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Hála P, Mlček M, Ošťádal P, Popková M, Janák D, Bouček T, Lacko S, Kudlička J, Neužil P, Kittnar O. Increasing venoarterial extracorporeal membrane oxygenation flow puts higher demands on left ventricular work in a porcine model of chronic heart failure. J Transl Med 2020; 18:75. [PMID: 32054495 PMCID: PMC7017528 DOI: 10.1186/s12967-020-02250-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/30/2020] [Indexed: 11/10/2022] Open
Abstract
Background Venoarterial extracorporeal membrane oxygenation (VA ECMO) is widely used in the treatment of circulatory failure, but repeatedly, its negative effects on the left ventricle (LV) have been observed. The purpose of this study is to assess the influence of increasing extracorporeal blood flow (EBF) on LV performance during VA ECMO therapy of decompensated chronic heart failure. Methods A porcine model of low-output chronic heart failure was developed by long-term fast cardiac pacing. Subsequently, under total anesthesia and artificial ventilation, VA ECMO was introduced to a total of five swine with profound signs of chronic cardiac decompensation. LV performance and organ specific parameters were recorded at different levels of EBF using a pulmonary artery catheter, a pressure–volume loop catheter positioned in the LV, and arterial flow probes on systemic arteries. Results Tachycardia-induced cardiomyopathy led to decompensated chronic heart failure with mean cardiac output of 2.9 ± 0.4 L/min, severe LV dilation, and systemic hypoperfusion. By increasing the EBF from minimal flow to 5 L/min, we observed a gradual increase of LV peak pressure from 49 ± 15 to 73 ± 11 mmHg (P = 0.001) and an improvement in organ perfusion. On the other hand, cardiac performance parameters revealed higher demands put on LV function: LV end-diastolic pressure increased from 7 ± 2 to 15 ± 3 mmHg, end-diastolic volume increased from 189 ± 26 to 218 ± 30 mL, end-systolic volume increased from 139 ± 17 to 167 ± 15 mL (all P < 0.001), and stroke work increased from 1434 ± 941 to 1892 ± 1036 mmHg*mL (P < 0.05). LV ejection fraction and isovolumetric contractility index did not change significantly. Conclusions In decompensated chronic heart failure, excessive VA ECMO flow increases demands and has negative effects on the workload of LV. To protect the myocardium from harm, VA ECMO flow should be adjusted with respect to not only systemic perfusion, but also to LV parameters.
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Affiliation(s)
- Pavel Hála
- Department of Physiology, First Faculty of Medicine, Charles University, Albertov 5, 128 00, Prague, Czech Republic. .,Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic.
| | - Mikuláš Mlček
- Department of Physiology, First Faculty of Medicine, Charles University, Albertov 5, 128 00, Prague, Czech Republic
| | - Petr Ošťádal
- Department of Physiology, First Faculty of Medicine, Charles University, Albertov 5, 128 00, Prague, Czech Republic.,Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Michaela Popková
- Department of Physiology, First Faculty of Medicine, Charles University, Albertov 5, 128 00, Prague, Czech Republic
| | - David Janák
- Department of Physiology, First Faculty of Medicine, Charles University, Albertov 5, 128 00, Prague, Czech Republic.,Department of Cardiovascular Surgery, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tomáš Bouček
- Department of Physiology, First Faculty of Medicine, Charles University, Albertov 5, 128 00, Prague, Czech Republic.,Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Stanislav Lacko
- Department of Physiology, First Faculty of Medicine, Charles University, Albertov 5, 128 00, Prague, Czech Republic
| | - Jaroslav Kudlička
- Department of Physiology, First Faculty of Medicine, Charles University, Albertov 5, 128 00, Prague, Czech Republic
| | - Petr Neužil
- Department of Physiology, First Faculty of Medicine, Charles University, Albertov 5, 128 00, Prague, Czech Republic.,Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Otomar Kittnar
- Department of Physiology, First Faculty of Medicine, Charles University, Albertov 5, 128 00, Prague, Czech Republic
