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Gerhardy B, Sivapathan S, Bowcock E, Orde S, Morgan L. Right Ventricular Dysfunction on Transthoracic Echocardiography and Long-Term Mortality in the Critically Unwell: A Systematic Review and Meta-Analysis. J Intensive Care Med 2024; 39:203-216. [PMID: 38056074 DOI: 10.1177/08850666231218713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
OBJECTIVE Right ventricular dysfunction (RVD) is common in the critically ill. To date studies exploring RVD sequelae have had heterogenous definitions and diagnostic methods, with limited follow-up. Additionally much literature has been pathology specific, limiting applicability to the general critically unwell patient. METHOD AND STUDY DESIGN We conducted a systematic review and meta-analysis to evaluate the impact of RVD diagnosed with transthoracic echocardiography (TTE) on long-term mortality in unselected critically unwell patients compared to those without RVD. A systematic search of EMBASE, Medline and Cochrane was performed from inception to March 2022. All RVD definitions using TTE were included. Patients were those admitted to a critical or intensive care unit, irrespective of disease processes. Long-term mortality was defined as all-cause mortality occurring at least 30 days after hospital admission. A priori subgroup analyses included disease specific and delayed mortality (death after hospital discharge/after the 30th day from hospital admission) in patients with RVD. A random effects model analysis was performed with the Dersimionian and Laird inverse variance method to generate effect estimates. RESULTS Of 5985 studies, 123 underwent full text review with 16 included (n = 3196). 1258 patients had RVD. 19 unique RVD criteria were identified. The odds ratio (OR) for long term mortality with RVD was 2.92 (95% CI 1.92-4.54, I2 76.4%) compared to no RVD. The direction and extent was similar for cardiac and COVID19 subgroups. Isolated RVD showed an increased risk of delayed mortality when compared to isolated left/biventricular dysfunction (OR 2.01, 95% CI 1.05-3.86, I2 46.8%). CONCLUSION RVD, irrespective of cause, is associated with increased long term mortality in the critically ill. Future studies should be aimed at understanding the pathophysiological mechanisms by which this occurs. Commonly used echocardiographic definitions of RVD show significant heterogeneity across studies, which contributes to uncertainty within this dataset.
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Affiliation(s)
- Benjamin Gerhardy
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, NSW, Australia
- Nepean Clinical School, University of Sydney School of Medicine, Sydney, NSW, Australia
- Department of Respiratory Medicine, Nepean Hospital, Kingswood, NSW, Australia
| | - Shanthosh Sivapathan
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, NSW, Australia
- Nepean Clinical School, University of Sydney School of Medicine, Sydney, NSW, Australia
| | - Emma Bowcock
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, NSW, Australia
- Nepean Clinical School, University of Sydney School of Medicine, Sydney, NSW, Australia
| | - Sam Orde
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, NSW, Australia
- Nepean Clinical School, University of Sydney School of Medicine, Sydney, NSW, Australia
| | - Lucy Morgan
- Nepean Clinical School, University of Sydney School of Medicine, Sydney, NSW, Australia
- Department of Respiratory Medicine, Nepean Hospital, Kingswood, NSW, Australia
- Department of Respiratory Medicine, Concord Repatriation Hospital, Concord, NSW, Australia
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2
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Alipour Symakani RS, van Genuchten WJ, Zandbergen LM, Henry S, Taverne YJHJ, Merkus D, Helbing WA, Bartelds B. The right ventricle in tetralogy of Fallot: adaptation to sequential loading. Front Pediatr 2023; 11:1098248. [PMID: 37009270 PMCID: PMC10061113 DOI: 10.3389/fped.2023.1098248] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/27/2023] [Indexed: 04/04/2023] Open
Abstract
Right ventricular dysfunction is a major determinant of outcome in patients with complex congenital heart disease, as in tetralogy of Fallot. In these patients, right ventricular dysfunction emerges after initial pressure overload and hypoxemia, which is followed by chronic volume overload due to pulmonary regurgitation after corrective surgery. Myocardial adaptation and the transition to right ventricular failure remain poorly understood. Combining insights from clinical and experimental physiology and myocardial (tissue) data has identified a disease phenotype with important distinctions from other types of heart failure. This phenotype of the right ventricle in tetralogy of Fallot can be described as a syndrome of dysfunctional characteristics affecting both contraction and filling. These characteristics are the end result of several adaptation pathways of the cardiomyocytes, myocardial vasculature and extracellular matrix. As long as the long-term outcome of surgical correction of tetralogy of Fallot remains suboptimal, other treatment strategies need to be explored. Novel insights in failure of adaptation and the role of cardiomyocyte proliferation might provide targets for treatment of the (dysfunctional) right ventricle under stress.
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Affiliation(s)
- Rahi S. Alipour Symakani
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands
- Department of Cardiology, Division of Experimental Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
- Correspondence: Rahi S. Alipour Symakani
| | - Wouter J. van Genuchten
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Lotte M. Zandbergen
- Department of Cardiology, Division of Experimental Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
- Walter Brendel Center of Experimental Medicine (WBex), University Clinic Munich, Munich, Germany
| | - Surya Henry
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands
- Department of Cell Biology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Daphne Merkus
- Department of Cardiology, Division of Experimental Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
- Walter Brendel Center of Experimental Medicine (WBex), University Clinic Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance (MHA), Munich, Germany
| | - Willem A. Helbing
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Beatrijs Bartelds
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands
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Abstract
Pulmonary hypertension (PH) describes heterogeneous population of patients with a mean pulmonary arterial pressure >20 mm Hg. Rarely, PH presents as a primary disorder but is more commonly part of a complex phenotype associated with comorbidities. Regardless of the cause, PH reduces life expectancy and impacts quality of life. The current clinical classification divides PH into 1 of 5 diagnostic groups to assign treatment. There are currently no pharmacological cures for any form of PH. Animal models are essential to help decipher the molecular mechanisms underlying the disease, to assign genotype-phenotype relationships to help identify new therapeutic targets, and for clinical translation to assess the mechanism of action and putative efficacy of new therapies. However, limitations inherent of all animal models of disease limit the ability of any single model to fully recapitulate complex human disease. Within the PH community, we are often critical of animal models due to the perceived low success upon clinical translation of new drugs. In this review, we describe the characteristics, advantages, and disadvantages of existing animal models developed to gain insight into the molecular and pathological mechanisms and test new therapeutics, focusing on adult forms of PH from groups 1 to 3. We also discuss areas of improvement for animal models with approaches combining several hits to better reflect the clinical situation and elevate their translational value.
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Affiliation(s)
- Olivier Boucherat
- Pulmonary Hypertension Research Group, Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
- Department of Medicine, Université Laval, Québec, QC, Canada
| | - Vineet Agrawal
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Allan Lawrie
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK & Insigneo institute for in silico medicine, Sheffield, UK
| | - Sebastien Bonnet
- Pulmonary Hypertension Research Group, Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
- Department of Medicine, Université Laval, Québec, QC, Canada
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4
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Keskin M, Borklu EB, Doğan S, Öztürk B, Kaya A, Öcal L, Çerşit S, Tenekecioğlu E, Keskin Ü, Keser N, Orhan AL. Effect of the number of parity on right heart chamber quantification. Echocardiography 2022; 39:592-598. [PMID: 35253268 DOI: 10.1111/echo.15333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 01/05/2022] [Accepted: 02/14/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Pregnancy is a process that can cause several physiologic changes to the cardiovascular system such as ventricular hypertrophy and dilation of cardiac chambers. Although there are studies about pregnancy-related changes in echocardiographic examination; there is no data about the long-term effects of parity on these alterations. Therefore, we evaluated the long-term effect of pregnancy on right ventricular (RV) dilation and RV hypertrophy and their relation to the parity number. METHODS This prospective study included a total of 600 women (200 consecutive women who had no parity, 200 women who had a parity number of 1 to 4 and 200 women who had a parity number of more than 4). Right chambers' measurements were compared between the groups. RESULTS In echocardiographic analysis, RV and right atrial dimensions and areas and RV wall thickness were higher in parous women. On the other hand, RV systolic function parameters were significantly lower in parous women. These significant changes showed a gradual increase or decrease by increasing parity number. By multivariate hierarchical logistic regression analysis, the four independent factors that increased the risk of RV dilation were age (OR: 1.16 CI: 1.10-1.20), body mass index (OR: 1.05, CI: 1.02-1.08), smoking (OR: 1.87, CI: 1.28-4.02), and giving a birth (OR: 3.94 CI: 1.82-8.81). There was also independent relationship between the number of parity and RV hypertrophy even after adjustment for several confounders. CONCLUSION Pregnancy-related physiological changes mostly resolve after delivery. This study about long-term effects of pregnancy on RV has demonstrated that there is a significant relation between the number of parity and either RV dilation or RV hypertrophy. Each parity had also additive effect on these changes.
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Affiliation(s)
- Muhammed Keskin
- Cardiology, Bahcesehir University, Faculty of Medicine, Medical Park Goztepe Hospital, Istanbul, Turkey
| | - Edibe Betul Borklu
- Cardiology, Health Sciences University, Kartal Lutfu Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Selami Doğan
- Cardiology, Health Sciences University, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | | | - Adnan Kaya
- Cardiology, Bahcesehir University, Faculty of Medicine, Medical Park Goztepe Hospital, Istanbul, Turkey
| | - Lütfi Öcal
- Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Sinan Çerşit
- Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | | | - Ümran Keskin
- Internal Medicine, Health Sciences University, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Nurgül Keser
- Cardiology, Health Sciences University, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Ahmet L Orhan
- Cardiology, Health Sciences University, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
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5
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Liu D, Qin S, Su D, Wang K, Huang Y, Huang Y, Pang Y. Metabolic Reprogramming of the Right Ventricle and Pulmonary Arteries in a Flow-Associated Pulmonary Arterial Hypertension Rat Model. ACS OMEGA 2022; 7:1273-1287. [PMID: 35036789 PMCID: PMC8757344 DOI: 10.1021/acsomega.1c05895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/13/2021] [Indexed: 06/14/2023]
Abstract
Pulmonary arterial hypertension (PAH) is a complex devastating disease relevant to remarkable metabolic dysregulation. Although various research studies on PAH from a metabolic perspective have been emerging, pathogenesis of PAH varies in different categories. Research on metabolic reprogramming in flow-associated PAH remains insufficient. An untargeted metabolomic profiling platform was used to evaluate the metabolic profile of pulmonary arteries (PAs) as well as the right ventricle (RV) in a flow-associated PAH rat model in the present work. A total of 79 PAs and 128 RV metabolites were significantly altered in PAH rats, among which 39 metabolites were assessed as shared dysregulated metabolites in PAs and the RV. Pathway analysis elucidated that, in PAs of PAH rats, pathways of phenylalanine, tyrosine, and tryptophan biosynthesis and linoleic acid metabolism were significantly altered, while in the RV, arginine biosynthesis and linoleic acid metabolism were altered dramatically. Further integrated analysis of shared dysregulated PA and RV metabolites demonstrated that the linoleic acid metabolism and the arachidonic acid (AA) metabolism were the key pathways involved in the pathogenesis of flow-associated PAH. Results obtained from the present work indicate that the PAH pathogenesis could be mediated by widespread metabolic reprogramming. In particular, the dysregulation of AA metabolism may considerably contribute to the development of high blood flow-associated PAH.
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Affiliation(s)
- Dongli Liu
- Department
of Pediatrics, The First Affiliated Hospital
of Guangxi Medical University, Nanning 530021, China
| | - Suyuan Qin
- Department
of Pediatrics, The First Affiliated Hospital
of Guangxi Medical University, Nanning 530021, China
| | - Danyan Su
- Department
of Pediatrics, The First Affiliated Hospital
of Guangxi Medical University, Nanning 530021, China
| | - Kai Wang
- Department
of Pediatrics, The First Affiliated Hospital
of Guangxi Medical University, Nanning 530021, China
- Department
of Pediatrics, The First Affiliated Hospital
of Wenzhou Medical University, Wenzhou 325015, China
| | - Yanyun Huang
- Department
of Pediatrics, The First Affiliated Hospital
of Guangxi Medical University, Nanning 530021, China
| | - Yuqin Huang
- Department
of Pediatrics, The First Affiliated Hospital
of Guangxi Medical University, Nanning 530021, China
| | - Yusheng Pang
- Department
of Pediatrics, The First Affiliated Hospital
of Guangxi Medical University, Nanning 530021, China
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6
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Hari Gopal S, Patel N, Fernandes CJ. Use of Prostaglandin E1 in the Management of Congenital Diaphragmatic Hernia-A Review. Front Pediatr 2022; 10:911588. [PMID: 35844758 PMCID: PMC9283565 DOI: 10.3389/fped.2022.911588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/10/2022] [Indexed: 11/17/2022] Open
Abstract
Congenital diaphragmatic hernia (CDH) is a rare congenital anomaly, whose presentation is complicated by pulmonary hypertension (PH), pulmonary hypoplasia, and myocardial dysfunction, each of which have significant impact on short-term clinical management and long-term outcomes. Despite many advances in therapy and surgical technique, optimal CDH management remains a topic of debate, due to the variable presentation, complex pathophysiology, and continued impact on morbidity and mortality. One of the more recent management strategies is the use of prostaglandin E1 (PGE1) infusion in the management of PH associated with CDH. PGE1 is widely used in the NICU in critical congenital cardiac disease to maintain ductal patency and facilitate pulmonary and systemic blood flow. In a related paradigm, PGE1 infusion has been used in situations of supra-systemic right ventricular pressures, including CDH, with the therapeutic intent to maintain ductal patency as a "pressure relief valve" to reduce the effective afterload on the right ventricle (RV), optimize cardiac function and support pulmonary and systemic blood flow. This paper reviews the current evidence for use of PGE1 in the CDH population and the opportunities for future investigations.
