suitable to study clinically relevant problems related to CPB,myocardial protection and systemic inflammation.
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Affiliation(s)
- Ralf Günzinger
- Dept of Cardiovascular Surgery, German Heart Center Munich, Technical University of Munich, Munich, Germany
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Günzinger* R, Wildhirt* SM, Schad H, Heimisch W, Mendler N, Grammer J, Lange R, Bauernschmitt R. A rat model of cardiopulmonary bypass with cardioplegic arrest and hemodynamic assessment by conductance catheter technique. Basic Res Cardiol 2007. [DOI: 10.1007/s00395-007-0677-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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