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Stonko DP, Rousseau MC, Price C, Benike A, Treffalls RN, Brunton NE, Rosen D, Morrison JJ. Technical and analytical approach to biventricular pressure-volume loops in swine including a completely endovascular, percutaneous closed-chest large animal model. JVS Vasc Sci 2024; 5:100190. [PMID: 38486870 PMCID: PMC10938295 DOI: 10.1016/j.jvssci.2024.100190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/29/2023] [Indexed: 03/17/2024] Open
Abstract
Pressure-volume (PV) loop analysis is a sophisticated invasive approach to quantifying load-dependent and independent measures of cardiac function. Biventricular (BV) PV loops allow left and right ventricular function to be quantified simultaneously and independently, which is important for conditions and certain physiologic states, such as ventricular decoupling or acute physiologic changes. BV PV loops can be performed in an entirely endovascular, percutaneous, and closed-chest setting. This technique is helpful in a survival animal model, as a percutaneous monitoring system during endovascular device experiments, or in cases where chest wall compliance is being tested or may be a confounder. In this article, we describe the end-to-end implementation of a completely endovascular, totally percutaneous, and closed-chest large animal model to obtain contemporaneous BV PV loops in 40 to 70 kg swine. We describe the associated surgical and technical challenges and our solutions to obtaining endovascular BV PV loops, closed-chest cardiac output, and stroke volume (including validation of the correction factor necessary for thermodilution), as well as how to perform endovascular inferior vena cava occlusion in this swine model. We also include techniques for data acquisition and analysis that are required for this method.
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Affiliation(s)
- David P. Stonko
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Mathieu C. Rousseau
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
- Division of Thoracic Surgery, Department of Surgery, University of Montreal, Montreal, QC, Canada
| | - Colin Price
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Amy Benike
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Rebecca N. Treffalls
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
- School of Medicine, University of the Incarnate Word, San Antonio, TX
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Ruppert M, Korkmaz-Icöz S, Benczik B, Ágg B, Nagy D, Bálint T, Sayour AA, Oláh A, Barta BA, Benke K, Ferdinandy P, Karck M, Merkely B, Radovits T, Szabó G. Pressure overload-induced systolic heart failure is associated with characteristic myocardial microRNA expression signature and post-transcriptional gene regulation in male rats. Sci Rep 2023; 13:16122. [PMID: 37752166 PMCID: PMC10522609 DOI: 10.1038/s41598-023-43171-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/20/2023] [Indexed: 09/28/2023] Open
Abstract
Although systolic function characteristically shows gradual impairment in pressure overload (PO)-evoked left ventricular (LV) hypertrophy (LVH), rapid progression to congestive heart failure (HF) occurs in distinct cases. The molecular mechanisms for the differences in maladaptation are unknown. Here, we examined microRNA (miRNA) expression and miRNA-driven posttranscriptional gene regulation in the two forms of PO-induced LVH (with/without systolic HF). PO was induced by aortic banding (AB) in male Sprague-Dawley rats. Sham-operated animals were controls. The majority of AB animals demonstrated concentric LVH and slightly decreased systolic function (termed as ABLVH). In contrast, in some AB rats severely reduced ejection fraction, LV dilatation and increased lung weight-to-tibial length ratio was noted (referred to as ABHF). Global LV miRNA sequencing revealed fifty differentially regulated miRNAs in ABHF compared to ABLVH. Network theoretical miRNA-target analysis predicted more than three thousand genes with miRNA-driven dysregulation between the two groups. Seventeen genes with high node strength value were selected for target validation, of which five (Fmr1, Zfpm2, Wasl, Ets1, Atg16l1) showed decreased mRNA expression in ABHF by PCR. PO-evoked systolic HF is associated with unique miRNA alterations, which negatively regulate the mRNA expression of Fmr1, Zfmp2, Wasl, Ets1 and Atg16l1.