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Affiliation(s)
- Srirupa Hari Gopal
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Neil Patel
- Department of Neonatology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Caraciolo J Fernandes
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
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7
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Acute right ventricular failure associated with pulmonary hypertension in pediatrics: understanding the hemodynamic profiles. J Perinatol 2022; 42:139-142. [PMID: 34663899 DOI: 10.1038/s41372-021-01231-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/20/2021] [Accepted: 10/01/2021] [Indexed: 11/08/2022]
Abstract
Pulmonary hypertension (PHTN) is a common pathology in pediatrics, arising from a diverse array of etiologies and manifesting in equally diverse patient populations. The inpatient management of these infants and children may be complicated by dynamic and at times severe increases in pulmonary vascular resistance (PVR) and right ventricular (RV) afterload. Yet absent are cognitively accessible heuristics in the field whereby providers can reconcile the various clinical manifestations they observe with an understanding of the cardiac physiology at play, and therefore, appropriate physiology-driven interventions. Described herein is a framework for understanding the pathophysiology of four clinical phenotypes which are driven by two echocardiographic patient characteristics: the presence or absence of an atrial communication and the capacity of the right ventricle to maintain ventricular-vascular coupling. Application of this paradigm may facilitate accurate interpretation of observed clinical data, and alignment of treatment strategies with the underlying pathophysiology.
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8
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Havlenova T, Skaroupkova P, Miklovic M, Behounek M, Chmel M, Jarkovska D, Sviglerova J, Stengl M, Kolar M, Novotny J, Benes J, Cervenka L, Petrak J, Melenovsky V. Right versus left ventricular remodeling in heart failure due to chronic volume overload. Sci Rep 2021; 11:17136. [PMID: 34429479 PMCID: PMC8384875 DOI: 10.1038/s41598-021-96618-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/10/2021] [Indexed: 02/07/2023] Open
Abstract
Mechanisms of right ventricular (RV) dysfunction in heart failure (HF) are poorly understood. RV response to volume overload (VO), a common contributing factor to HF, is rarely studied. The goal was to identify interventricular differences in response to chronic VO. Rats underwent aorto-caval fistula (ACF)/sham operation to induce VO. After 24 weeks, RV and left ventricular (LV) functions, gene expression and proteomics were studied. ACF led to biventricular dilatation, systolic dysfunction and hypertrophy affecting relatively more RV. Increased RV afterload contributed to larger RV stroke work increment compared to LV. Both ACF ventricles displayed upregulation of genes of myocardial stress and metabolism. Most proteins reacted to VO in a similar direction in both ventricles, yet the expression changes were more pronounced in RV (pslope: < 0.001). The most upregulated were extracellular matrix (POSTN, NRAP, TGM2, CKAP4), cell adhesion (NCAM, NRAP, XIRP2) and cytoskeletal proteins (FHL1, CSRP3) and enzymes of carbohydrate (PKM) or norepinephrine (MAOA) metabolism. Downregulated were MYH6 and FAO enzymes. Therefore, when exposed to identical VO, both ventricles display similar upregulation of stress and metabolic markers. Relatively larger response of ACF RV compared to the LV may be caused by concomitant pulmonary hypertension. No evidence supports RV chamber-specific regulation of protein expression in response to VO.
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Affiliation(s)
- Tereza Havlenova
- grid.418930.70000 0001 2299 1368Department of Cardiology, Institute for Clinical and Experimental Medicine - IKEM, Videnska 1958/9, 140 21 Prague 4, Czech Republic ,grid.4491.80000 0004 1937 116XDepartment of Pathophysiology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petra Skaroupkova
- grid.418930.70000 0001 2299 1368Department of Cardiology, Institute for Clinical and Experimental Medicine - IKEM, Videnska 1958/9, 140 21 Prague 4, Czech Republic
| | - Matus Miklovic
- grid.418930.70000 0001 2299 1368Department of Cardiology, Institute for Clinical and Experimental Medicine - IKEM, Videnska 1958/9, 140 21 Prague 4, Czech Republic ,grid.4491.80000 0004 1937 116XDepartment of Pathophysiology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Matej Behounek
- grid.4491.80000 0004 1937 116XBIOCEV, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Chmel
- grid.4491.80000 0004 1937 116XBIOCEV, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Dagmar Jarkovska
- grid.4491.80000 0004 1937 116XFaculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Jitka Sviglerova
- grid.4491.80000 0004 1937 116XFaculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Milan Stengl
- grid.4491.80000 0004 1937 116XFaculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Michal Kolar
- grid.418827.00000 0004 0620 870XInstitute of Molecular Genetics of the Czech Academy of Sciences, Prague, Czech Republic
| | - Jiri Novotny
- grid.418827.00000 0004 0620 870XInstitute of Molecular Genetics of the Czech Academy of Sciences, Prague, Czech Republic
| | - Jan Benes
- grid.418930.70000 0001 2299 1368Department of Cardiology, Institute for Clinical and Experimental Medicine - IKEM, Videnska 1958/9, 140 21 Prague 4, Czech Republic
| | - Ludek Cervenka
- grid.418930.70000 0001 2299 1368Department of Cardiology, Institute for Clinical and Experimental Medicine - IKEM, Videnska 1958/9, 140 21 Prague 4, Czech Republic ,grid.4491.80000 0004 1937 116XDepartment of Pathophysiology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiri Petrak
- grid.4491.80000 0004 1937 116XBIOCEV, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vojtech Melenovsky
- grid.418930.70000 0001 2299 1368Department of Cardiology, Institute for Clinical and Experimental Medicine - IKEM, Videnska 1958/9, 140 21 Prague 4, Czech Republic
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Jung YH, Ren X, Suffredini G, Dodd-O JM, Gao WD. Right ventricular diastolic dysfunction and failure: a review. Heart Fail Rev 2021; 27:1077-1090. [PMID: 34013436 DOI: 10.1007/s10741-021-10123-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 01/08/2023]
Abstract
Right ventricular diastolic dysfunction and failure (RVDDF) has been increasingly identified in patients with cardiovascular diseases, including heart failure and other diseases with cardiac involvement. It is unknown whether RVDDF exists as a distinct clinical entity; however, its presence and degree have been shown to be a sensitive marker of end-organ dysfunction related to multiple disease processes including systemic hypertension, pulmonary hypertension, heart failure, and endocrine disease. In this manuscript, we review issues pertaining to RVDDF including anatomic features of the right ventricle, physiologic measurements, RVDDF diagnosis, underlying mechanisms, clinical impact, and clinical management. Several unique features of RVDDF are also discussed.
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Affiliation(s)
- Youn-Hoa Jung
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Xianfeng Ren
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, China
| | - Giancarlo Suffredini
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Jeffery M Dodd-O
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Wei Dong Gao
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
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10
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Dignam JP, Scott TE, Kemp-Harper BK, Hobbs AJ. Animal models of pulmonary hypertension: Getting to the heart of the problem. Br J Pharmacol 2021; 179:811-837. [PMID: 33724447 DOI: 10.1111/bph.15444] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/04/2021] [Accepted: 03/06/2021] [Indexed: 12/12/2022] Open
Abstract
Despite recent therapeutic advances, pulmonary hypertension (PH) remains a fatal disease due to the development of right ventricular (RV) failure. At present, no treatments targeted at the right ventricle are available, and RV function is not widely considered in the preclinical assessment of new therapeutics. Several small animal models are used in the study of PH, including the classic models of exposure to either hypoxia or monocrotaline, newer combinational and genetic models, and pulmonary artery banding, a surgical model of pure RV pressure overload. These models reproduce selected features of the structural remodelling and functional decline seen in patients and have provided valuable insight into the pathophysiology of RV failure. However, significant reversal of remodelling and improvement in RV function remains a therapeutic obstacle. Emerging animal models will provide a deeper understanding of the mechanisms governing the transition from adaptive remodelling to a failing right ventricle, aiding the hunt for druggable molecular targets.
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Affiliation(s)
- Joshua P Dignam
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Tara E Scott
- Department of Pharmacology, Cardiovascular Disease Program, Biomedicine Discovery Institute, Monash University Clayton Campus, Clayton, Victoria, Australia.,Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University Parkville Campus, Parkville, Victoria, Australia
| | - Barbara K Kemp-Harper
- Department of Pharmacology, Cardiovascular Disease Program, Biomedicine Discovery Institute, Monash University Clayton Campus, Clayton, Victoria, Australia
| | - Adrian J Hobbs
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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11
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Hagdorn QAJ, Kurakula K, Koop AMC, Bossers GPL, Mavrogiannis E, van Leusden T, van der Feen DE, de Boer RA, Goumans MJTH, Berger RMF. Volume Load-Induced Right Ventricular Failure in Rats Is Not Associated With Myocardial Fibrosis. Front Physiol 2021; 12:557514. [PMID: 33716758 PMCID: PMC7952521 DOI: 10.3389/fphys.2021.557514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 01/25/2021] [Indexed: 01/15/2023] Open
Abstract
Background Right ventricular (RV) function and failure are key determinants of morbidity and mortality in various cardiovascular diseases. Myocardial fibrosis is regarded as a contributing factor to heart failure, but its importance in RV failure has been challenged. This study aims to assess whether myocardial fibrosis drives the transition from compensated to decompensated volume load-induced RV dysfunction. Methods Wistar rats were subjected to aorto-caval shunt (ACS, n = 23) or sham (control, n = 15) surgery, and sacrificed after 1 month, 3 months, or 6 months. Echocardiography, RV pressure-volume analysis, assessment of gene expression and cardiac histology were performed. Results At 6 months, 6/8 ACS-rats (75%) showed clinical signs of RV failure (pleural effusion, ascites and/or liver edema), whereas at 1 month and 3 months, no signs of RV failure had developed yet. Cardiac output has increased two- to threefold and biventricular dilatation occurred, while LV ejection fraction gradually decreased. At 1 month and 3 months, RV end-systolic elastance (Ees) remained unaltered, but at 6 months, RV Ees had decreased substantially. In the RV, no oxidative stress, inflammation, pro-fibrotic signaling (TGFβ1 and pSMAD2/3), or fibrosis were present at any time point. Conclusions In the ACS rat model, long-term volume load was initially well tolerated at 1 month and 3 months, but induced overt clinical signs of end-stage RV failure at 6 months. However, no myocardial fibrosis or increased pro-fibrotic signaling had developed. These findings indicate that myocardial fibrosis is not involved in the transition from compensated to decompensated RV dysfunction in this model.
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Affiliation(s)
- Quint A J Hagdorn
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Kondababu Kurakula
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Anne-Marie C Koop
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Guido P L Bossers
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Emmanouil Mavrogiannis
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Tom van Leusden
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Diederik E van der Feen
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Marie-José T H Goumans
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Rolf M F Berger
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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12
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Ishii R, Okumura K, Akazawa Y, Malhi M, Ebata R, Sun M, Fujioka T, Kato H, Honjo O, Kabir G, Kuebler WM, Connelly K, Maynes JT, Friedberg MK. Heart Rate Reduction Improves Right Ventricular Function and Fibrosis in Pulmonary Hypertension. Am J Respir Cell Mol Biol 2021; 63:843-855. [PMID: 32915674 DOI: 10.1165/rcmb.2019-0317oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The potential benefit of heart rate reduction (HRR), independent of β-blockade, on right ventricular (RV) function in pulmonary hypertension (PH) remains undecided. We studied HRR effects on RV fibrosis and function in PH and RV pressure-loading models. Adult rats were randomized to 1) sham controls, 2) monocrotaline (MCT)-induced PH, 3) SU5416 + hypoxia (SUHX)-induced PH, or 4) pulmonary artery banding (PAB). Ivabradine (IVA) (10 mg/kg/d) was administered from 2 weeks after PH induction or PAB. Exercise tolerance, echocardiography, and pressure-volume hemodynamics were obtained at a terminal experiment 3 weeks later. RV myocardial samples were analyzed for putative mechanisms of HRR effects through fibrosis, profibrotic molecular signaling, and Ca++ handling. The effects of IVA versus carvedilol on human induced pluripotent stem cell-derived cardiomyocytes beat rate and relaxation properties were evaluated in vitro. Despite unabated severely elevated RV systolic pressures, IVA improved RV systolic and diastolic function, profibrotic signaling, and RV fibrosis in PH/PAB rats. RV systolic-elastance (control, 121 ± 116; MCT, 49 ± 36 vs. MCT+IVA, 120 ± 54; PAB, 70 ± 20 vs. PAB+IVA, 168 ± 76; SUHX, 86 ± 56 vs. SUHX +IVA, 218 ± 111; all P < 0.05), the time constant of RV relaxation, echo indices of RV function, and fibrosis (fibrosis: control, 4.6 ± 1%; MCT, 13.4 ± 6.5 vs. MCT+IVA, 6.7 ± 2.6%; PAB, 11.4 ± 4.5 vs. PAB+IVA, 6.4 ± 5.1%; SUHX, 10 ± 4.6 vs. SUHX+IVA, 3.9 ± 2.2%; all P < 0.001) were improved by IVA versus controls. IVA had a dose-response effect on induced pluripotent stem cell-derived cardiomyocytes beat rate by delaying Ca++ loss from the cytoplasm. In experimental PH or RV pressure loading, HRR improves RV fibrosis, function, and exercise endurance independent of β-blockade. The balance between adverse tachycardia and bradycardia requires further study, but judicious HRR may provide a promising strategy to improve RV function in clinical PH.