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Benitez‐Amaro A, Samouillan V, Jorge E, Dandurand J, Nasarre L, de Gonzalo‐Calvo D, Bornachea O, Amoros‐Figueras G, Lacabanne C, Vilades D, Leta R, Carreras F, Gallardo A, Lerma E, Cinca J, Guerra JM, Llorente‐Cortés V. Identification of new biophysical markers for pathological ventricular remodelling in tachycardia-induced dilated cardiomyopathy. J Cell Mol Med 2018; 22:4197-4208. [PMID: 29921039 PMCID: PMC6111813 DOI: 10.1111/jcmm.13699] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 04/17/2018] [Indexed: 11/28/2022] Open
Abstract
Our aim was to identify biophysical biomarkers of ventricular remodelling in tachycardia-induced dilated cardiomyopathy (DCM). Our study includes healthy controls (N = 7) and DCM pigs (N = 10). Molecular analysis showed global myocardial metabolic abnormalities, some of them related to myocardial hibernation in failing hearts, supporting the translationality of our model to study cardiac remodelling in dilated cardiomyopathy. Histological analysis showed unorganized and agglomerated collagen accumulation in the dilated ventricles and a higher percentage of fibrosis in the right (RV) than in the left (LV) ventricle (P = .016). The Fourier Transform Infrared Spectroscopy (FTIR) 1st and 2nd indicators, which are markers of the myofiber/collagen ratio, were reduced in dilated hearts, with the 1st indicator reduced by 45% and 53% in the RV and LV, respectively, and the 2nd indicator reduced by 25% in the RV. The 3rd FTIR indicator, a marker of the carbohydrate/lipid ratio, was up-regulated in the right and left dilated ventricles but to a greater extent in the RV (2.60-fold vs 1.61-fold, P = .049). Differential scanning calorimetry (DSC) showed a depression of the freezable water melting point in DCM ventricles - indicating structural changes in the tissue architecture - and lower protein stability. Our results suggest that the 1st, 2nd and 3rd FTIR indicators are useful markers of cardiac remodelling. Moreover, the 2nd and 3rd FITR indicators, which are altered to a greater extent in the right ventricle, are associated with greater fibrosis.
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Affiliation(s)
- Aleyda Benitez‐Amaro
- Group of Lipids and Cardiovascular PathologyICCC ProgramBiomedical Research Institute Sant Pau (IIB Sant Pau)Hospital de la Santa Creu i Sant PauBarcelonaSpain
- Institute of Biomedical Research of Barcelona (IIBB)Spanish National Research Council (CSIC)BarcelonaSpain
| | - Valerie Samouillan
- CIRIMATUniversité de ToulouseUniversité Paul Sabatier, Physique des PolymèresToulouseFrance
| | - Esther Jorge
- CIBERCVBarcelonaSpain
- Department of CardiologyHospital de la Santa Creu i Sant PauBiomedical Research Institute Sant Pau (IIB Sant Pau)Universitat Autonoma de BarcelonaBarcelonaSpain
| | - Jany Dandurand
- CIRIMATUniversité de ToulouseUniversité Paul Sabatier, Physique des PolymèresToulouseFrance
| | - Laura Nasarre
- Group of Lipids and Cardiovascular PathologyICCC ProgramBiomedical Research Institute Sant Pau (IIB Sant Pau)Hospital de la Santa Creu i Sant PauBarcelonaSpain
| | - David de Gonzalo‐Calvo
- Group of Lipids and Cardiovascular PathologyICCC ProgramBiomedical Research Institute Sant Pau (IIB Sant Pau)Hospital de la Santa Creu i Sant PauBarcelonaSpain
- Institute of Biomedical Research of Barcelona (IIBB)Spanish National Research Council (CSIC)BarcelonaSpain
- CIBERCVBarcelonaSpain
| | - Olga Bornachea
- Group of Lipids and Cardiovascular PathologyICCC ProgramBiomedical Research Institute Sant Pau (IIB Sant Pau)Hospital de la Santa Creu i Sant PauBarcelonaSpain
- Institute of Biomedical Research of Barcelona (IIBB)Spanish National Research Council (CSIC)BarcelonaSpain
| | - Gerard Amoros‐Figueras
- CIBERCVBarcelonaSpain
- Department of CardiologyHospital de la Santa Creu i Sant PauBiomedical Research Institute Sant Pau (IIB Sant Pau)Universitat Autonoma de BarcelonaBarcelonaSpain
| | - Colette Lacabanne
- CIRIMATUniversité de ToulouseUniversité Paul Sabatier, Physique des PolymèresToulouseFrance
| | - David Vilades