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Affiliation(s)
- Mihály Ruppert
- Experimental Research Laboratory, Heart and Vascular Center, Semmelweis University, Városmajor u. 68, 1122, Budapest, Hungary.
| | - Sevil Korkmaz-Icöz
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
- Department of Cardiac Surgery, University Hospital Halle (Saale), Halle, Germany
| | - Bettina Benczik
- Pharmahungary Group, Szeged, Hungary
- Cardiometabolic and HUN-REN-SU System Pharmacology Research Group, Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
| | - Bence Ágg
- Pharmahungary Group, Szeged, Hungary
- Cardiometabolic and HUN-REN-SU System Pharmacology Research Group, Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
| | - Dávid Nagy
- Experimental Research Laboratory, Heart and Vascular Center, Semmelweis University, Városmajor u. 68, 1122, Budapest, Hungary
| | - Tímea Bálint
- Experimental Research Laboratory, Heart and Vascular Center, Semmelweis University, Városmajor u. 68, 1122, Budapest, Hungary
| | - Alex Ali Sayour
- Experimental Research Laboratory, Heart and Vascular Center, Semmelweis University, Városmajor u. 68, 1122, Budapest, Hungary
| | - Attila Oláh
- Experimental Research Laboratory, Heart and Vascular Center, Semmelweis University, Városmajor u. 68, 1122, Budapest, Hungary
| | - Bálint András Barta
- Experimental Research Laboratory, Heart and Vascular Center, Semmelweis University, Városmajor u. 68, 1122, Budapest, Hungary
| | - Kálmán Benke
- Experimental Research Laboratory, Heart and Vascular Center, Semmelweis University, Városmajor u. 68, 1122, Budapest, Hungary
| | - Péter Ferdinandy
- Pharmahungary Group, Szeged, Hungary
- Cardiometabolic and HUN-REN-SU System Pharmacology Research Group, Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
| | - Matthias Karck
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Béla Merkely
- Experimental Research Laboratory, Heart and Vascular Center, Semmelweis University, Városmajor u. 68, 1122, Budapest, Hungary
| | - Tamás Radovits
- Experimental Research Laboratory, Heart and Vascular Center, Semmelweis University, Városmajor u. 68, 1122, Budapest, Hungary
| | - Gábor Szabó
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
- Department of Cardiac Surgery, University Hospital Halle (Saale), Halle, Germany
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3
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Werida RH, Elshafiey RA, Ghoneim A, Elzawawy S, Mostafa TM. Role of alpha-lipoic acid in counteracting paclitaxel- and doxorubicin-induced toxicities: a randomized controlled trial in breast cancer patients. Support Care Cancer 2022; 30:7281-7292. [PMID: 35596774 PMCID: PMC9385783 DOI: 10.1007/s00520-022-07124-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 05/05/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Paclitaxel and doxorubicin are associated with neurotoxicity and cardiotoxicity respectively. This study aimed at investigating the role of alpha-lipoic acid (ALA) in counteracting paclitaxel-induced neuropathy and doxorubicin-associated cardiotoxicity in women with breast cancer. PATIENTS AND METHODS This randomized double-blind placebo-controlled prospective study included 64 patients with breast cancer who were randomized into control group (n = 32) which received 4 cycles of doxorubicin plus cyclophosphamide (every 21 days) followed by weekly doses of paclitaxel for 12 weeks plus placebo tablets once daily and ALA group (n = 32) which received the same chemotherapeutic regimen plus ALA 600 once daily for 6 months. Patients were assessed by National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE version 4.0) for grading of neuropathy and by 12-item neurotoxicity questionnaire (Ntx-12). The assessment included also echocardiography and evaluation of serum levels of brain natriuretic peptide (BNP), tumor necrosis factor-alpha (TNF-α), malondialdehyde (MDA), and neurotensin (NT). Data were analyzed by paired and unpaired t-test, Mann-Whitney U test, and chi-square test. RESULTS As compared to placebo, ALA provoked significant improvement in NCI-CTCAE neuropathy grading and Ntx-12 score after the end of 9th and 12th weeks of paclitaxel intake (p = 0.039, p = 0.039, p = 0.03, p = 0.004, respectively). At the end of the chemotherapy cycles, ALA resulted in significant decline in serum levels of BNP, TNF-α, MDA, and neurotensin (p < 0.05) as compared to baseline data and placebo. CONCLUSION Alpha-lipoic acid may represent a promising adjuvant therapy to attenuate paclitaxel-associated neuropathy and doxorubicin-induced cardiotoxicity in women with breast cancer. TRIAL REGISTRATION ClinicalTrials.gov: NCT03908528.