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Affiliation(s)
- Ryo Ishii
- The Labatt Family Heart Center, Division of Cardiology and Cardiovascular Surgery, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Kenichi Okumura
- The Labatt Family Heart Center, Division of Cardiology and Cardiovascular Surgery, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Yohei Akazawa
- The Labatt Family Heart Center, Division of Cardiology and Cardiovascular Surgery, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Manpreet Malhi
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Canada
| | - Ryota Ebata
- The Labatt Family Heart Center, Division of Cardiology and Cardiovascular Surgery, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Mei Sun
- The Labatt Family Heart Center, Division of Cardiology and Cardiovascular Surgery, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Tao Fujioka
- The Labatt Family Heart Center, Division of Cardiology and Cardiovascular Surgery, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Hideyuki Kato
- The Labatt Family Heart Center, Division of Cardiology and Cardiovascular Surgery, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Osami Honjo
- The Labatt Family Heart Center, Division of Cardiology and Cardiovascular Surgery, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Golam Kabir
- The Keenan Research Center for Biomedical Research of St. Michael's Hospital, Toronto, Canada; and
| | - Wolfgang M Kuebler
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kim Connelly
- The Keenan Research Center for Biomedical Research of St. Michael's Hospital, Toronto, Canada; and
| | - Jason T Maynes
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Canada
| | - Mark K Friedberg
- The Labatt Family Heart Center, Division of Cardiology and Cardiovascular Surgery, Hospital for Sick Children and University of Toronto, Toronto, Canada
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13
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Andersen A, van der Feen DE, Andersen S, Schultz JG, Hansmann G, Bogaard HJ. Animal models of right heart failure. Cardiovasc Diagn Ther 2020; 10:1561-1579. [PMID: 33224774 PMCID: PMC7666958 DOI: 10.21037/cdt-20-400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/13/2020] [Indexed: 12/17/2022]
Abstract
Right heart failure may be the ultimate cause of death in patients with acute or chronic pulmonary hypertension (PH). As PH is often secondary to other cardiovascular diseases, the treatment goal is to target the underlying disease. We do however know, that right heart failure is an independent risk factor, and therefore, treatments that improve right heart function may improve morbidity and mortality in patients with PH. There are no therapies that directly target and support the failing right heart and translation from therapies that improve left heart failure have been unsuccessful, with the exception of mineralocorticoid receptor antagonists. To understand the underlying pathophysiology of right heart failure and to aid in the development of new treatments we need solid animal models that mimic the pathophysiology of human disease. There are several available animal models of acute and chronic PH. They range from flow induced to pressure overload induced right heart failure and have been introduced in both small and large animals. When initiating new pre-clinical or basic research studies it is key to choose the right animal model to ensure successful translation to the clinical setting. Selecting the right animal model for the right study is hence important, but may be difficult due to the plethora of different models and local availability. In this review we provide an overview of the available animal models of acute and chronic right heart failure and discuss the strengths and limitations of the different models.
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Affiliation(s)
- Asger Andersen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Diederik E. van der Feen
- Center for Congenital Heart Diseases, University Medical Center Groningen, Groningen, The Netherlands
| | - Stine Andersen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Georg Hansmann
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
| | - Harm Jan Bogaard
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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14
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Akazawa Y, Okumura K, Ishii R, Slorach C, Hui W, Ide H, Honjo O, Sun M, Kabir G, Connelly K, Friedberg MK. Pulmonary artery banding is a relevant model to study the right ventricular remodeling and dysfunction that occurs in pulmonary arterial hypertension. J Appl Physiol (1985) 2020; 129:238-246. [PMID: 32644912 DOI: 10.1152/japplphysiol.00148.2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Right ventricular (RV) dysfunction determines mortality in patients with pulmonary arterial hypertension (PAH) and RV pressure loading. Experimental models commonly use Sugen hypoxia (SuHx)-induced PAH, monocrotaline (MCT)-induced PAH, or pulmonary artery banding (PAB). Because PAH models cannot interrogate RV effects or therapies independent of pulmonary vascular effects, we aimed to compare RV function and fibrosis in experimental PAB vs. PAH. Thirty rats were randomized to either sham controls, PAB, SuHx-, or MCT-induced PAH. RV pressures and function were assessed by high-fidelity pressure-tipped catheters and by echocardiography. RV myocyte hypertrophy, fibrosis, and capillary density were quantified from hematoxylin-eosin, picrosirius red-stained, and CD31-immunostained RV sections, respectively. RV pressures and the RV-to-left ventricular pressure ratio were significantly increased in all three groups to a similar degree (PAB 65 ± 17 mmHg, SuHx 72 ± 16 mmHg, and MCT 70 ± 12 mmHg) vs. controls (23 ± 2 mmHg, all P < 0.01). RV dilatation, hypertrophy, and fibrosis were similarly increased, and capillary density decreased, in the three models (RV fibrosis; PAB 13.3 ± 3.6%, SuHx 9.8 ± 3.0% and MCT 10.9 ± 2.4% vs control 5.5 ± 1.1%, all P < 0.05). RV function was similarly decreased in all models vs. controls. We observed comparable RV dilatation, hypertrophy, systolic and diastolic dysfunction, fibrosis, and capillary rarefaction in rat models of PAB, SuHx-, and MCT-induced PAH. These results suggest that PAB, when sufficiently severe, induces features of maladaptive RV remodeling and can be used to investigate RV pathophysiology and therapy effects independent of pulmonary vascular resistance.NEW & NOTEWORTHY Although animal models of pulmonary arterial hypertension and pressure loading are important to study right ventricular (RV) pathophysiology, pulmonary arterial hypertension models cannot interrogate RV responses independent of pulmonary vascular effects. Comparing three commonly used rat models under similar elevated RV pressure, we found that all models resulted in comparable maladaptive RV remodeling and dysfunction. Thus, these findings suggest that the pulmonary artery banding model can be used to investigate mechanisms of RV dysfunction in RV pressure overload and the effect of potential therapies.
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Affiliation(s)
- Yohei Akazawa
- Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kenichi Okumura
- Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ryo Ishii
- Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cameron Slorach
- Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Wei Hui
- Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Haruki Ide
- Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Osami Honjo
- Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mei Sun
- Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Golam Kabir
- Division of Cardiology, Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Kim Connelly
- Division of Cardiology, Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Mark K Friedberg
- Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada
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15
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Taverne YJHJ, Sadeghi A, Bartelds B, Bogers AJJC, Merkus D. Right ventricular phenotype, function, and failure: a journey from evolution to clinics. Heart Fail Rev 2020; 26:1447-1466. [PMID: 32556672 PMCID: PMC8510935 DOI: 10.1007/s10741-020-09982-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The right ventricle has long been perceived as the "low pressure bystander" of the left ventricle. Although the structure consists of, at first glance, the same cardiomyocytes as the left ventricle, it is in fact derived from a different set of precursor cells and has a complex three-dimensional anatomy and a very distinct contraction pattern. Mechanisms of right ventricular failure, its detection and follow-up, and more specific different responses to pressure versus volume overload are still incompletely understood. In order to fully comprehend right ventricular form and function, evolutionary biological entities that have led to the specifics of right ventricular physiology and morphology need to be addressed. Processes responsible for cardiac formation are based on very ancient cardiac lineages and within the first few weeks of fetal life, the human heart seems to repeat cardiac evolution. Furthermore, it appears that most cardiogenic signal pathways (if not all) act in combination with tissue-specific transcriptional cofactors to exert inductive responses reflecting an important expansion of ancestral regulatory genes throughout evolution and eventually cardiac complexity. Such molecular entities result in specific biomechanics of the RV that differs from that of the left ventricle. It is clear that sole descriptions of right ventricular contraction patterns (and LV contraction patterns for that matter) are futile and need to be addressed into a bigger multilayer three-dimensional picture. Therefore, we aim to present a complete picture from evolution, formation, and clinical presentation of right ventricular (mal)adaptation and failure on a molecular, cellular, biomechanical, and (patho)anatomical basis.
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Affiliation(s)
- Yannick J H J Taverne
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Room Rg627, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands. .,Division of Experimental Cardiology, Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands. .,Unit for Cardiac Morphology and Translational Electrophysiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Amir Sadeghi
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Room Rg627, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - Beatrijs Bartelds
- Division of Pediatrics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Room Rg627, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - Daphne Merkus
- Division of Experimental Cardiology, Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
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16
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Waller L, Krüger K, Conrad K, Weiss A, Alack K. Effects of Different Types of Exercise Training on Pulmonary Arterial Hypertension: A Systematic Review. J Clin Med 2020; 9:jcm9061689. [PMID: 32498263 PMCID: PMC7356848 DOI: 10.3390/jcm9061689] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/13/2020] [Accepted: 05/26/2020] [Indexed: 12/12/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) represents a chronic progressive disease characterized by high blood pressure in the pulmonary arteries leading to right heart failure. The disease has been a focus of medical research for many years due to its worse prognosis and limited treatment options. The aim of this study was to systematically assess the effects of different types of exercise interventions on PAH. Electronic databases were searched until July 2019. MEDLINE database was used as the predominant source for this paper. Studies with regards to chronic physical activity in adult PAH patients are compared on retrieving evidence on cellular, physiological, and psychological alterations in the PAH setting. Twenty human studies and 12 rat trials were identified. Amongst all studies, a total of 628 human subjects and 614 rats were examined. Regular physical activity affects the production of nitric oxygen and attenuates right ventricular hypertrophy. A combination of aerobic, anaerobic, and respiratory muscle training induces the strongest improvement in functional capacity indicated by an increase of 6 MWD and VO2peak. In human studies, an increase of quality of life was found. Exercise training has an overall positive effect on the physiological and psychological components of PAH. Consequently, PAH patients should be encouraged to take part in regular exercise training programs.
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Affiliation(s)
- Lena Waller
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Sciences, Justus-Liebig-University Giessen, 35394 Giessen, Germany; (K.K.); (K.C.); (K.A.)
- Correspondence: ; Tel.: +49-641-99-25212
| | - Karsten Krüger
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Sciences, Justus-Liebig-University Giessen, 35394 Giessen, Germany; (K.K.); (K.C.); (K.A.)
| | - Kerstin Conrad
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Sciences, Justus-Liebig-University Giessen, 35394 Giessen, Germany; (K.K.); (K.C.); (K.A.)
| | - Astrid Weiss
- Department of Internal Medicine, Institute of Pulmonary Pharmacotherapy, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), 35392 Giessen, Germany;
| | - Katharina Alack
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Sciences, Justus-Liebig-University Giessen, 35394 Giessen, Germany; (K.K.); (K.C.); (K.A.)
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17
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Monitillo F, Di Terlizzi V, Gioia MI, Barone R, Grande D, Parisi G, Brunetti ND, Iacoviello M. Right Ventricular Function in Chronic Heart Failure: From the Diagnosis to the Therapeutic Approach. J Cardiovasc Dev Dis 2020; 7:E12. [PMID: 32283619 PMCID: PMC7344512 DOI: 10.3390/jcdd7020012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/05/2020] [Accepted: 04/06/2020] [Indexed: 12/17/2022] Open
Abstract
There is growing attention for the study of the right ventricle in cardiovascular disease and in particular in heart failure. In this clinical setting, right ventricle dysfunction is a significant marker of poor prognosis, regardless of the degree of left ventricular dysfunction. Novel echocardiographic methods allow for obtaining a more complete evaluation of the right ventricle anatomy and function as well as of the related abnormalities in filling pressures. Specific and effective therapies for the right ventricle dysfunction are still not well defined and this represents the most difficult and important challenge. This article focuses on available diagnostic techniques for studying right ventricle dysfunction as well as on the therapies for right ventricle dysfunction.
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Affiliation(s)
- Francesco Monitillo
- Emergency Cardiology Unit, University Policlinic Hospital, 70124 Bari, Italy;
| | - Vito Di Terlizzi
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (V.D.T.); (R.B.); (N.D.B.)
| | | | - Roberta Barone
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (V.D.T.); (R.B.); (N.D.B.)
| | - Dario Grande
- Cardiology Unit, Sarcone Hospital, 70038 Terlizzi, Italy; (D.G.); (G.P.)
| | - Giuseppe Parisi
- Cardiology Unit, Sarcone Hospital, 70038 Terlizzi, Italy; (D.G.); (G.P.)
| | - Natale Daniele Brunetti
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (V.D.T.); (R.B.); (N.D.B.)
| | - Massimo Iacoviello
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (V.D.T.); (R.B.); (N.D.B.)
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18
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Krueger W, Bender N, Haeusler M, Henneberg M. The role of mechanotransduction in heart failure pathobiology-a concise review. Heart Fail Rev 2020; 26:981-995. [PMID: 31965473 DOI: 10.1007/s10741-020-09915-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This review evaluates the role of mechanotransduction (MT) in heart failure (HF) pathobiology. Cardiac functional and structural modifications are regulated by biomechanical forces. Exposing cardiomyocytes and the myocardial tissue to altered biomechanical stress precipitates changes in the end-diastolic wall stress (EDWS). Thereby various interconnected biomolecular pathways, essentially mediated and orchestrated by MT, are launched and jointly contribute to adapt and remodel the myocardium. This cardiac MT-mediated feedback decisively determines the primary cardiac cellular and tissue response, the sort (concentric or eccentric) of hypertrophy/remodeling, to mechanical and/or hemodynamic alterations. Moreover, the altered EDWS affects the diastolic myocardial properties independent of the systolic function, and elevated EDWS causes diastolic dysfunction. The close interconnection between MT pathways and the cell nucleus, the genetic endowment, principally allows for the wide variety of phenotypic appearances. However, demographic, environmental features, comorbidities, and also the genetic make-up may modulate the phenotypic result. Cardiac MT takes a fundamental and superordinate position in the myocardial adaptation and remodeling processes in all HF categories and phenotypes. Therefore, the effects of MT should be integrated in all our scientific, clinical, and therapeutic considerations.