- Department of CardiologyHospital de la Santa Creu i Sant PauBiomedical Research Institute Sant Pau (IIB Sant Pau)Universitat Autonoma de BarcelonaBarcelonaSpain
| | - Ruben Leta
- Department of CardiologyHospital de la Santa Creu i Sant PauBiomedical Research Institute Sant Pau (IIB Sant Pau)Universitat Autonoma de BarcelonaBarcelonaSpain
| | - Francesc Carreras
- CIBERCVBarcelonaSpain
- Department of CardiologyHospital de la Santa Creu i Sant PauBiomedical Research Institute Sant Pau (IIB Sant Pau)Universitat Autonoma de BarcelonaBarcelonaSpain
| | - Alberto Gallardo
- Department of PathologyHospital de la Santa Creu i Sant PauBarcelonaSpain
| | - Enrique Lerma
- Department of PathologyHospital de la Santa Creu i Sant PauBarcelonaSpain
| | - Juan Cinca
- CIBERCVBarcelonaSpain
- Department of CardiologyHospital de la Santa Creu i Sant PauBiomedical Research Institute Sant Pau (IIB Sant Pau)Universitat Autonoma de BarcelonaBarcelonaSpain
| | - Jose M. Guerra
- CIBERCVBarcelonaSpain
- Department of CardiologyHospital de la Santa Creu i Sant PauBiomedical Research Institute Sant Pau (IIB Sant Pau)Universitat Autonoma de BarcelonaBarcelonaSpain
| | - Vicenta Llorente‐Cortés
- Group of Lipids and Cardiovascular PathologyICCC ProgramBiomedical Research Institute Sant Pau (IIB Sant Pau)Hospital de la Santa Creu i Sant PauBarcelonaSpain
- Institute of Biomedical Research of Barcelona (IIBB)Spanish National Research Council (CSIC)BarcelonaSpain
- CIBERCVBarcelonaSpain
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Yoshie K, Rajendran PS, Massoud L, Kwon O, Tadimeti V, Salavatian S, Ardell JL, Shivkumar K, Ajijola OA. Cardiac vanilloid receptor-1 afferent depletion enhances stellate ganglion neuronal activity and efferent sympathetic response to cardiac stress. Am J Physiol Heart Circ Physiol 2018; 314:H954-H966. [PMID: 29351450 DOI: 10.1152/ajpheart.00593.2017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Afferent fibers expressing the vanilloid receptor 1 (VR1) channel have been implicated in cardiac nociception; however, their role in modulating reflex responses to cardiac stress is not well understood. We evaluated this role in Yorkshire pigs by percutaneous epicardial application of resiniferatoxin (RTX), a toxic activator of the VR1 channel, resulting in the depletion of cardiac VR1-expressing afferents. Hemodynamics, epicardial activation recovery intervals, and in vivo activity of stellate ganglion neurons (SGNs) were recorded in control and RTX-treated animals. Stressors included inferior vena cava or aortic occlusion and rapid right ventricular pacing (RVP) to induce dyssynchrony and ischemia. In the epicardium, stellate ganglia, and dorsal root ganglia, immunostaining for the VR1 channel, calcitonin gene-related peptide, and substance P was significantly diminished by RTX. RTX-treated animals exhibited higher basal systolic blood pressures and contractility than control animals. Reflex responses to epicardial bradykinin and capsaicin were mitigated by RTX. Cardiovascular reflex function, as assessed by inferior vena cava or aortic occlusion, was similar in RTX-treated versus control animals. RTX-treated animals exhibited resistance to hemodynamic collapse induced by RVP. Activation recovery interval shortening during RVP, a marker of cardiac sympathetic outflow, was greater in RTX-treated animals and exhibited significant delay in returning to baseline values after cessation of RVP. The basal firing rate of SGNs and firing rates in response to RVP were also greater in RTX-treated animals, as was the SGN network activity in response to cardiac stressors. These data suggest that elimination of cardiac nociceptive afferents reorganizes the central-peripheral nervous system interaction to enhance cardiac sympathetic outflow. NEW & NOTEWORTHY Our work demonstrates a role for cardiac vanilloid receptor-1-expressing afferents in reflex processing of cardiovascular stress. Current understanding suggests that elimination of vanilloid receptor-1 afferents would decrease reflex cardiac sympathetic outflow. We found, paradoxically, that sympathetic outflow to the heart is instead enhanced at baseline and during cardiac stress.