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Affiliation(s)
- Rehab H Werida
- Clinical Pharmacy & Pharmacy Practice Department, Faculty of Pharmacy, Damanhour University, Damanhour, Egypt.
| | - Reham A Elshafiey
- Clinical Pharmacy & Pharmacy Practice Department, Faculty of Pharmacy, Damanhour University, Damanhour, Egypt
| | - Asser Ghoneim
- Pharmacology & Toxicology Department, Faculty of Pharmacy, Damanhour University, Damanhour, Egypt
| | - Sherif Elzawawy
- Clinical Oncology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Tarek M Mostafa
- Clinical Pharmacy Department, Faculty of Pharmacy, Tanta University, Tanta, Egypt
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Akgoz H, Gurkan U. Subclinical myocardial dysfunction in patients with complete recovery from peripartum cardiomyopathy: a long-term clinical strain-echocardiographic study. Hypertens Pregnancy 2022; 41:89-96. [DOI: 10.1080/10641955.2022.2046049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Haldun Akgoz
- Cardiology Department, Acıbadem Kadıkoy Hospital, Istanbul, Turkey
| | - Ufuk Gurkan
- Cardiology Department, Siyami Ersek Thoracic and Cardiovascular Surgery Center, İstanbul, Turkey
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Alsaied T, Geva T, Graf JA, Sleeper LA, Marie Valente A. Biventricular Global Function Index Is Associated With Adverse Outcomes in Repaired Tetralogy of Fallot. Circ Cardiovasc Imaging 2021; 14:e012519. [PMID: 34387102 DOI: 10.1161/circimaging.121.012519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Cardiac magnetic resonance (CMR) derived biventricular global function index (BVGFI) is a new CMR parameter that integrates biventricular volumes, mass, and function using clinically available CMR parameters. The associations of BVGFI with clinical outcomes in repaired tetralogy of Fallot are unknown. METHODS Patients with repaired tetralogy of Fallot who had a CMR before the occurrence of a composite outcome of death, resuscitated sudden death, or sustained ventricular tachycardia were studied. BVGFI was calculated as the average of right and left GFI. GFI was defined as (ventricular stroke volume×100)/(ventricular mean cavity volume + total ventricular myocardial volume). Ventricular mean cavity volume was defined as ([end-diastolic + end-systolic volume]/2). Cox multivariable regression analysis and classification and regression tree methodology were used. RESULTS Of the 736 eligible subjects (mean age at CMR 25.4±14.5 years), with a median follow-up of 28 months, 55 subjects (7.4%) reached the composite outcome (46 deaths and 9 sustained ventricular tachycardia). Independent associations with the composite outcome were as follows: BVGFI <37 (hazard ratio, 2.52; P=0.004), right ventricular end-systolic volume index >85 mL/m2 (hazard ratio, 3.25; P<0.001), atrial tachycardia (hazard ratio, 2.03; P=0.021), and age at repair >2.5 years (hazard ratio, 3.37; P<0.001). Classification and regression tree analysis identified BVGFI as the most discriminatory CMR parameter associated with a high risk for adverse outcomes. CONCLUSIONS BVGFI, a novel CMR-derived imaging biomarker combining biventricular volumes, mass, and function, may improve risk stratification for adverse clinical outcomes in patients with repaired tetralogy of Fallot.
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Affiliation(s)
- Tarek Alsaied
- Department of Cardiology. Boston Children's Hospital, Harvard Medical School, MA (T.A., T.G., J.A.G., L.A.S., A.M.V.)
| | - Tal Geva
- Department of Cardiology. Boston Children's Hospital, Harvard Medical School, MA (T.A., T.G., J.A.G., L.A.S., A.M.V.)
| | - Julia A Graf
- Department of Cardiology. Boston Children's Hospital, Harvard Medical School, MA (T.A., T.G., J.A.G., L.A.S., A.M.V.)
| | - Lynn A Sleeper
- Department of Cardiology. Boston Children's Hospital, Harvard Medical School, MA (T.A., T.G., J.A.G., L.A.S., A.M.V.)
| | - Anne Marie Valente
- Department of Cardiology. Boston Children's Hospital, Harvard Medical School, MA (T.A., T.G., J.A.G., L.A.S., A.M.V.).,Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.M.V.)