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Affiliation(s)
- Wolfgang Krueger
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland. .,Medical University Department, Kantonsspital Aarau, Aarau, Switzerland.
| | - Nicole Bender
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
| | - Martin Haeusler
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
| | - Maciej Henneberg
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland.,Adelaide Medical School, The University of Adelaide, Adelaide, Australia
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19
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Antigny F, Mercier O, Humbert M, Sabourin J. Excitation-contraction coupling and relaxation alteration in right ventricular remodelling caused by pulmonary arterial hypertension. Arch Cardiovasc Dis 2020; 113:70-84. [DOI: 10.1016/j.acvd.2019.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/18/2019] [Accepted: 10/23/2019] [Indexed: 02/09/2023]
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20
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Wood KC, Durgin BG, Schmidt HM, Hahn SA, Baust JJ, Bachman T, Vitturi DA, Ghosh S, Ofori-Acquah SF, Mora AL, Gladwin MT, Straub AC. Smooth muscle cytochrome b5 reductase 3 deficiency accelerates pulmonary hypertension development in sickle cell mice. Blood Adv 2019; 3:4104-4116. [PMID: 31821458 PMCID: PMC6963246 DOI: 10.1182/bloodadvances.2019000621] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/29/2019] [Indexed: 01/26/2023] Open
Abstract
Pulmonary and systemic vasculopathies are significant risk factors for early morbidity and death in patients with sickle cell disease (SCD). An underlying mechanism of SCD vasculopathy is vascular smooth muscle (VSM) nitric oxide (NO) resistance, which is mediated by NO scavenging reactions with plasma hemoglobin (Hb) and reactive oxygen species that can oxidize soluble guanylyl cyclase (sGC), the NO receptor. Prior studies show that cytochrome b5 reductase 3 (CYB5R3), known as methemoglobin reductase in erythrocytes, functions in VSM as an sGC heme iron reductase critical for reducing and sensitizing sGC to NO and generating cyclic guanosine monophosphate for vasodilation. Therefore, we hypothesized that VSM CYB5R3 deficiency accelerates development of pulmonary hypertension (PH) in SCD. Bone marrow transplant was used to create SCD chimeric mice with background smooth muscle cell (SMC)-specific tamoxifen-inducible Cyb5r3 knockout (SMC R3 KO) and wild-type (WT) control. Three weeks after completing tamoxifen treatment, we observed 60% knockdown of pulmonary arterial SMC CYB5R3, 5 to 6 mm Hg elevated right-ventricular (RV) maximum systolic pressure (RVmaxSP) and biventricular hypertrophy in SS chimeras with SMC R3 KO (SS/R3KD) relative to WT (SS/R3WT). RV contractility, heart rate, hematological parameters, and cell-free Hb were similar between groups. When identically generated SS/R3 chimeras were studied 12 weeks after completing tamoxifen treatment, RVmaxSP in SS/R3KD had not increased further, but RV hypertrophy relative to SS/R3WT persisted. These are the first studies to establish involvement of SMC CYB5R3 in SCD-associated development of PH, which can exist in mice by 5 weeks of SMC CYB5R3 protein deficiency.
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Affiliation(s)
- Katherine C Wood
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, Department of Medicine
| | - Brittany G Durgin
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, Department of Medicine
| | - Heidi M Schmidt
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, Department of Medicine
- Department of Pharmacology and Chemical Biology
| | - Scott A Hahn
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, Department of Medicine
| | - Jeffrey J Baust
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, Department of Medicine
| | - Tim Bachman
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, Department of Medicine
| | - Dario A Vitturi
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, Department of Medicine
- Department of Pharmacology and Chemical Biology
| | - Samit Ghosh
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, Department of Medicine
| | - Solomon F Ofori-Acquah
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, Department of Medicine
- Division of Hematology and Oncology, Department of Medicine, and
| | - Ana L Mora
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, Department of Medicine
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Mark T Gladwin
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, Department of Medicine
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Adam C Straub
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, Department of Medicine
- Department of Pharmacology and Chemical Biology
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21
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Finsberg H, Xi C, Zhao X, Tan JL, Genet M, Sundnes J, Lee LC, Zhong L, Wall ST. Computational quantification of patient-specific changes in ventricular dynamics associated with pulmonary hypertension. Am J Physiol Heart Circ Physiol 2019; 317:H1363-H1375. [PMID: 31674809 DOI: 10.1152/ajpheart.00094.2019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pulmonary arterial hypertension (PAH) causes an increase in the mechanical loading imposed on the right ventricle (RV) that results in progressive changes to its mechanics and function. Here, we quantify the mechanical changes associated with PAH by assimilating clinical data consisting of reconstructed three-dimensional geometry, pressure, and volume waveforms, as well as regional strains measured in patients with PAH (n = 12) and controls (n = 6) within a computational modeling framework of the ventricles. Modeling parameters reflecting regional passive stiffness and load-independent contractility as indexed by the tissue active tension were optimized so that simulation results matched the measurements. The optimized parameters were compared with clinical metrics to find usable indicators associated with the underlying mechanical changes. Peak contractility of the RV free wall (RVFW) γRVFW,max was found to be strongly correlated and had an inverse relationship with the RV and left ventricle (LV) end-diastolic volume ratio (i.e., RVEDV/LVEDV) (RVEDV/LVEDV)+ 0.44, R2 = 0.77). Correlation with RV ejection fraction (R2 = 0.50) and end-diastolic volume index (R2 = 0.40) were comparatively weaker. Patients with with RVEDV/LVEDV > 1.5 had 25% lower γRVFW,max (P < 0.05) than that of the control. On average, RVFW passive stiffness progressively increased with the degree of remodeling as indexed by RVEDV/LVEDV. These results suggest a mechanical basis of using RVEDV/LVEDV as a clinical index for delineating disease severity and estimating RVFW contractility in patients with PAH.NEW & NOTEWORTHY This article presents patient-specific data assimilation of a patient cohort and physical description of clinical observations.
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Affiliation(s)
- Henrik Finsberg
- Simula Research Laboratory, Oslo, Norway.,Center for Cardiological Innovation, Oslo, Norway.,Department of Informatics, University of Oslo, Oslo, Norway
| | - Ce Xi
- Department of Mechanical Engineering, Michigan State University, East Lansing, Michigan
| | | | - Ju Le Tan
- National Heart Center Singapore, Singapore
| | - Martin Genet
- Mechanics Department and Solid Mechanics Laboratory, École Polytechnique/Le Centre national de la recherche scientifique/Paris-Saclay University, Palaiseau, France.,M3DISIM research team, Institut national de recherche en informatique et en automatique/Paris-Saclay University, Palaiseau, France
| | - Joakim Sundnes
- Simula Research Laboratory, Oslo, Norway.,Center for Cardiological Innovation, Oslo, Norway.,Department of Informatics, University of Oslo, Oslo, Norway
| | - Lik Chuan Lee
- Department of Mechanical Engineering, Michigan State University, East Lansing, Michigan
| | - Liang Zhong
- National Heart Center Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore
| | - Samuel T Wall
- Simula Research Laboratory, Oslo, Norway.,Center for Cardiological Innovation, Oslo, Norway
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22
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Van der Feen DE, Kurakula K, Tremblay E, Boucherat O, Bossers GPL, Szulcek R, Bourgeois A, Lampron MC, Habbout K, Martineau S, Paulin R, Kulikowski E, Jahagirdar R, Schalij I, Bogaard HJ, Bartelds B, Provencher S, Berger RMF, Bonnet S, Goumans MJ. Multicenter Preclinical Validation of BET Inhibition for the Treatment of Pulmonary Arterial Hypertension. Am J Respir Crit Care Med 2019; 200:910-920. [PMID: 31042405 DOI: 10.1164/rccm.201812-2275oc] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Rationale: Pulmonary arterial hypertension (PAH) is a degenerative arteriopathy that leads to right ventricular (RV) failure. BRD4 (bromodomain-containing protein 4), a member of the BET (bromodomain and extra-terminal motif) family, has been identified as a critical epigenetic driver for cardiovascular diseases.Objectives: To explore the therapeutic potential in PAH of RVX208, a clinically available BET inhibitor.Methods: Microvascular endothelial cells, smooth muscle cells isolated from distal pulmonary arteries of patients with PAH, rats with Sugen5416 + hypoxia- or monocrotaline + shunt-induced PAH, and rats with RV pressure overload induced by pulmonary artery banding were treated with RVX208 in three independent laboratories.Measurements and Main Results: BRD4 is upregulated in the remodeled pulmonary vasculature of patients with PAH, where it regulates FoxM1 and PLK1, proteins implicated in the DNA damage response. RVX208 normalized the hyperproliferative, apoptosis-resistant, and inflammatory phenotype of microvascular endothelial cells and smooth muscle cells isolated from patients with PAH. Oral treatment with RVX208 reversed vascular remodeling and improved pulmonary hemodynamics in two independent trials in Sugen5416 + hypoxia-PAH and in monocrotaline + shunt-PAH. RVX208 could be combined safely with contemporary PAH standard of care. RVX208 treatment also supported the pressure-loaded RV in pulmonary artery banding rats.Conclusions: RVX208, a clinically available BET inhibitor, modulates proproliferative, prosurvival, and proinflammatory pathways, potentially through interactions with FoxM1 and PLK1. This reversed the PAH phenotype in isolated PAH microvascular endothelial cells and smooth muscle cells in vitro, and in diverse PAH rat models. RVX208 also supported the pressure-loaded RV in vivo. Together, these data support the establishment of a clinical trial with RVX208 in patients with PAH.
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Affiliation(s)
- Diederik E Van der Feen
- Center for Congenital Heart Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Kondababu Kurakula
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands
| | - Eve Tremblay
- Pulmonary Hypertension and Vascular Biology Research Group of Quebec Heart and Lung Institute, Laval University, Quebec, Canada
| | - Olivier Boucherat
- Pulmonary Hypertension and Vascular Biology Research Group of Quebec Heart and Lung Institute, Laval University, Quebec, Canada
| | - Guido P L Bossers
- Center for Congenital Heart Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Robert Szulcek
- Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Alice Bourgeois
- Pulmonary Hypertension and Vascular Biology Research Group of Quebec Heart and Lung Institute, Laval University, Quebec, Canada
| | - Marie-Claude Lampron
- Pulmonary Hypertension and Vascular Biology Research Group of Quebec Heart and Lung Institute, Laval University, Quebec, Canada
| | - Karima Habbout
- Pulmonary Hypertension and Vascular Biology Research Group of Quebec Heart and Lung Institute, Laval University, Quebec, Canada
| | - Sandra Martineau
- Pulmonary Hypertension and Vascular Biology Research Group of Quebec Heart and Lung Institute, Laval University, Quebec, Canada
| | - Roxane Paulin
- Pulmonary Hypertension and Vascular Biology Research Group of Quebec Heart and Lung Institute, Laval University, Quebec, Canada
| | | | | | - Ingrid Schalij
- Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Harm Jan Bogaard
- Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Beatrijs Bartelds
- Center for Congenital Heart Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Division of Cardiology, Department of Pediatrics, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Steeve Provencher
- Pulmonary Hypertension and Vascular Biology Research Group of Quebec Heart and Lung Institute, Laval University, Quebec, Canada
| | - Rolf M F Berger
- Center for Congenital Heart Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Sébastien Bonnet
- Pulmonary Hypertension and Vascular Biology Research Group of Quebec Heart and Lung Institute, Laval University, Quebec, Canada
| | - Marie-José Goumans
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands
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23
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Abstract
Right ventricular (RV) function has proven to be a prognostic factor in heart failure with reduced and preserved ejection fraction and in pulmonary hypertension. RV function is also a cornerstone in the management of novel clinical issues, such as mechanical circulatory support devices or grown-up congenital heart disease patients. Despite the notable amount of circumferentially oriented myofibers in the subepicardial layer of the RV myocardium, the non-longitudinal motion directions are often neglected in the everyday assessment of RV function by echocardiography. However, the complex RV contraction pattern incorporates different motion components along three anatomically relevant axes: longitudinal shortening with traction of the tricuspid annulus towards the apex, radial motion of free wall often referred as the "bellows effect", and anteroposterior shortening of the chamber by stretching the free wall over the septum. Advanced echocardiographic techniques, such as speckle-tracking and 3D echocardiography allow an in-depth characterization of RV mechanical pattern, providing better understanding of RV systolic and diastolic function. In our current review, we summarize the existing knowledge regarding RV mechanical adaptation to pressure- and/or volume-overloaded states and also other physiologic or pathologic conditions.
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MESH Headings
- Adaptation, Physiological/physiology
- Arrhythmogenic Right Ventricular Dysplasia/physiopathology
- Cardiac Surgical Procedures/adverse effects
- Cardiomegaly, Exercise-Induced/physiology
- Echocardiography, Three-Dimensional
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/physiopathology
- Heart Failure/complications
- Heart Failure/physiopathology
- Heart Ventricles/diagnostic imaging
- Humans
- Hypertension, Pulmonary/complications
- Hypertension, Pulmonary/physiopathology
- Ventricular Dysfunction, Right/diagnostic imaging
- Ventricular Dysfunction, Right/etiology
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Function, Right/physiology
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Affiliation(s)
- Attila Kovács
- Semmelweis University Heart and Vascular Center, Városmajor St. 68, Budapest, H-1122, Hungary.
| | - Bálint Lakatos
- Semmelweis University Heart and Vascular Center, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Márton Tokodi
- Semmelweis University Heart and Vascular Center, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Béla Merkely
- Semmelweis University Heart and Vascular Center, Városmajor St. 68, Budapest, H-1122, Hungary
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24
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Ren X, Johns RA, Gao WD. EXPRESS: Right Heart in Pulmonary Hypertension: From Adaptation to Failure. Pulm Circ 2019; 9:2045894019845611. [PMID: 30942134 PMCID: PMC6681271 DOI: 10.1177/2045894019845611] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/27/2019] [Indexed: 01/24/2023] Open
Abstract
Right ventricular (RV) failure (RVF) has garnered significant attention in recent years because of its negative impact on clinical outcomes in patients with pulmonary hypertension (PH). PH triggers a series of events, including activation of several signaling pathways that regulate cell growth, metabolism, extracellular matrix remodeling, and energy production. These processes render the RV adaptive to PH. However, RVF develops when PH persists, accompanied by RV ischemia, alterations in substrate and mitochondrial energy metabolism, increased free oxygen radicals, increased cell loss, downregulation of adrenergic receptors, increased inflammation and fibrosis, and pathologic microRNAs. Diastolic dysfunction is also an integral part of RVF. Emerging non-invasive technologies such as molecular or metallic imaging, cardiac MRI, and ultrafast Doppler coronary flow mapping will be valuable tools to monitor RVF, especially the transition to RVF. Most PH therapies cannot treat RVF once it has occurred. A variety of therapies are available to treat acute and chronic RVF, but they are mainly supportive, and no effective therapy directly targets the failing RV. Therapies that target cell growth, cellular metabolism, oxidative stress, and myocyte regeneration are being tested preclinically. Future research should include establishing novel RVF models based on existing models, increasing use of human samples, creating human stem cell-based in vitro models, and characterizing alterations in cardiac excitation–contraction coupling during transition from adaptive RV to RVF. More successful strategies to manage RVF will likely be developed as we learn more about the transition from adaptive remodeling to maladaptive RVF in the future.