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Affiliation(s)
- Koji Yoshie
- University of California, Los Angeles (UCLA) Cardiac Arrhythmia Center and UCLA Neurocardiology Research Center of Excellence, UCLA, Los Angeles, California
| | - Pradeep S Rajendran
- University of California, Los Angeles (UCLA) Cardiac Arrhythmia Center and UCLA Neurocardiology Research Center of Excellence, UCLA, Los Angeles, California
| | - Louis Massoud
- University of California, Los Angeles (UCLA) Cardiac Arrhythmia Center and UCLA Neurocardiology Research Center of Excellence, UCLA, Los Angeles, California
| | - OhJin Kwon
- University of California, Los Angeles (UCLA) Cardiac Arrhythmia Center and UCLA Neurocardiology Research Center of Excellence, UCLA, Los Angeles, California
| | - Vasudev Tadimeti
- University of California, Los Angeles (UCLA) Cardiac Arrhythmia Center and UCLA Neurocardiology Research Center of Excellence, UCLA, Los Angeles, California
| | - Siamak Salavatian
- University of California, Los Angeles (UCLA) Cardiac Arrhythmia Center and UCLA Neurocardiology Research Center of Excellence, UCLA, Los Angeles, California
| | - Jeffrey L Ardell
- University of California, Los Angeles (UCLA) Cardiac Arrhythmia Center and UCLA Neurocardiology Research Center of Excellence, UCLA, Los Angeles, California
| | - Kalyanam Shivkumar
- University of California, Los Angeles (UCLA) Cardiac Arrhythmia Center and UCLA Neurocardiology Research Center of Excellence, UCLA, Los Angeles, California
| | - Olujimi A Ajijola
- University of California, Los Angeles (UCLA) Cardiac Arrhythmia Center and UCLA Neurocardiology Research Center of Excellence, UCLA, Los Angeles, California
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De Pauw M, Mubagwa K, Hodeige D, Borgers M, Flameng W, Van de Voorde J, Heyndrickx GR. Response to exercise and mechanical efficiency in non-ischaemic stunning, induced by short-term rapid pacing in dogs: a role for calcium? Acta Physiol (Oxf) 2017; 219:768-780. [PMID: 26560191 DOI: 10.1111/apha.12629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 06/02/2015] [Accepted: 11/04/2015] [Indexed: 11/28/2022]
Abstract
AIM Rapid pacing (RP) is a regularly used model to induce heart failure in dogs. The aim of the study was to evaluate Ca2+ handling, left ventricular (LV) contractile response during Ca2+ administration compared to exercise, as well as oxygen consumption and mechanical efficiency after 48 h of RP. METHODS Fifty-three mongrel dogs were instrumented to measure LV pressure, LV fractional shortening, regional wall thickening and coronary blood flow. Contractile reserve was measured with isoproterenol and intravenous (IV) Ca2+ administration. To assess the function of the sarcoplasmic reticulum (SR), post-extrasystolic potentiation (PESP) and SR Ca2+ uptake were measured. A graded treadmill test was performed in baseline and after RP (n = 14). In a separate group of animals (n = 5), myocardial performance and oxygen consumption were measured using a wide range of loading conditions. RESULTS Left ventricular contractility was significantly decreased upon cessation of pacing. The contractile response to isoproterenol was blunted compared to a preserved response to IV Ca2+ . Post-extrasystolic potentiation was slightly increased after RP. Maximal velocity (Vmax ) of SR Ca2+ uptake was unchanged. Contractile response during exercise is attenuated after RP. External work is reduced, whereas oxygen consumption is preserved, provoking a reduced mechanical efficiency. CONCLUSION Forty-eight-hours RP provokes a reversible LV dysfunction, while the SR function and response to exogenous Ca2+ are preserved. This is compatible with an intracellular functional remodelling to counteract Ca2+ overload provoked by RP. Left ventricular dysfunction is accompanied by a reduced contractile reserve, but an unchanged oxygen consumption, illustrating an alteration in oxygen utilization.