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Lakatos BK, Ruppert M, Tokodi M, Oláh A, Braun S, Karime C, Ladányi Z, Sayour AA, Barta BA, Merkely B, Radovits T, Kovács A. Myocardial work index: a marker of left ventricular contractility in pressure- or volume overload-induced heart failure. ESC Heart Fail 2021; 8:2220-2231. [PMID: 33754487 PMCID: PMC8120402 DOI: 10.1002/ehf2.13314] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/15/2021] [Accepted: 03/02/2021] [Indexed: 12/11/2022] Open
Abstract
Aims While global longitudinal strain (GLS) is considered to be a sensitive marker of left ventricular (LV) function, it is significantly influenced by loading conditions. We hypothesized that global myocardial work index (GMWI), a novel marker of LV function, may show better correlation with load‐independent markers of LV contractility in rat models of pressure‐induced or volume overload‐induced heart failure. Methods and results Male Wistar rats underwent either transverse aortic constriction (TAC; n = 12) or aortocaval fistula creation (ACF; n = 12), inducing LV pressure or volume overload, respectively. Sham procedures were performed to establish control groups (n = 12/12). Echocardiographic loops were obtained to determine GLS and GMWI. Pressure‐volume analysis with transient occlusion of the inferior caval vein was carried out to calculate preload recruitable stroke work (PRSW), a load‐independent ‘gold‐standard’ parameter of LV contractility. Myocardial samples were collected to assess interstitial and perivascular fibrosis area and also myocardial atrial‐type natriuretic peptide (ANP) and brain‐type natriuretic peptide (BNP) relative mRNA expression. Compared with controls, GLS was substantially lower in the TAC group (−7.0 ± 2.8 vs. −14.5 ± 2.5%; P < 0.001) and was only mildly reduced in the ACF group (−13.2 ± 2.4 vs. −15.4 ± 2.0%, P < 0.05). In contrast with these findings, PRSW and GMWI were comparable with sham in TAC (110 ± 26 vs. 116 ± 68 mmHg; 1687 ± 275 mmHg% vs. 1537 ± 662 mmHg%; both P = NS), while it was found to be significantly reduced in ACF (58 ± 14 vs. 111 ± 40 mmHg; 1328 ± 411 vs. 1934 ± 308 mmHg%, both P < 0.01). In the pooled population, GMWI (r = 0.70; P < 0.001) but not GLS (r = −0.23; P = 0.12) showed a strong correlation with PRSW. GLS correlated with interstitial (r = 0.61; P < 0.001) and perivascular fibrosis area (r = 0.54; P < 0.001), and also with myocardial ANP (r = 0.85; P < 0.001) and BNP relative mRNA expression (r = 0.75; P < 0.001), while GMWI demonstrated no or only marginal correlation with these parameters. Conclusions Being significantly influenced by loading conditions, GLS may not be a reliable marker of LV contractility in heart failure induced by pressure or volume overload. GMWI better reflects contractility in haemodynamic overload states, making it a more robust marker of systolic function, while GLS should be considered as an integrative marker, incorporating systolic function, haemodynamic loading state, and adverse tissue remodelling of the LV.