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Affiliation(s)
- Xianfeng Ren
- Department of Anesthesiology,
China-Japan
Friendship Hospital, Beijing, China
| | - Roger A. Johns
- Department of Anesthesiology and
Critical Care Medicine,
Johns
Hopkins University School of Medicine,
Baltimore, MD, USA
| | - Wei Dong Gao
- Department of Anesthesiology and
Critical Care Medicine,
Johns
Hopkins University School of Medicine,
Baltimore, MD, USA
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25
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Wang Z, Patel JR, Schreier DA, Hacker TA, Moss RL, Chesler NC. Organ-level right ventricular dysfunction with preserved Frank-Starling mechanism in a mouse model of pulmonary arterial hypertension. J Appl Physiol (1985) 2018; 124:1244-1253. [PMID: 29369739 PMCID: PMC6008075 DOI: 10.1152/japplphysiol.00725.2017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 01/08/2018] [Accepted: 01/22/2018] [Indexed: 01/08/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is a rapidly fatal disease in which mortality is due to right ventricular (RV) failure. It is unclear whether RV dysfunction initiates at the organ level or the subcellular level or both. We hypothesized that chronic pressure overload-induced RV dysfunction begins at the organ level with preserved Frank-Starling mechanism in myocytes. To test this hypothesis, we induced PAH with Sugen + hypoxia (HySu) in mice and measured RV whole organ and subcellular functional changes by in vivo pressure-volume measurements and in vitro trabeculae length-tension measurements, respectively, at multiple time points for up to 56 days. We observed progressive changes in RV function at the organ level: in contrast to early PAH (14-day HySu), in late PAH (56-day HySu) ejection fraction and ventricular-vascular coupling were decreased. At the subcellular level, direct measurements of myofilament contraction showed that RV contractile force was similarly increased at any stage of PAH development. Moreover, cross-bridge kinetics were not changed and length dependence of force development (Frank-Starling relation) were not different from baseline in any PAH group. Histological examinations confirmed increased cardiomyocyte cross-sectional area and decreased von Willebrand factor expression in RVs with PAH. In summary, RV dysfunction developed at the organ level with preserved Frank-Starling mechanism in myofilaments, and these results provide novel insight into the development of RV dysfunction, which is critical to understanding the mechanisms of RV failure. NEW & NOTEWORTHY A multiscale investigation of pulmonary artery pressure overload in mice showed time-dependent organ-level right ventricular (RV) dysfunction with preserved Frank-Starling relations in myofilaments. Our findings provide novel insight into the development of RV dysfunction, which is critical to understanding mechanisms of RV failure.
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Affiliation(s)
- Zhijie Wang
- Department of Biomedical Engineering, University of Wisconsin-Madison , Madison, Wisconsin
- Department of Mechanical Engineering, Colorado State University , Fort Collins, Colorado
| | - Jitandrakumar R Patel
- Department of Cell and Regenerative Biology, University of Wisconsin-Madison , Madison, Wisconsin
| | - David A Schreier
- Department of Biomedical Engineering, University of Wisconsin-Madison , Madison, Wisconsin
| | - Timothy A Hacker
- Department of Medicine, University of Wisconsin-Madison , Madison, Wisconsin
| | - Richard L Moss
- Department of Cell and Regenerative Biology, University of Wisconsin-Madison , Madison, Wisconsin
| | - Naomi C Chesler
- Department of Biomedical Engineering, University of Wisconsin-Madison , Madison, Wisconsin
- Department of Medicine, University of Wisconsin-Madison , Madison, Wisconsin
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26
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Gomez AD, Zou H, Bowen ME, Liu X, Hsu EW, McKellar SH. Right Ventricular Fiber Structure as a Compensatory Mechanism in Pressure Overload: A Computational Study. J Biomech Eng 2018; 139:2621589. [PMID: 28418458 DOI: 10.1115/1.4036485] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Indexed: 01/08/2023]
Abstract
Right ventricular failure (RVF) is a lethal condition in diverse pathologies. Pressure overload is the most common etiology of RVF, but our understanding of the tissue structure remodeling and other biomechanical factors involved in RVF is limited. Some remodeling patterns are interpreted as compensatory mechanisms including myocyte hypertrophy, extracellular fibrosis, and changes in fiber orientation. However, the specific implications of these changes, especially in relation to clinically observable measurements, are difficult to investigate experimentally. In this computational study, we hypothesized that, with other variables constant, fiber orientation alteration provides a quantifiable and distinct compensatory mechanism during RV pressure overload (RVPO). Numerical models were constructed using a rabbit model of chronic pressure overload RVF based on intraventricular pressure measurements, CINE magnetic resonance imaging (MRI), and diffusion tensor MRI (DT-MRI). Biventricular simulations were conducted under normotensive and hypertensive boundary conditions using variations in RV wall thickness, tissue stiffness, and fiber orientation to investigate their effect on RV pump function. Our results show that a longitudinally aligned myocardial fiber orientation contributed to an increase in RV ejection fraction (RVEF). This effect was more pronounced in response to pressure overload. Likewise, models with longitudinally aligned fiber orientation required a lesser contractility for maintaining a target RVEF against elevated pressures. In addition to increased wall thickness and material stiffness (diastolic compensation), systolic mechanisms in the forms of myocardial fiber realignment and changes in contractility are likely involved in the overall compensatory responses to pressure overload.
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Affiliation(s)
- Arnold D Gomez
- Mem. ASME Electrical and Computer Engineering Department, Johns Hopkins University, 3400 North Charles Street, RM Clark 201B, Baltimore, MD 21218 e-mail:
| | - Huashan Zou
- Bioengineering Department, University of Utah, 36 S. Wasatch Drive, SMBB RM 3100, Salt Lake City, UT 84112-2101 e-mail:
| | - Megan E Bowen
- Surgery Department, University of Utah, 30 N 1900 E, RM 3B205, Salt Lake City, UT 84112-2101 e-mail:
| | - Xiaoqing Liu
- Cardiothoracic Division, Surgery Department, University of Utah, 2000 Circle of Hope, RM LL376, Salt Lake City, UT 84112-2101 e-mail:
| | - Edward W Hsu
- Bioengineering Department, University of Utah, 36 S. Wasatch Drive, SMBB RM 1242, Salt Lake City, UT 84112-2101 e-mail:
| | - Stephen H McKellar
- Cardiothoracic Division, Surgery Department, University of Utah, 30 N 1900 E, RM 3B205 Salt Lake City, UT 84112-2101 e-mail:
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27
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Nguyen-Truong M, Wang Z. Biomechanical Properties and Mechanobiology of Cardiac ECM. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1098:1-19. [PMID: 30238363 DOI: 10.1007/978-3-319-97421-7_1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The heart is comprised of cardiac cells and extracellular matrix (ECM) which function together to pump blood throughout the body, provide organs with nutrients and oxygen, and remove metabolic wastes. Cardiac ECM provides a scaffold to cardiac cells and contributes to the mechanical properties and function of the cardiac tissue. Recently, more evidence suggests that cardiac ECM plays an active role in cardiac remodeling in response to mechanical loads. To that end, we provide an overview of the structure and function of the heart and the currently available in vivo and ex vivo mechanical measurements of cardiac tissues. We also review the biomechanical properties of cardiac tissues including the myocardium and heart valves, with a discussion on the differences between the right ventricle and left ventricle. Lastly, we go into the mechanical factors involved in cardiac remodeling and review the mechanobiology of cardiac tissues, i.e., the biomechanical responses at the cellular and tissue level, with an emphasis on the impact on the cardiac ECM. The regulation of cardiac ECM on cell function, which is a new and open area of research, is also briefly discussed. Future investigation into the ECM deposition and the interaction of cardiac cells and ECM components for mechanotransduction can assist to understand cardiac remodeling and inspire new therapies for cardiac diseases.
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Affiliation(s)
| | - Zhijie Wang
- School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA. .,Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA.
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28
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Luitel H, Sydykov A, Schymura Y, Mamazhakypov A, Janssen W, Pradhan K, Wietelmann A, Kosanovic D, Dahal BK, Weissmann N, Seeger W, Grimminger F, Ghofrani HA, Schermuly RT. Pressure overload leads to an increased accumulation and activity of mast cells in the right ventricle. Physiol Rep 2017; 5:5/6/e13146. [PMID: 28330950 PMCID: PMC5371552 DOI: 10.14814/phy2.13146] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 12/20/2016] [Accepted: 01/09/2017] [Indexed: 01/11/2023] Open
Abstract
Right ventricular (RV) remodeling represents a complex set of functional and structural adaptations in response to chronic pressure or volume overload due to various inborn defects or acquired diseases and is an important determinant of patient outcome. However, the underlying molecular mechanisms remain elusive. We investigated the time course of structural and functional changes in the RV in the murine model of pressure overload‐induced RV hypertrophy in C57Bl/6J mice. Using magnetic resonance imaging, we assessed the changes of RV structure and function at different time points for a period of 21 days. Pressure overload led to significant dilatation, cellular and chamber hypertrophy, myocardial fibrosis, and functional impairment of the RV. Progressive remodeling of the RV after pulmonary artery banding (PAB) in mice was associated with upregulation of myocardial gene markers of hypertrophy and fibrosis. Furthermore, remodeling of the RV was associated with accumulation and activation of mast cells in the RV tissue of PAB mice. Our data suggest possible involvement of mast cells in the RV remodeling process in response to pressure overload. Mast cells may thus represent an interesting target for the development of new therapeutic approaches directed specifically at the RV.
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Affiliation(s)
- Himal Luitel
- Excellence Cluster Cardio-Pulmonary System, Universities of Giessen and Marburg Lung Center Member of the German Lung Center Justus-Liebig-University Giessen, Giessen, Germany
| | - Akylbek Sydykov
- Excellence Cluster Cardio-Pulmonary System, Universities of Giessen and Marburg Lung Center Member of the German Lung Center Justus-Liebig-University Giessen, Giessen, Germany
| | - Yves Schymura
- Department of Lung Development and Remodelling, Max-Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Argen Mamazhakypov
- Excellence Cluster Cardio-Pulmonary System, Universities of Giessen and Marburg Lung Center Member of the German Lung Center Justus-Liebig-University Giessen, Giessen, Germany
| | - Wiebke Janssen
- Excellence Cluster Cardio-Pulmonary System, Universities of Giessen and Marburg Lung Center Member of the German Lung Center Justus-Liebig-University Giessen, Giessen, Germany.,Department of Lung Development and Remodelling, Max-Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Kabita Pradhan
- Excellence Cluster Cardio-Pulmonary System, Universities of Giessen and Marburg Lung Center Member of the German Lung Center Justus-Liebig-University Giessen, Giessen, Germany
| | - Astrid Wietelmann
- Max-Planck Institute for Heart and Lung Research MRI Service Group, Bad Nauheim, Germany
| | - Djuro Kosanovic
- Excellence Cluster Cardio-Pulmonary System, Universities of Giessen and Marburg Lung Center Member of the German Lung Center Justus-Liebig-University Giessen, Giessen, Germany
| | - Bhola Kumar Dahal
- Excellence Cluster Cardio-Pulmonary System, Universities of Giessen and Marburg Lung Center Member of the German Lung Center Justus-Liebig-University Giessen, Giessen, Germany
| | - Norbert Weissmann
- Excellence Cluster Cardio-Pulmonary System, Universities of Giessen and Marburg Lung Center Member of the German Lung Center Justus-Liebig-University Giessen, Giessen, Germany
| | - Werner Seeger
- Excellence Cluster Cardio-Pulmonary System, Universities of Giessen and Marburg Lung Center Member of the German Lung Center Justus-Liebig-University Giessen, Giessen, Germany.,Department of Lung Development and Remodelling, Max-Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Friedrich Grimminger
- Excellence Cluster Cardio-Pulmonary System, Universities of Giessen and Marburg Lung Center Member of the German Lung Center Justus-Liebig-University Giessen, Giessen, Germany
| | - Hossein Ardeschir Ghofrani
- Excellence Cluster Cardio-Pulmonary System, Universities of Giessen and Marburg Lung Center Member of the German Lung Center Justus-Liebig-University Giessen, Giessen, Germany
| | - Ralph Theo Schermuly
- Excellence Cluster Cardio-Pulmonary System, Universities of Giessen and Marburg Lung Center Member of the German Lung Center Justus-Liebig-University Giessen, Giessen, Germany
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29
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Bossers GP, Hagdorn QA, Ploegstra MJ, Borgdorff MA, Silljé HH, Berger RM, Bartelds B. Volume load-induced right ventricular dysfunction in animal models: insights in a translational gap in congenital heart disease. Eur J Heart Fail 2017; 20:808-812. [DOI: 10.1002/ejhf.931] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 06/01/2017] [Accepted: 06/05/2017] [Indexed: 12/13/2022] Open
Affiliation(s)
- Guido P.L. Bossers
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology; University of Groningen, University Medical Center Groningen; The Netherlands
| | - Quint A.J. Hagdorn
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology; University of Groningen, University Medical Center Groningen; The Netherlands
| | - Mark Jan Ploegstra
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology; University of Groningen, University Medical Center Groningen; The Netherlands
| | - Marinus A.J. Borgdorff
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology; University of Groningen, University Medical Center Groningen; The Netherlands
| | - Herman H.W. Silljé
- Department of Cardiology, University of Groningen; University Medical Center Groningen; The Netherlands
| | - Rolf M.F. Berger
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology; University of Groningen, University Medical Center Groningen; The Netherlands
| | - Beatrijs Bartelds
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology; University of Groningen, University Medical Center Groningen; The Netherlands
- Department of Pediatrics, Division of Pediatric Cardiology; Sophia Children's Hospital; Rotterdam The Netherlands
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30
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Cao Y, Song J, Shen S, Fu H, Li X, Xu Y, Wang A, Li X, Zhang M. Trimedazidine alleviates pulmonary artery banding-induced acute right heart dysfunction and activates PRAS40 in rats. Oncotarget 2017; 8:92064-92078. [PMID: 29190898 PMCID: PMC5696164 DOI: 10.18632/oncotarget.20752] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 08/08/2017] [Indexed: 02/01/2023] Open
Abstract
The molecular mechanism underlying acute right heart failure (RHF) is poorly understood. We used pulmonary artery banding (PAB) to induce acute RHF characterized by a rapid rise of right ventricular pressure, and then a decrease in right ventricular pressure along with a decrease in blood pressure right after banding. We found higher brain natriuretic peptide (BNP) and beta-myosin heavy chain (βMHC) levels and lower alpha-myosin heavy chain (αMHC) levels in RHF rats than sham-operated rats. Hemodynamic indexes in rats with acute RHF were slightly improved by trimedazidine TMZ, a key inhibitor of fatty acid (FA) oxidation. TMZ also reversed downregulation of peroxisome proliferator-activated receptor gamma coactivator 1-beta (PGC-1β) and peroxisome proliferator-activated receptor alpha (PPARα) by PAB and up-regulates peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α), peroxisome proliferator-activated receptor delta (PPARδ) and pyruvate dehydrogenase kinase isoform 4 (PDK4). In addition, TMZ reversed upregulation of phosphorylated Akt by PAB and increased phosphorylated proline-rich Akt-substrate 40 (PRAS40). Autophagy and apoptosis were not modified by PAB or TMZ. An acute RHF model was established in rats through 70% constriction of the pulmonary artery. TMZ treatment alleviated PAB-induced acute RHF by activating PRAS40 and upregulatingPGC-1α, PGC-1β, PPARα, PPARδ, and PDK4.