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Affiliation(s)
- M. De Pauw
- The Department of Cardiology; Ghent University Hospital; Ghent Belgium
| | - K. Mubagwa
- Unit of Experimental Cardiac Surgery; Department of Cardiovascular Sciences; University of Leuven; Leuven Belgium
| | - D. Hodeige
- University of Louvain Medical School Brussels; Brussels Belgium
| | - M. Borgers
- The Janssen Research Foundation; Beerse Belgium
| | - W. Flameng
- Unit of Experimental Cardiac Surgery; Department of Cardiovascular Sciences; University of Leuven; Leuven Belgium
| | | | - G. R. Heyndrickx
- University of Louvain Medical School Brussels; Brussels Belgium
- Cardiovascular Center Aalst; Aalst Belgium
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5
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HÁLA P, MLČEK M, OŠŤÁDAL P, JANÁK D, POPKOVÁ M, BOUČEK T, LACKO S, KUDLIČKA J, NEUŽIL P, KITTNAR O. Regional Tissue Oximetry Reflects Changes in Arterial Flow in Porcine Chronic Heart Failure Treated With Venoarterial Extracorporeal Membrane Oxygenation. Physiol Res 2016; 65:S621-S631. [DOI: 10.33549/physiolres.933532] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Venoarterial extracorporeal membrane oxygenation (VA ECMO) is widely used in treatment of decompensated heart failure. Our aim was to investigate its effects on regional perfusion and tissue oxygenation with respect to extracorporeal blood flow (EBF). In five swine, decompensated low-output chronic heart failure was induced by long-term rapid ventricular pacing. Subsequently, VA ECMO was introduced and left ventricular (LV) volume, aortic blood pressure, regional arterial flow and tissue oxygenation were continuously recorded at different levels of EBF. With increasing EBF from minimal to 5 l/min, mean arterial pressure increased from 47±22 to 84±12 mm Hg (P<0.001) and arterial blood flow increased in carotid artery from 211±72 to 479±58 ml/min (P<0.01) and in subclavian artery from 103±49 to 296±54 ml/min (P<0.001). Corresponding brain and brachial tissue oxygenation increased promptly from 57±6 to 74±3 % and from 37±6 to 77±6 %, respectively (both P<0.01). Presented results confirm that VA ECMO is a capable form of heart support. Regional arterial flow and tissue oxygenation suggest that partial circulatory support may be sufficient to supply brain and peripheral tissue by oxygen.
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Affiliation(s)
- P. HÁLA
- Department of Physiology, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Czarnowska E, Bierła JB, Toczek M, Tyrankiewicz U, Pająk B, Domal-Kwiatkowska D, Ratajska A, Smoleński RT, Mende U, Chłopicki S. Narrow time window of metabolic changes associated with transition to overt heart failure in Tgaq*44 mice. Pharmacol Rep 2016; 68:707-14. [PMID: 27126697 DOI: 10.1016/j.pharep.2016.03.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/15/2016] [Accepted: 03/16/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND The timing and consequences of alternations in substrate utilization in heart failure (HF) and their relationship with structural changes remain unclear. This study aimed to analyze metabolic changes associated with transition to overt heart failure in transgenic mouse model of HF resulting from cardiac-specific overexpression of constitutively active Gαq*. METHODS Structural changes quantified by morphometry, relative cardiac mRNA and protein expression of PPARα, FAT/CD36, CPT-1, GLUT-4 and glycolytic efficiency following administration of 1-(13)C glucose were investigated in 4-14-month-old Tgαq*44 mice (TG), compared with age-matched FVB wild type mice (WT). RESULTS Initial hypertrophy in TG (4-10-month of age) was featured by an accelerated glycolytic pathway that was not accompanied by structural changes in cardiomyocytes. In 10-month-old TG, cardiomyocyte elongation and hypertrophic remodeling and increased glycolytic flux was accompanied by relatively low expression of FAT/CD36, CPT-1 and PPARα. During the transition phase (12-month-old TG), a pronounced increase in PPARα with an increase in relative fatty acid (FA) flux was associated with anomalies of cardiomyocytes with accumulation of lipid droplets and glycogen as well as cell death. At the stage of overt heart failure (14-month-old TG), an accelerated glycolytic pathway with a decline in FA oxidation was accompanied by further structural changes. CONCLUSION Tgαq*44 mice display three distinct phases of metabolic/structural changes during hypertrophy and progression to HF, with relatively short period of increase in FA metabolism, highlighting a narrow metabolic changes associated with transition to overt heart failure in Tgaq*44 mice that have therapeutic significance.