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Affiliation(s)
- Bálint Károly Lakatos
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Mihály Ruppert
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Márton Tokodi
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Attila Oláh
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Szilveszter Braun
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Christian Karime
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Zsuzsanna Ladányi
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Alex Ali Sayour
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Bálint András Barta
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Tamás Radovits
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
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7
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Ruppert M, Lakatos BK, Braun S, Tokodi M, Karime C, Oláh A, Sayour AA, Hizoh I, Barta BA, Merkely B, Kovács A, Radovits T. Longitudinal Strain Reflects Ventriculoarterial Coupling Rather Than Mere Contractility in Rat Models of Hemodynamic Overload–Induced Heart Failure. J Am Soc Echocardiogr 2020; 33:1264-1275.e4. [DOI: 10.1016/j.echo.2020.05.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 02/07/2023]
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8
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Ta HT, Critser PJ, Alsaied T, Germann J, Powell AW, Redington AN, Tretter JT. Modified Ventricular Global Function Index Correlates With Exercise Capacity in Repaired Tetralogy of Fallot. J Am Heart Assoc 2020; 9:e016308. [PMID: 32633206 PMCID: PMC7660707 DOI: 10.1161/jaha.120.016308] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Cardiac MRI (CMR) derived ventricular global function index (GFI), a ratio of stroke volume to the sum of mean ventricular cavity and myocardial volumes, has demonstrated improved prediction of clinical outcomes in adults with atherosclerotic disease over ejection fraction. We sought to assess CMR derived GFI and a novel modification that accounts for unique loading conditions in patients with repaired tetralogy of Fallot (rTOF) and determine its correlation with exercise performance. Methods and Results Seventy‐five patients with rTOF who underwent CMR were identified. Clinical variables were recorded and biventricular GFI calculated. A right ventricular (RV) effective GFI (eGFI) was derived by incorporating effective stroke volume. Thirty‐five pediatric patients were matched with 29 age‐matched healthy controls. Twenty‐five patients completed cardiopulmonary exercise tests within 6 months of CMR. Stepwise regression models were used to determine univariate and multivariable predictors of indexed and percent predicted peak VO2. Median age at CMR was 20 years (interquartile range, 13–28). Pediatric rTOF patients had lower RV eGFI (P < 0.001), RV ejection fraction (P=0.002), but higher indexed RV end‐diastolic and end‐systolic volumes (P < 0.001, P < 0.001) compared with controls. Univariate analysis demonstrated a correlation between indexed peak VO2 with RV eGFI (R2=0.32, P=0.004), but with neither RVGFI, RV ejection fraction, indexed RV volumes nor RV mass. RV eGFI remained significantly associated with indexed peak VO2 during multivariable modeling. Conclusions Reduced RV eGFI was associated with reduced exercise capacity in rTOF patients, while RV GFI, RV ejection fraction, indexed RV volumes and mass were not. Our modification of the GFI, RV eGFI, may be a valuable non‐invasive marker of cardiac function in rTOF.
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Affiliation(s)
- Hieu T Ta
- Heart Institute Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Paul J Critser
- Heart Institute Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Tarek Alsaied
- Heart Institute Cincinnati Children's Hospital Medical Center Cincinnati OH.,Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH
| | - Joshua Germann
- Heart Institute Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Adam W Powell
- Heart Institute Cincinnati Children's Hospital Medical Center Cincinnati OH.,Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH
| | - Andrew N Redington
- Heart Institute Cincinnati Children's Hospital Medical Center Cincinnati OH.,Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH
| | - Justin T Tretter
- Heart Institute Cincinnati Children's Hospital Medical Center Cincinnati OH.,Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH
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9
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Lewalle A, Land S, Carruth E, Frank LR, Lamata P, Omens JH, McCulloch AD, Niederer SA, Smith NP. Decreasing Compensatory Ability of Concentric Ventricular Hypertrophy in Aortic-Banded Rat Hearts. Front Physiol 2018; 9:37. [PMID: 29527171 PMCID: PMC5829063 DOI: 10.3389/fphys.2018.00037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 01/10/2018] [Indexed: 11/28/2022] Open
Abstract
The cardiac system compensates for variations in physiological and pathophysiological conditions through a dynamic remodeling at the organ, tissue, and intracellular levels in order to maintain function. However, on longer time scales following the onset of ventricular pressure overload, such remodeling may begin to inhibit physiological function and ultimately lead to heart failure. This progression from compensatory to decompensatory behavior is poorly understood, in particular owing to the absence of a unified perspective of the concomitantly remodeling subsystems. To address this issue, the present study investigates the evolution of compensatory mechanisms, in response to overload, by integrating diffusion-tensor MRI, echocardiography, and intracellular and hemodynamic measurements within consistent computational simulations of aortic-banded rat hearts. This approach allows a comparison of the relative leverage of different cardiac properties (geometry, passive mechanical stiffness, fiber configuration, diastolic and peak calcium concentrations, calcium-binding affinity, and aortic impedance) to affect cardiac contraction. Measurements indicate that, following aortic banding, an ejection fraction (EF) of 75% was maintained, relative to control rats, despite significant remodeling of the left-ventricular wall thickness (increasing by ~90% over 4 weeks). Applying our framework, we identified the left-ventricular wall thickness (concentric hypertrophy) and the intracellular calcium dynamics as playing the dominant roles in preserving EF acutely, whereas the significance of hypertrophy decreased subsequently. This trend suggests an increasing reliance on intracellular mechanisms (average increase ~50%), rather than on anatomical features (average decrease ~60%), to achieve compensation of pump function in the early phase of heart failure.