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Affiliation(s)
- Yunshan Cao
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou 730000, China.,Department of Heart Failure, Shanghai East Hospital, Tongji University School of Medicine, Research Center for Translational Medicine, Shanghai 200120, China
| | - Jiyang Song
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou 730000, China
| | - Shutong Shen
- Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Heling Fu
- Animal Core Facility, Nanjing Medical University, Nanjing 210029, China
| | - Xiang Li
- Department of Intensive Care, Minhang Hospital, Fudan University, Shanghai 201100, China
| | - Ying Xu
- Intensive Care Unit, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Aqian Wang
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou 730000, China
| | - Xinli Li
- Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Min Zhang
- Department of Pathology, Gansu Provincial Hospital, Lanzhou 730000, China
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31
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32
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van der Feen DE, Weij M, Smit-van Oosten A, Jorna LM, Hagdorn QAJ, Bartelds B, Berger RMF. Shunt Surgery, Right Heart Catheterization, and Vascular Morphometry in a Rat Model for Flow-induced Pulmonary Arterial Hypertension. J Vis Exp 2017. [PMID: 28287603 DOI: 10.3791/55065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
In this protocol, PAH is induced by combining a 60 mg/kg monocrotalin (MCT) injection with increased pulmonary blood flow through an aorto-caval shunt (MCT+Flow). The shunt is created by inserting an 18-G needle from the abdominal aorta into the adjacent caval vein. Increased pulmonary flow has been demonstrated as an essential trigger for a severe form of PAH with distinct phases of disease progression, characterized by early medial hypertrophy followed by neointimal lesions and the progressive occlusion of the small pulmonary vessels. To measure the right heart and pulmonary hemodynamics in this model, right heart catheterization is performed by inserting a rigid cannula containing a flexible ball-tip catheter via the right jugular vein into the right ventricle. The catheter is then advanced into the main and the more distal pulmonary arteries. The histopathology of the pulmonary vasculature is assessed qualitatively, by scoring the pre- and intra-acinar vessels on the degree of muscularization and the presence of a neointima, and quantitatively, by measuring the wall thickness, the wall-lumen ratios, and the occlusion score.
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Affiliation(s)
- Diederik E van der Feen
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen;
| | - Michel Weij
- Research and Development Facility, University Medical Center Groningen, University of Groningen
| | | | - Lysanne M Jorna
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen
| | - Quint A J Hagdorn
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen
| | - Beatrijs Bartelds
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen
| | - Rolf M F Berger
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen
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Golob MJ, Wang Z, Prostrollo AJ, Hacker TA, Chesler NC. Limiting collagen turnover via collagenase-resistance attenuates right ventricular dysfunction and fibrosis in pulmonary arterial hypertension. Physiol Rep 2016; 4:4/11/e12815. [PMID: 27252252 PMCID: PMC4908492 DOI: 10.14814/phy2.12815] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 05/03/2016] [Indexed: 12/22/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a severe form of pulmonary hypertension in which right ventricular (RV) afterload is increased and death typically occurs due to decompensated RV hypertrophy and failure. Collagen accumulation has been implicated in pulmonary artery remodeling, but how it affects RV performance remains unclear. Here, we sought to identify the role of collagen turnover, defined as the balance between collagen synthesis and degradation, in RV structure and function in PAH. To do so, we exposed mutant (Col1a1R/R) mice, in which collagen type I degradation is impaired such that collagen turnover is reduced, and wild‐type (Col1a1+/+) littermates to 14 days of chronic hypoxia combined with SUGEN treatment (HySu) to recapitulate characteristics of clinical PAH. RV structure and function were measured by echocardiography, RV catheterization, and histology. Despite comparable increases in RV systolic pressure (Col1a1+/+: 46 ± 2 mmHg; Col1a1R/R: 47 ± 3 mmHg), the impaired collagen degradation in Col1a1R/R mice resulted in no RV collagen accumulation, limited RV hypertrophy, and maintained right ventricular‐pulmonary vascular coupling with HySu exposure. The preservation of cardiac function in the mutant mice indicates a beneficial role of limited collagen turnover via impaired degradation in RV remodeling in response to chronic pressure overload. Our results suggest novel treatments that reduce collagen turnover may offer a new therapeutic strategy for PAH patients.
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Affiliation(s)
- Mark J Golob
- Department of Biomedical Engineering, University of Wisconsin-Madison College of Engineering, Madison, Wisconsin Materials Science Program, University of Wisconsin-Madison College of Engineering, Madison, Wisconsin
| | - Zhijie Wang
- Department of Biomedical Engineering, University of Wisconsin-Madison College of Engineering, Madison, Wisconsin
| | - Anthony J Prostrollo
- Department of Biomedical Engineering, University of Wisconsin-Madison College of Engineering, Madison, Wisconsin
| | - Timothy A Hacker
- Department of Medicine, Medical Science Center University of Wisconsin-Madison, Madison, Wisconsin
| | - Naomi C Chesler
- Department of Biomedical Engineering, University of Wisconsin-Madison College of Engineering, Madison, Wisconsin
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Estrogen Preserves Pulsatile Pulmonary Arterial Hemodynamics in Pulmonary Arterial Hypertension. Ann Biomed Eng 2016; 45:632-643. [PMID: 27557900 DOI: 10.1007/s10439-016-1716-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 08/18/2016] [Indexed: 10/21/2022]
Abstract
Pulmonary arterial hypertension (PAH) is caused by extensive pulmonary vascular remodeling that increases right ventricular (RV) afterload and leads to RV failure. PAH predominantly affects women; paradoxically, female PAH patients have better outcomes than men. The roles of estrogen in PAH remain controversial, which is referred to as "the estrogen paradox". Here, we sought to determine the role of estrogen in pulsatile pulmonary arterial hemodynamic changes and its impact on RV functional adaption to PAH. Female mice were ovariectomized and replenished with estrogen or placebo. PAH was induced with SU5416 and chronic hypoxia. In vivo hemodynamic measurements showed that (1) estrogen prevented loss of pulmonary vascular compliance with limited effects on the increase of pulmonary vascular resistance in PAH; (2) estrogen attenuated increases in wave reflections in PAH and limited its adverse effects on PA systolic and pulse pressures; and (3) estrogen maintained the total hydraulic power and preserved transpulmonary vascular efficiency in PAH. This study demonstrates that estrogen preserves pulmonary vascular compliance independent of pulmonary vascular resistance, which provides a mechanical mechanism for ability of estrogen to delay disease progression without preventing onset. The estrogenic protection of pulsatile pulmonary hemodynamics underscores the therapeutic potential of estrogen in PAH.
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35
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Dandel M, Hetzer R. Echocardiographic assessment of the right ventricle: Impact of the distinctly load dependency of its size, geometry and performance. Int J Cardiol 2016; 221:1132-42. [PMID: 27474972 DOI: 10.1016/j.ijcard.2016.07.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 07/03/2016] [Indexed: 10/21/2022]
Abstract
Right ventricular (RV) size, shape and function are distinctly load-dependent and pulmonary load is an important determinant of RV function in patients with congestive heart failure (CHF) due to primary impaired left ventricular function and in those with pre-capillary pulmonary hypertension (PH). In a pressure overloaded RV, not only dilation and aggravation of tricuspid regurgitation, but also systolic dysfunction leading to RV failure (RVF) can occur already before the development of irreversible alterations in RV myocardial contractility. This explains RV ability for reverse remodeling and functional improvement in patients with post-capillary and pre-capillary PH of a different etiology, after normalization of loading conditions. There is increasing evidence that RV evaluation by echocardiography in relation with its loading conditions can improve the decision-making process and prognosis assessments in clinical praxis. Recent approaches to evaluate the RV in relation with its actual loading conditions by echo-derived composite variables which either incorporate a certain functional parameter (i.e. tricuspid annulus peak systolic excursion, stroke volume, RV end-systolic volume index, velocity of myocardial shortening) and load, or incorporate measures which reflect the relationship between RV load and RV dilation, also taking the right atrial pressure into account (i.e. "load adaptation index"), appeared particularly suited and therefore also potentially useful for evaluation of RV contractile function. Special attention is focused on the usefulness of RV echo-evaluation in relation to load for proper decision making before ventricular assist-device implantation in patients with CHF and for optimal timing of listing procedures to transplantation in patients with end-stage pre-capillary PH.
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Affiliation(s)
- Michael Dandel
- German Centre for Cardiovascular Research (DZHK), Partner site Berlin, Germany; Deutsches Herzzentrum Berlin, Germany.
| | - Roland Hetzer
- Deutsches Herzzentrum Berlin, Germany; Cardio Centrum Berlin, Germany
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Mendes-Ferreira P, Santos-Ribeiro D, Adão R, Maia-Rocha C, Mendes-Ferreira M, Sousa-Mendes C, Leite-Moreira AF, Brás-Silva C. Distinct right ventricle remodeling in response to pressure overload in the rat. Am J Physiol Heart Circ Physiol 2016; 311:H85-95. [PMID: 27199115 DOI: 10.1152/ajpheart.00089.2016] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 05/02/2016] [Indexed: 12/15/2022]
Abstract
Pulmonary arterial hypertension (PAH), the most serious chronic disorder of the pulmonary circulation, is characterized by pulmonary vasoconstriction and remodeling, resulting in increased afterload on the right ventricle (RV). In fact, RV function is the main determinant of prognosis in PAH. The most frequently used experimental models of PAH include monocrotaline- and chronic hypoxia-induced PAH, which primarily affect the pulmonary circulation. Alternatively, pulmonary artery banding (PAB) can be performed to achieve RV overload without affecting the pulmonary vasculature, allowing researchers to determine the RV-specific effects of their drugs/interventions. In this work, using two different degrees of pulmonary artery constriction, we characterize, in full detail, PAB-induced adaptive and maladaptive remodeling of the RV at 3 wk after PAB surgery. Our results show that application of a mild constriction resulted in adaptive hypertrophy of the RV, with preserved systolic and diastolic function, while application of a severe constriction resulted in maladaptive hypertrophy, with chamber dilation and systolic and diastolic dysfunction up to the isolated cardiomyocyte level. By applying two different degrees of constriction, we describe, for the first time, a reliable and short-duration PAB model in which RV adaptation can be distinguished at 3 wk after surgery. We characterize, in full detail, structural and functional changes of the RV in its response to moderate and severe constriction, allowing researchers to better study RV physiology and transition to dysfunction and failure, as well as to determine the effects of new therapies.
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Affiliation(s)
- P Mendes-Ferreira
- Deparment of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal; and
| | - D Santos-Ribeiro
- Deparment of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal; and
| | - R Adão
- Deparment of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal; and
| | - C Maia-Rocha
- Deparment of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal; and
| | - M Mendes-Ferreira
- Deparment of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal; and
| | - C Sousa-Mendes
- Deparment of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal; and
| | - A F Leite-Moreira
- Deparment of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal; and
| | - C Brás-Silva
- Deparment of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal; and Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
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Borgdorff MAJ, Dickinson MG, Berger RMF, Bartelds B. Right ventricular failure due to chronic pressure load: What have we learned in animal models since the NIH working group statement? Heart Fail Rev 2016; 20:475-91. [PMID: 25771982 PMCID: PMC4463984 DOI: 10.1007/s10741-015-9479-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Right ventricular (RV) failure determines outcome in patients with pulmonary hypertension, congenital heart diseases and in left ventricular failure. In 2006, the Working Group on Cellular and Molecular Mechanisms of Right Heart Failure of the NIH advocated the development of preclinical models to study the pathophysiology and pathobiology of RV failure. In this review, we summarize the progress of research into the pathobiology of RV failure and potential therapeutic interventions. The picture emerging from this research is that RV adaptation to increased afterload is characterized by increased contractility, dilatation and hypertrophy. Clinical RV failure is associated with progressive diastolic deterioration and disturbed ventricular–arterial coupling in the presence of increased contractility. The pathobiology of the failing RV shows similarities with that of the LV and is marked by lack of adequate increase in capillary density leading to a hypoxic environment and oxidative stress and a metabolic switch from fatty acids to glucose utilization. However, RV failure also has characteristic features. So far, therapies aiming to specifically improve RV function have had limited success. The use of beta blockers and sildenafil may hold promise, but new therapies have to be developed. The use of recently developed animal models will aid in further understanding of the pathobiology of RV failure and development of new therapeutic strategies.