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Affiliation(s)
- Elżbieta Czarnowska
- Department of Pathology, The Children's Memorial Health Institute, Warszawa, Poland.
| | - Joanna B Bierła
- Department of Pathology, The Children's Memorial Health Institute, Warszawa, Poland
| | - Marta Toczek
- Department of Biochemistry, Medical University of Gdansk, Gdańsk, Poland
| | - Urszula Tyrankiewicz
- Department of Magnetic Resonance Imaging Institute of Nuclear Physics, Polish Academy of Sciences, Kraków, Poland; Jagiellonian Centre for Experimental Therapeutics (JCET), Jagiellonian University, Kraków, Poland
| | - Beata Pająk
- Electron Microscopy Platform, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warszawa, Poland; Department of Physiological Sciences, Faculty of Veterinary Medicine, Warsaw University of Life Sciences - SGGW, Warszawa, Poland
| | - Dorota Domal-Kwiatkowska
- Department of Biochemistry, Medical University of Silesia, School of Pharmacy with the Division of Laboratory Medicine, Sosnowiec, Poland
| | - Anna Ratajska
- Department of Pathology, The Medical University of Warsaw, Warszawa, Poland
| | | | - Ulrike Mende
- Cardiovascular Research Center, Cardiology Division, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI, USA
| | - Stefan Chłopicki
- Jagiellonian Centre for Experimental Therapeutics (JCET), Jagiellonian University, Kraków, Poland; Department of Experimental Pharmacology, Jagiellonian University Medical College, Kraków, Poland.
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Bhashyam S, Fields AV, Patterson B, Testani JM, Chen L, Shen YT, Shannon RP. Glucagon-like peptide-1 increases myocardial glucose uptake via p38alpha MAP kinase-mediated, nitric oxide-dependent mechanisms in conscious dogs with dilated cardiomyopathy. Circ Heart Fail 2010; 3:512-21. [PMID: 20466848 DOI: 10.1161/circheartfailure.109.900282] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND We have shown that glucagon-like peptide-1 (GLP-1[7-36] amide) stimulates myocardial glucose uptake in dilated cardiomyopathy (DCM) independent of an insulinotropic effect. The cellular mechanisms of GLP-1-induced myocardial glucose uptake are unknown. METHODS AND RESULTS Myocardial substrates and glucoregulatory hormones were measured in conscious, chronically instrumented dogs at control (n=6), DCM (n=9) and DCM after treatment with a 48-hour infusion of GLP-1 (7-36) amide (n=9) or vehicle (n=6). GLP-1 receptors and cellular pathways implicated in myocardial glucose uptake were measured in sarcolemmal membranes harvested from the 4 groups. GLP-1 stimulated myocardial glucose uptake (DCM: 20+/-7 nmol/min/g; DCM+GLP-1: 61+/-12 nmol/min/g; P=0.001) independent of increased plasma insulin levels. The GLP-1 receptors were upregulated in the sarcolemmal membranes (control: 98+/-2 density units; DCM: 256+/-58 density units; P=0.046) and were expressed in their activated (65 kDa) form in DCM. The GLP-1-induced increases in myocardial glucose uptake did not involve adenylyl cyclase or Akt activation but was associated with marked increases in p38alpha MAP kinase activity (DCM+vehicle: 97+/-22 pmol ATP/mg/min; DCM+GLP-1: 170+/-36 pmol ATP/mg/min; P=0.051), induction of nitric oxide synthase 2 (DCM+vehicle: 151+/-13 density units; DCM+GLP-1: 306+/-12 density units; P=0.001), and GLUT-1 translocation (DCM+vehicle: 21+/-3% membrane bound; DCM+GLP-1: 39+/-3% membrane bound; P=0.005). The effects of GLP-1 on myocardial glucose uptake were blocked by pretreatment with the p38alpha MAP kinase inhibitor or the nonspecific nitric oxide synthase inhibitor nitro-l-arginine. CONCLUSIONS GLP-1 stimulates myocardial glucose uptake through a non-Akt-1-dependent mechanism by activating cellular pathways that have been identified in mediating chronic hibernation and the late phase of ischemic preconditioning.