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Affiliation(s)
- Marinus A J Borgdorff
- Department of Pediatrics, Center for Congenital Heart Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands,
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Merchant SS, Gomez AD, Morgan JL, Hsu EW. Parametric Modeling of the Mouse Left Ventricular Myocardial Fiber Structure. Ann Biomed Eng 2016; 44:2661-73. [PMID: 26942586 DOI: 10.1007/s10439-016-1574-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 02/17/2016] [Indexed: 12/26/2022]
Abstract
Magnetic resonance diffusion tensor imaging (DTI) has greatly facilitated detailed quantifications of myocardial structures. However, structural patterns, such as the distinctive transmural rotation of the fibers, remain incompletely described. To investigate the validity and practicality of pattern-based analysis, 3D DTI was performed on 13 fixed mouse hearts and fiber angles in the left ventricle were transformed and fitted to parametric expressions constructed from elementary functions of the prolate spheroidal spatial variables. It was found that, on average, the myocardial fiber helix angle could be represented to 6.5° accuracy by the equivalence of a product of 10th-order polynomials of the radial and longitudinal variables, and 17th-order Fourier series of the circumferential variable. Similarly, the fiber imbrication angle could be described by 10th-order polynomials and 24th-order Fourier series, to 5.6° accuracy. The representations, while relatively concise, did not adversely affect the information commonly derived from DTI datasets including the whole-ventricle mean fiber helix angle transmural span and atlases constructed for the group. The unique ability of parametric models for predicting the 3D myocardial fiber structure from finite number of 2D slices was also demonstrated. These findings strongly support the principle of parametric modeling for characterizing myocardial structures in the mouse and beyond.
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Affiliation(s)
- Samer S Merchant
- Department of Bioengineering, University of Utah, 36 S Wasatch Dr Rm 3100, Salt Lake City, UT, 84112, USA.
| | - Arnold David Gomez
- Department of Bioengineering, University of Utah, 36 S Wasatch Dr Rm 3100, Salt Lake City, UT, 84112, USA
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, UT, USA
| | - James L Morgan
- Department of Bioengineering, University of Utah, 36 S Wasatch Dr Rm 3100, Salt Lake City, UT, 84112, USA
| | - Edward W Hsu
- Department of Bioengineering, University of Utah, 36 S Wasatch Dr Rm 3100, Salt Lake City, UT, 84112, USA
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Kaneko Y. Role of volume loading in left ventricular training. Eur J Cardiothorac Surg 2016; 49:1576-7. [PMID: 26719399 DOI: 10.1093/ejcts/ezv444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yukihiro Kaneko
- Division of Cardiovascular Surgery, National Medical Center for Children and Mothers, Tokyo, Japan
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40
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Egr-1 identifies neointimal remodeling and relates to progression in human pulmonary arterial hypertension. J Heart Lung Transplant 2015; 35:481-90. [PMID: 26774383 DOI: 10.1016/j.healun.2015.12.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 10/22/2015] [Accepted: 12/04/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is hallmarked by the development of neointimal lesions. The transcription factor Egr-1 seems to play a critical role in neointimal formation in experimental PAH and was identified as a putative target for intervention. In this study we investigated whether Egr-1 is also associated with neointimal-type vascular remodeling in different forms of human PAH or pulmonary hypertension. METHODS Using immunohistochemistry, we studied Egr-1 expression specifically in a wide morphologic spectrum of pulmonary arteries in the lung tissue of 72 patients with different forms and stages of PAH, specifically idiopathic PAH (n = 18), advanced-stage congenital heart disease‒associated PAH (PAH-CHD) (n = 21), early-stage PAH-CHD (n = 19) and non-neointimal hypoxic pulmonary hypertension (PH) (n = 4), and controls (n = 10). RESULTS In PAH patients, pulmonary vascular expression of Egr-1 protein was abundant, whereas it was sporadic in non-neointimal (hypoxic) PH patients and controls. In PAH-CHD, protein expression was more pronounced in patients with advanced vascular lesions compared to those with less advanced lesions, such as medial hypertrophy. CONCLUSIONS Pulmonary vascular Egr-1 expression is significantly increased in patients with PAH, appears specifically associated with neointimal-type vascular remodeling, and correlates with disease progression. These data translate the critical role of Egr-1 in the development of experimental PAH to human pulmonary vascular disease forms.
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41
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Duppen N, Geerdink LM, Kuipers IM, Bossers SSM, Koopman LP, van Dijk APJ, Roos-Hesselink JW, De Korte CL, Helbing WA, Kapusta L. Regional ventricular performance and exercise training in children and young adults after repair of tetralogy of Fallot: randomized controlled pilot study. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.114.002006. [PMID: 25784723 DOI: 10.1161/circimaging.114.002006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Public-health guidelines recommend patients with congenital heart disease to exercise. Studies have shown that patients with congenital heart disease can improve physical exercise capacity. The effect of training on regional ventricular performance has hardly been studied. We performed a pilot study to assess whether an exercise training program would result in adverse changes of regional ventricular performance in patients with corrected tetralogy of Fallot. METHODS AND RESULTS Multicenter prospective randomized controlled pilot study in patients with tetralogy of Fallot aged 10 to 25 years. A 12-week standardized aerobic dynamic exercise training program (3 one-hour sessions per week) was used. Pre- and post-training cardiopulmonary exercise tests, MRI, and echocardiography, including tissue-Doppler imaging, were performed. Patients were randomized to the exercise group (n=28) or control group (n=20). One patient in the exercise group dropped out. Change in tissue-Doppler imaging parameters was similar in the exercise group and control group (change in right ventricle free wall peak velocity E' exercise group, 0.8±2.6 cm/s; control group, 0.9±4.1; peak velocity A' exercise group, 0.4±2.4 m/s; control group 4.6±18.1 cm/s). CONCLUSIONS This randomized controlled pilot study provides preliminary data suggesting that regional ventricular performance is well maintained during 3-month aerobic dynamic exercise training in children and young adults with repaired tetralogy of Fallot. This information might help patients adhere to current public-health guidelines. CLINICAL TRIAL REGISTRATION URL: http//:www.trialregister.nl. Unique identifier: NTR2731.
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Affiliation(s)
- Nienke Duppen
- From the Division of Cardiology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands (N.D., S.S.M.B., L.P.K., W.A.H.); Departments of Radiology (N.D., S.S.M.B., W.A.H.) and Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, the Netherlands; Departments of Pediatric Cardiology (L.M.G., L.K.), Cardiology (A.P.J.v.D.), and Radiology, Laboratory of Clinical Physics (C.L.D.K.), Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, the Netherlands (I.M.K.); and Pediatric Cardiology Unit, Department of Pediatrics, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel (L.K.)
| | - Lianne M Geerdink
- From the Division of Cardiology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands (N.D., S.S.M.B., L.P.K., W.A.H.); Departments of Radiology (N.D., S.S.M.B., W.A.H.) and Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, the Netherlands; Departments of Pediatric Cardiology (L.M.G., L.K.), Cardiology (A.P.J.v.D.), and Radiology, Laboratory of Clinical Physics (C.L.D.K.), Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, the Netherlands (I.M.K.); and Pediatric Cardiology Unit, Department of Pediatrics, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel (L.K.)
| | - Irene M Kuipers
- From the Division of Cardiology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands (N.D., S.S.M.B., L.P.K., W.A.H.); Departments of Radiology (N.D., S.S.M.B., W.A.H.) and Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, the Netherlands; Departments of Pediatric Cardiology (L.M.G., L.K.), Cardiology (A.P.J.v.D.), and Radiology, Laboratory of Clinical Physics (C.L.D.K.), Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, the Netherlands (I.M.K.); and Pediatric Cardiology Unit, Department of Pediatrics, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel (L.K.)
| | - Sjoerd S M Bossers
- From the Division of Cardiology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands (N.D., S.S.M.B., L.P.K., W.A.H.); Departments of Radiology (N.D., S.S.M.B., W.A.H.) and Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, the Netherlands; Departments of Pediatric Cardiology (L.M.G., L.K.), Cardiology (A.P.J.v.D.), and Radiology, Laboratory of Clinical Physics (C.L.D.K.), Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, the Netherlands (I.M.K.); and Pediatric Cardiology Unit, Department of Pediatrics, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel (L.K.)
| | - Laurens P Koopman
- From the Division of Cardiology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands (N.D., S.S.M.B., L.P.K., W.A.H.); Departments of Radiology (N.D., S.S.M.B., W.A.H.) and Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, the Netherlands; Departments of Pediatric Cardiology (L.M.G., L.K.), Cardiology (A.P.J.v.D.), and Radiology, Laboratory of Clinical Physics (C.L.D.K.), Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, the Netherlands (I.M.K.); and Pediatric Cardiology Unit, Department of Pediatrics, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel (L.K.)
| | - Arie P J van Dijk
- From the Division of Cardiology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands (N.D., S.S.M.B., L.P.K., W.A.H.); Departments of Radiology (N.D., S.S.M.B., W.A.H.) and Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, the Netherlands; Departments of Pediatric Cardiology (L.M.G., L.K.), Cardiology (A.P.J.v.D.), and Radiology, Laboratory of Clinical Physics (C.L.D.K.), Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, the Netherlands (I.M.K.); and Pediatric Cardiology Unit, Department of Pediatrics, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel (L.K.)
| | - Jolien W Roos-Hesselink
- From the Division of Cardiology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands (N.D., S.S.M.B., L.P.K., W.A.H.); Departments of Radiology (N.D., S.S.M.B., W.A.H.) and Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, the Netherlands; Departments of Pediatric Cardiology (L.M.G., L.K.), Cardiology (A.P.J.v.D.), and Radiology, Laboratory of Clinical Physics (C.L.D.K.), Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, the Netherlands (I.M.K.); and Pediatric Cardiology Unit, Department of Pediatrics, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel (L.K.)
| | - Chris L De Korte
- From the Division of Cardiology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands (N.D., S.S.M.B., L.P.K., W.A.H.); Departments of Radiology (N.D., S.S.M.B., W.A.H.) and Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, the Netherlands; Departments of Pediatric Cardiology (L.M.G., L.K.), Cardiology (A.P.J.v.D.), and Radiology, Laboratory of Clinical Physics (C.L.D.K.), Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, the Netherlands (I.M.K.); and Pediatric Cardiology Unit, Department of Pediatrics, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel (L.K.)
| | - Willem A Helbing
- From the Division of Cardiology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands (N.D., S.S.M.B., L.P.K., W.A.H.); Departments of Radiology (N.D., S.S.M.B., W.A.H.) and Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, the Netherlands; Departments of Pediatric Cardiology (L.M.G., L.K.), Cardiology (A.P.J.v.D.), and Radiology, Laboratory of Clinical Physics (C.L.D.K.), Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, the Netherlands (I.M.K.); and Pediatric Cardiology Unit, Department of Pediatrics, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel (L.K.).
| | - Livia Kapusta
- From the Division of Cardiology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands (N.D., S.S.M.B., L.P.K., W.A.H.); Departments of Radiology (N.D., S.S.M.B., W.A.H.) and Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, the Netherlands; Departments of Pediatric Cardiology (L.M.G., L.K.), Cardiology (A.P.J.v.D.), and Radiology, Laboratory of Clinical Physics (C.L.D.K.), Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, the Netherlands (I.M.K.); and Pediatric Cardiology Unit, Department of Pediatrics, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel (L.K.)
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Hyldebrandt JA, Sivén E, Agger P, Frederiksen CA, Heiberg J, Wemmelund KB, Ravn HB. Effects of milrinone and epinephrine or dopamine on biventricular function and hemodynamics in an animal model with right ventricular failure after pulmonary artery banding. Am J Physiol Heart Circ Physiol 2015; 309:H206-12. [DOI: 10.1152/ajpheart.00921.2014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 05/04/2015] [Indexed: 11/22/2022]
Abstract
Right ventricular (RV) failure due to chronic pressure overload is a main determinant of outcome in congenital heart disease. Medical management is challenging because not only contractility but also the interventricular relationship is important for increasing cardiac output. This study evaluated the effect of milrinone alone and in combination with epinephrine or dopamine on hemodynamics, ventricular performance, and the interventricular relationship. RV failure was induced in 21 Danish landrace pigs by pulmonary artery banding. After 10 wk, animals were reexamined using biventricular pressure-volume conductance catheters. The maximum pressure in the RV increased by 113% ( P < 0.0001) and end-diastolic volume by 43% ( P < 0.002), while left ventricular (LV) pressure simultaneously decreased ( P = 0.006). Concomitantly, mean arterial pressure (MAP; −16%, P = 0.01), cardiac index (CI; −23%, P < 0.0001), and mixed venous oxygen saturation (SvO2; −40%, P < 0.0001) decreased. Milrinone increased CI (11%, P = 0.008) and heart rate (HR; 21%, P < 0.0001). Stroke volume index (SVI) decreased (7%, P = 0.03), although RV contractility was improved. The addition of either epinephrine or dopamine further increased CI and HR in a dose-dependent manner but without any significant differences between the two interventions. A more pronounced increase in biventricular contractility was observed in the dopamine-treated animals. LV volume was reduced in both the dopamine and epinephrine groups with increasing doses In the failing pressure overloaded RV, milrinone improved CI and increased contractility. Albeit additional dose-dependent effects of both epinephrine and dopamine on CI and contractility, neither of the interventions improved SVI due to reduced filling of the LV.
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Affiliation(s)
- Janus Adler Hyldebrandt
- Department of Anaesthesia and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark; and
| | - Eleonora Sivén
- Department of Anaesthesia and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Peter Agger
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark; and
| | | | - Johan Heiberg
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Hanne Berg Ravn
- Department of Anaesthesia and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
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Murch SD, La Gerche A, Roberts TJ, Prior DL, MacIsaac AI, Burns AT. Abnormal right ventricular relaxation in pulmonary hypertension. Pulm Circ 2015; 5:370-5. [PMID: 26064464 DOI: 10.1086/681268] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 12/06/2014] [Indexed: 12/21/2022] Open
Abstract
Left ventricular diastolic dysfunction is a well-described complication of systemic hypertension. However, less is known regarding the effect of chronic pressure overload on right ventricular (RV) diastolic function. We hypothesized that pulmonary hypertension (PHT) is associated with abnormal RV early relaxation and that this would be best shown by invasive pressure measurement. Twenty-five patients undergoing right heart catheterization for investigation of breathlessness and/or suspected PHT were studied. In addition to standard measurements, RV pressure was sampled with a high-fidelity micromanometer, and RV pressure/time curves were analyzed. Patients were divided into a PHT group and a non-PHT group on the basis of a derived mean pulmonary artery systolic pressure of 25 mmHg. Eleven patients were classified to the PHT group. This group had significantly higher RV minimum diastolic pressure ([Formula: see text] vs. [Formula: see text] mmHg, [Formula: see text]) and RV end-diastolic pressure (RVEDP; [Formula: see text] vs. [Formula: see text] mmHg, [Formula: see text]), and RV τ was significantly prolonged ([Formula: see text] vs. [Formula: see text] ms, [Formula: see text]). There were strong correlations between RV τ and RV minimum diastolic pressure ([Formula: see text], [Formula: see text]) and between RV τ and RVEDP ([Formula: see text], [Formula: see text]). There was a trend toward increased RV contractility (end-systolic elastance) in the PHT group ([Formula: see text] vs. [Formula: see text] mmHg/mL, [Formula: see text]) and a correlation between RV systolic pressure and first derivative of maximum pressure change ([Formula: see text], [Formula: see text]). Stroke volumes were similar. Invasive measures of RV early relaxation are abnormal in patients with PHT, whereas measured contractility is static or increasing, which suggests that diastolic dysfunction may precede systolic dysfunction. Furthermore, there is a strong association between measures of RV relaxation and RV filling pressures.