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Affiliation(s)
- Siva Bhashyam
- Department of Medicine, Allegheny General Hospital, Pittsburgh, Pa 19104, USA
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Severe Mechanical Dyssynchrony Causes Regional Hibernation-Like Changes in Pigs With Nonischemic Heart Failure. J Card Fail 2009; 15:920-8. [DOI: 10.1016/j.cardfail.2009.06.436] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Revised: 06/04/2009] [Accepted: 06/08/2009] [Indexed: 10/20/2022]
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Heilmann C, Kostic C, Giannone B, Grawitz AB, Armbruster W, Lutter G, Beyersdorf F, Göbel H. Improvement of contractility accompanies angiogenesis rather than arteriogenesis in chronic myocardial ischemia. Vascul Pharmacol 2006; 44:326-32. [PMID: 16530020 DOI: 10.1016/j.vph.2006.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2005] [Accepted: 01/11/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Growth factor therapy provides a therapeutic alternative for "no option" patients with coronary disease. Fibroblast Growth Factor-2 (FGF-2) predominantly stimulates angiogenesis, the growth of new capillaries, whereas Monocyte Chemoattractant Protein-1 (MCP-1) is considered an arteriogenic agent. We hypothesised a synergetic effect of FGF-2 and MCP-1 in ischemic myocardium. METHODS A severe coronary stenosis was created in pigs. After one week, chronic ischemia was confirmed by angiography, echocardiography, reduced ejection fraction, and increase of marker enzymes. FGF-2, MCP-1, both, or vector only were then injected intramyocardially as plasmid DNA in the impaired area. Regional contractility and number of capillaries and arterial vessels were evaluated after three months. RESULTS FGF-2, FGF-2+MCP-1, and vector, but not MCP-1 alone improved regional contractility at rest, whereas only FGF-2 alone ameliorated function under stress conditions. Angiogenesis in the ischemic area was stimulated by FGF-2 compared to MCP-1. In contrast, MCP-1 induced arteriogenesis relative to FGF-2. CONCLUSION Differences for vessel growth and regional function were apparent between FGF-2 and MCP-1. This contrast could allow the speculation that development of a flow reserve in chronically ischemic myocardium is linked to angiogenesis rather than to arteriogenesis. No additional benefits were seen following combined therapy.
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Affiliation(s)
- Claudia Heilmann
- Department of Cardiovascular Surgery, University Hospital Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.
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Nikolaidis LA, Mathier MA, Doverspike A, Hentosz T, Huerbin R, Stolarski CJ, Shannon RP. Coronary Blood Flow Responses are Impaired Independent of NO and Endothelial Function in Conscious Dogs with Dilated Cardiomyopathy. J Card Fail 2005; 11:313-21. [PMID: 15880342 DOI: 10.1016/j.cardfail.2004.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Dilated cardiomyopathy (DCM) is characterized by nitric oxide (NO) deficiency and endothelial dysfunction. Whether endothelium-independent vasodilation is preserved, particularly in the coronary circulation, remains controversial. METHODS AND RESULTS We studied systemic and coronary flow responses to the endothelium-dependent agonist, acetylcholine, the cGMP-dependent NO-donor, nitroglycerin, the predominantly endothelium-independent agonist, adenosine, the beta-adrenergic cAMP-dependent agonist, isoproterenol, and the calcium channel antagonist, nicardipine, in conscious dogs with pacing-induced DCM. Systemic blood flow response was impaired to acetylcholine but preserved to other vasodilators in DCM. In contrast, coronary blood flow response was significantly ( P < .05) depressed to all agonists. (Peak coronary blood flow response, control versus DCM: acetylcholine: 221 +/- 14% versus 156 +/- 11%; nitroglycerin: 220 +/- 17% versus 138 +/- 9%; adenosine: 635 +/- 65% versus 376 +/- 56%; nicardipine: 338 +/- 59% versus 115 +/- 23%; isoproterenol: 219 +/- 18% versus 86 +/- 20%). The attenuation was independent of systemic hemodynamic differences. CONCLUSION In contrast to systemic responses, coronary blood flow responses in DCM are impaired dependent or independent of NO or second messenger mechanisms, implying either distal signaling defects or structural abnormalities in the coronary vasculature.
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Affiliation(s)
- Lazaros A Nikolaidis
- Cardiovascular Research Institute and Department of Medicine, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212, USA
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Abstract
Beneficial actions of nitric oxide (NO) in failing myocardium have frequently been overshadowed by poorly documented negative inotropic effects mainly derived from in vitro cardiac preparations. NO's beneficial actions include control of myocardial energetics and improvement of left ventricular (LV) diastolic distensibility. In isolated cardiomyocytes, administration of NO increases their diastolic cell length consistent with a rightward shift of the passive length-tension relation. This shift is explained by cGMP-induced phosphorylation of troponin I, which prevents calcium-independent diastolic cross-bridge cycling and concomitant diastolic stiffening of the myocardium. Similar improvements in diastolic stiffness have been observed in isolated guinea pig hearts, in pacing-induced heart failure dogs, and in patients with dilated cardiomyopathy or aortic stenosis and have been shown to result in higher LV preload reserve and stroke work. NO also controls myocardial energetics through its effects on mitochondrial respiration, oxygen consumption, and substrate utilization. The effects of NO on diastolic LV performance appear to be synergistic with its effects on myocardial energetics through prevention of myocardial energy wastage induced by LV contraction against late-systolic reflected arterial pressure waves and through prevention of diastolic LV stiffening, which is essential for the maintenance of adequate subendocardial coronary perfusion. A drop in these concerted actions of NO on diastolic LV distensibility and on myocardial energetics could well be instrumental for the relentless deterioration of failing myocardium.