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Affiliation(s)
- Stuart D Murch
- Department of Cardiology, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; and University of Melbourne, Department of Medicine, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Andre La Gerche
- Department of Cardiology, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; and University of Melbourne, Department of Medicine, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Timothy J Roberts
- Department of Cardiology, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; and University of Melbourne, Department of Medicine, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - David L Prior
- Department of Cardiology, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; and University of Melbourne, Department of Medicine, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Andrew I MacIsaac
- Department of Cardiology, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; and University of Melbourne, Department of Medicine, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Andrew T Burns
- Department of Cardiology, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; and University of Melbourne, Department of Medicine, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
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Borgdorff MA, Koop AMC, Bloks VW, Dickinson MG, Steendijk P, Sillje HH, van Wiechen MP, Berger RM, Bartelds B. Clinical symptoms of right ventricular failure in experimental chronic pressure load are associated with progressive diastolic dysfunction. J Mol Cell Cardiol 2015; 79:244-53. [DOI: 10.1016/j.yjmcc.2014.11.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 11/05/2014] [Accepted: 11/25/2014] [Indexed: 12/23/2022]
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Naeije R, Brimioulle S, Dewachter L. Biomechanics of the right ventricle in health and disease (2013 Grover Conference series). Pulm Circ 2015; 4:395-406. [PMID: 25621153 DOI: 10.1086/677354] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 01/22/2014] [Indexed: 02/02/2023] Open
Abstract
Right ventricular (RV) function is a major determinant of the symptomatology and outcome in pulmonary hypertension. The normal RV is a thin-walled flow generator able to accommodate large changes in venous return but unable to maintain flow output in the presence of a brisk increase in pulmonary artery pressure. The RV chronically exposed to pulmonary hypertension undergoes hypertrophic changes and an increase in contractility, allowing for preserved flow output in response to peripheral demand. Failure of systolic function adaptation (homeometric adaptation, described by Anrep's law of the heart) results in increased dimensions (heterometric adaptation; Starling's law of the heart), with a negative effect on diastolic ventricular interactions, limitation of exercise capacity, and vascular congestion. Ventricular function is described by pressure-volume relationships. The gold standard of systolic function is maximum elastance (E max), or the maximal value of the ratio of pressure to volume. This value is not immediately sensitive to changes in loading conditions. The gold standard of afterload is arterial elastance (E a), defined by the ratio of pressure at E max to stroke volume. The optimal coupling of ventricular function to the arterial circulation occurs at an E max/E a ratio between 1.5 and 2. Patients with severe pulmonary hypertension present with an increased E max, a trend toward decreased E max/E a, and increased RV dimensions, along with progression of the pulmonary vascular disease, systemic factors, and left ventricular function. The molecular mechanisms of RV systolic failure are currently being investigated. It is important to refer biological findings to sound measurements of function. Surrogates for E max and E a are being developed through bedside imaging techniques.
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Affiliation(s)
- Robert Naeije
- Department of Physiology, Faculty of Medicine, Free University of Brussels, Brussels, Belgium
| | - Serge Brimioulle
- Department of Physiology, Faculty of Medicine, Free University of Brussels, Brussels, Belgium
| | - Laurence Dewachter
- Department of Physiology, Faculty of Medicine, Free University of Brussels, Brussels, Belgium
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Golob MJ, Tian L, Wang Z, Zimmerman TA, Caneba CA, Hacker TA, Song G, Chesler NC. Mitochondria DNA mutations cause sex-dependent development of hypertension and alterations in cardiovascular function. J Biomech 2014; 48:405-12. [PMID: 25582357 DOI: 10.1016/j.jbiomech.2014.12.044] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 11/30/2014] [Accepted: 12/19/2014] [Indexed: 11/27/2022]
Abstract
Aging is associated with conduit artery stiffening that is a risk factor for and can precede hypertension and ventricular dysfunction. Increases in mitochondria DNA (mtDNA) frequency have been correlated with aging. Mice with a mutation in the encoding domain (D257A) of a proof-reading deficient version of mtDNA polymerase-γ (POLG) have musculoskeletal features of premature aging and a shortened lifespan. However, few studies using these mice have investigated the effects of mtDNA mutations on cardiovascular function. We hypothesized that the proof-reading deficient mtDNA POLG leads to arterial stiffening, hypertension, and ventricular hypertrophy. Ten to twelve month-old D257A mice (n=13) and age- and sex-matched wild-type controls (n=13) were catheterized for hemodynamic and ventricular function measurements. Left common carotid arteries (LCCA) were harvested for mechanical tests followed by histology. Male D257A mice had pulmonary and systemic hypertension, arterial stiffening, larger LCCA diameter (701±45 vs. 597±60μm), shorter LCCA axial length (8.96±0.56 vs. 10.10±0.80mm), and reduced hematocrit (29.1±6.1 vs. 41.3±8.1; all p<0.05). Male and female D257A mice had biventricular hypertrophy (p<0.05). Female D257A mice did not have significant increases in pressure or arterial stiffening, suggesting that the mechanisms of hypertension or arterial stiffening from mtDNA mutations differ based on sex. Our results lend insight into the mechanisms of age-related cardiovascular disease and may point to novel treatment strategies to address cardiovascular mortality in the elderly.
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Affiliation(s)
- Mark J Golob
- Department of Biomedical Engineering, UW-Madison College of Engineering, Madison, WI 53706, United States; Material Science Program, UW-Madison College of Engineering, Madison, WI 53706, United States
| | - Lian Tian
- Department of Biomedical Engineering, UW-Madison College of Engineering, Madison, WI 53706, United States
| | - Zhijie Wang
- Department of Biomedical Engineering, UW-Madison College of Engineering, Madison, WI 53706, United States
| | - Todd A Zimmerman
- Department of Biomedical Engineering, UW-Madison College of Engineering, Madison, WI 53706, United States
| | - Christine A Caneba
- Department of Biomedical Engineering, UW-Madison College of Engineering, Madison, WI 53706, United States
| | - Timothy A Hacker
- Department of Medicine, Medical Science Center, University of Wisconsin-Madison, Madison, WI 53706, United States
| | - Guoqing Song
- Department of Medicine, Medical Science Center, University of Wisconsin-Madison, Madison, WI 53706, United States
| | - Naomi C Chesler
- Department of Biomedical Engineering, UW-Madison College of Engineering, Madison, WI 53706, United States; Department of Medicine, Medical Science Center, University of Wisconsin-Madison, Madison, WI 53706, United States.
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Maron BA. Emerging hemodynamic signatures of the right heart (Third International Right Heart Failure Summit, part 2). Pulm Circ 2014; 4:705-716. [PMID: 25610606 PMCID: PMC4278630 DOI: 10.1086/678544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 04/10/2014] [Indexed: 02/01/2023] Open
Abstract
Despite the importance of preserved right ventricular structure and function with respect to outcome across the spectrum of lung, cardiac, and pulmonary vascular diseases, only recently have organized efforts developed to consider the pulmonary vascular-right ventricular apparatus as a specific unit within the larger context of cardiopulmonary pathophysiology. The Third International Right Heart Failure Summit (Boston, MA) was a multidisciplinary event dedicated to promoting a dialogue about the scientific and clinical basis of right heart disease. The current review provides a synopsis of key discussions presented during the section of the summit titled "Emerging Hemodynamic Signatures of the Right Heart." Specifically, topics emphasized in this element of the symposium included (1) the effects of pulmonary vascular dysfunction at rest or provoked by exercise on the right ventricular pressure-volume relationship, (2) the role of pressure-volume loop analysis as a method to characterize right ventricular inefficiency and predict right heart failure, and (3) the importance of a systems biology approach to identifying novel factors that contribute to pathophenotypes associated with pulmonary arterial hypertension and/or right ventricular dysfunction. Collectively, these concepts frame a forward-thinking paradigm shift in the approach to right heart disease by emphasizing factors that regulate the transition from adaptive to maladaptive right ventricular-pulmonary vascular (patho)physiology.
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Affiliation(s)
- Bradley A Maron
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; and Department of Cardiology, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
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Borgdorff MA, Bartelds B, Dickinson MG, van Wiechen MPH, Steendijk P, de Vroomen M, Berger RMF. Sildenafil treatment in established right ventricular dysfunction improves diastolic function and attenuates interstitial fibrosis independent from afterload. Am J Physiol Heart Circ Physiol 2014; 307:H361-9. [DOI: 10.1152/ajpheart.00843.2013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Right ventricular (RV) function is an important determinant of prognosis in congenital heart diseases, pulmonary hypertension, and heart failure. Preventive sildenafil treatment has been shown to enhance systolic RV function and improve exercise capacity in a model of fixed RV pressure load. However, it is unknown whether sildenafil has beneficial effects when treatment is started in established RV dysfunction, which is clinically more relevant. Our aim was to assess the effects of sildenafil treatment on RV function and fibrosis in a model of established RV dysfunction due to fixed afterload. Rats were subjected to pulmonary artery banding (PAB), which induced RV dysfunction after 4 wk, characterized by reduced exercise capacity, decreased tricuspid annular plane systolic excursion, and RV dilatation. From week 4 onward, 50% of rats were treated with sildenafil (100 mg·kg−1·day−1, n = 9; PAB-SIL group) or vehicle ( n = 9; PAB-VEH group). At 8 wk, exercise capacity was assessed using cage wheels, and RV function was assessed using invasive RV pressure-volume measurements under anesthesia. Sildenafil treatment, compared with vehicle, improved RV ejection fraction (44 ± 2% vs. 34 ± 2%, P < 0.05, PAB-SIL vs. PAB-VEH groups), reduced RV end-diastolic pressure (2.3 ± 0.5 vs. 5.1 ± 0.9 mmHg, P < 0.05), and RV dilatation (end-systolic volume: 468 ± 45 vs. 643 ± 71 μl, P = 0.05). Sildenafil treatment also attenuated RV fibrosis (30 ± 6 vs. 17 ± 3‰, P < 0.05) but did not affect end-systolic elastance, exercise capacity, or PKG or PKA activity. In conclusion, sildenafil improves RV diastolic function and attenuates interstitial fibrosis in rats with established RV dysfunction, independent from afterload. These results indicate that sildenafil treatment has therapeutic potential for established RV dysfunction.
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Affiliation(s)
- Marinus A. Borgdorff
- Center for Congenital Heart Diseases, Division of Pediatric Cardiology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; and
| | - Beatrijs Bartelds
- Center for Congenital Heart Diseases, Division of Pediatric Cardiology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; and
| | - Michael G. Dickinson
- Center for Congenital Heart Diseases, Division of Pediatric Cardiology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; and
| | - Maarten P. H. van Wiechen
- Center for Congenital Heart Diseases, Division of Pediatric Cardiology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; and
| | - Paul Steendijk
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maartje de Vroomen
- Center for Congenital Heart Diseases, Division of Pediatric Cardiology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; and
| | - Rolf M. F. Berger
- Center for Congenital Heart Diseases, Division of Pediatric Cardiology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; and
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Borgdorff MA, Bartelds B, Dickinson MG, Steendijk P, Berger RMF. A cornerstone of heart failure treatment is not effective in experimental right ventricular failure. Int J Cardiol 2013; 169:183-9. [PMID: 24067600 DOI: 10.1016/j.ijcard.2013.08.102] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 08/20/2013] [Accepted: 08/29/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Right ventricular (RV) failure due to increased pressure load causes significant morbidity and mortality in patients with congenital heart diseases and pulmonary arterial hypertension. It is unknown whether renin-angiotensin-aldosterone-system (RAAS) inhibition (the cornerstone of left ventricular failure treatment) is effective in RV failure. We investigated the effects of combination treatment of aldosterone-blocker eplerenone+angiotensin II receptor blocker losartan (Ep/Lo) on RV remodeling and function in a model of RV failure due to increased pressure load. METHODS AND RESULTS Rats (n=48) were randomized for pulmonary artery banding (PAB) or sham surgery and for losartan (20 mg/kg/d)+eplerenone (100 mg/kg/d) treatment (Ep/Lo) or vehicle (VEH). RV function was assessed by echocardiography and pressure-volume analysis at 5 and 11 weeks, or at the occurrence of clinical RV failure symptoms necessitating termination. PAB resulted in RV failure in all rats, as defined by reduced cardiac output, RV stroke volume, increased RV end diastolic pressure and liver congestion as well as RV fibrosis, hypertrophy and reduced capillary density. Clinical RV failure necessitated termination in 5/12 PAB-VEH rats. Angiotensin II type 1-receptor expression in the RV was reduced in PAB rats indicating local RAAS activation. Treatment of PAB rats with Ep/Lo significantly lowered arterial pressures, but had no significant effect on RV function, remodeling or survival compared to PAB-VEH rats. CONCLUSIONS RAAS inhibition does not beneficially affect experimental RV failure due to chronic pressure load. This is of high clinical relevance, because it indicates that the RV response to RAAS inhibition might fundamentally differ from that of the LV.
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Affiliation(s)
- Marinus A Borgdorff
- Center for Congenital Heart Diseases, Pediatric Cardiology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, The Netherlands.
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