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Affiliation(s)
- Walter J Paulus
- Institute for Cardiovascular Research, Vrije Universiteit, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
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12
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Nikolaidis LA, Trumble D, Hentosz T, Doverspike A, Huerbin R, Mathier MA, Shen YT, Shannon RP. Catecholamines restore myocardial contractility in dilated cardiomyopathy at the expense of increased coronary blood flow and myocardial oxygen consumption (MvO2cost of catecholamines in heart failure). Eur J Heart Fail 2004; 6:409-19. [PMID: 15182765 DOI: 10.1016/j.ejheart.2003.09.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2003] [Accepted: 09/15/2003] [Indexed: 11/30/2022] Open
Abstract
To investigate the metabolic cost of catecholamine use in heart failure, we administered intravenous dobutamine or norepinephrine to dogs with moderate and severe LV dysfunction until LV contractile function was restored to normal levels. Both drugs were associated with significant increases in myocardial O(2) consumption, increased coronary blood flow requirements and decreased myocardial mechanical efficiency. These mechanisms may contribute to the deleterious effects of catecholamines in heart failure.
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Affiliation(s)
- Lazaros A Nikolaidis
- Department of Medicine, Allegheny General Hospital, Drexel University College of Medicine, 320 E. North Avenue, Pittsburgh, PA 15212, USA
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13
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Shen W, Gill RM, Jones BD, Zhang JP, Corbly AK, Steinberg MI. Combined inotropic and bradycardic effects of a sodium channel enhancer in conscious dogs with heart failure: a mechanism for improved myocardial efficiency compared with dobutamine. J Pharmacol Exp Ther 2002; 303:673-80. [PMID: 12388650 DOI: 10.1124/jpet.303.2.673] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We compared the cardiac inotropic, chronotropic, and myocardial O(2) consumption (MVO(2)) responses to the sodium (Na(+)) channel enhancer, LY341311 [(S)-4-[3-[[1-(diphenyl-methyl)-3-azetidinyl]oxy]-2-hydroxypropoxy]-1H-indole-2-carbonitrile monohydrate], with the beta-receptor agonist dobutamine in conscious dogs with heart failure. Heart failure was induced in chronically instrumented dogs by right ventricular pacing at 240 beats per minute for 3 to 4 weeks. LY341311 (10-100 microg/kg/min i.v.) dose dependently increased cardiac contractile function as reflected, at the highest dose, by increases in left ventricular dP/dt(max) (55 +/- 7%), and fractional shortening (62 +/- 9%), accompanied by increases in cardiac stroke work (111 +/- 18%) and minute work (34 +/- 10%) and decreases in heart rate (33 +/- 4%). Dobutamine (2-15 microg/kg/min i.v.) increased contractile responses to a similar degree but also increased heart rate (15 +/- 5%) at the highest dose. Complete ganglionic blockade with hexamethonium and atropine or with hexamethonium alone abolished the bradycardic effect but not the inotropic response to LY341311. At similar levels of inotropic response, dobutamine (10 microg/kg/min) increased MVO(2) by 23 +/- 7% (P < 0.05), whereas LY341311 (100 microg/kg/min) had no effect. In the presence of left atrial pacing at a constant heart rate and at matched contractile work, MVO(2) was increased by LY341311 to the same extent as dobutamine. These data indicate that autonomically mediated bradycardia produced by LY341311 contributes to a favorable net metabolic effect on myocardial O(2) utilization in the failing heart while providing inotropic support comparable to a beta-receptor-mediated agonist.
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Affiliation(s)
- Weiqun Shen
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN 46285, USA.
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14
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Affiliation(s)
- T H Hintze
- Department of Physiology, New York Medical College, Valhalla, 10595, USA
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