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Affiliation(s)
- Alexandre Lewalle
- Department of Biomedical Engineering, King's College London, St. Thomas's Hospital, London, United Kingdom
| | - Sander Land
- Department of Biomedical Engineering, King's College London, St. Thomas's Hospital, London, United Kingdom
| | - Eric Carruth
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States
| | - Lawrence R. Frank
- Radiology Department, University of California, San Diego, San Diego, CA, United States
| | - Pablo Lamata
- Department of Biomedical Engineering, King's College London, St. Thomas's Hospital, London, United Kingdom
| | - Jeffrey H. Omens
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States
- Department of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Andrew D. McCulloch
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States
- Department of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Steven A. Niederer
- Department of Biomedical Engineering, King's College London, St. Thomas's Hospital, London, United Kingdom
| | - Nicolas P. Smith
- Department of Biomedical Engineering, King's College London, St. Thomas's Hospital, London, United Kingdom
- Faculty of Engineering, University of Auckland, Auckland, New Zealand
- *Correspondence: Nicolas P. Smith
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10
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Mouton AJ, Ninh VK, El Hajj EC, El Hajj MC, Gilpin NW, Gardner JD. Exposure to chronic alcohol accelerates development of wall stress and eccentric remodeling in rats with volume overload. J Mol Cell Cardiol 2016; 97:15-23. [PMID: 27107489 DOI: 10.1016/j.yjmcc.2016.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 04/15/2016] [Accepted: 04/19/2016] [Indexed: 01/19/2023]
Abstract
Chronic alcohol abuse is one of the leading causes of dilated cardiomyopathy (DCM) in the United States. Volume overload (VO) also produces DCM characterized by left ventricular (LV) dilatation and reduced systolic and diastolic function, eventually progressing to congestive heart failure. For this study, we hypothesized that chronic alcohol exposure would exacerbate cardiac dysfunction and remodeling due to VO. Aortocaval fistula surgery was used to induce VO, and compensatory cardiac remodeling was allowed to progress for either 3days (acute) or 8weeks (chronic). Alcohol was administered via chronic intermittent ethanol vapor (EtOH) for 2weeks before the acute study and for the duration of the 8week chronic study. Temporal alterations in LV function were assessed by echocardiography. At the 8week end point, pressure-volume loop analysis was performed by LV catheterization and cardiac tissue collected. EtOH did not exacerbate LV dilatation (end-systolic and diastolic diameter) or systolic dysfunction (fractional shortening, ejection fraction) due to VO. The combined stress of EtOH and VO decreased the eccentric index (posterior wall thickness to end-diastolic diameter ratio), increased end-diastolic pressure (EDP), and elevated diastolic wall stress. VO also led to increases in posterior wall thickness, which was not observed in the VO+EtOH group, and wall thickness significantly correlated with LV BNP expression. VO alone led to increases in interstitial collagen staining (picrosirius red), which while not statistically significant, tended to be decreased by EtOH. VO increased LV collagen I protein expression, whereas in rats with VO+EtOH, LV collagen I was not elevated relative to Sham. The combination of VO and EtOH also led to increases in LV collagen III expression relative to Sham. Rats with VO+EtOH had significantly lower collagen I/III ratio than rats with VO alone. During the acute remodeling phase of VO (3days), VO significantly increased collagen III expression, whereas this effect was not observed in rats with VO+EtOH. In conclusion, chronic EtOH accelerates the development of elevated wall stress and promotes early eccentric remodeling in rats with VO. Our data indicate that these effects may be due to disruptions in compensatory hypertrophy and extracellular matrix remodeling in response to volume overload.
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Affiliation(s)
- Alan J Mouton
- LSU Health Sciences Center, Department of Physiology, 1901 Perdido Street, New Orleans, LA 70112, United States.
| | - Van K Ninh
- LSU Health Sciences Center, Department of Physiology, 1901 Perdido Street, New Orleans, LA 70112, United States.
| | - Elia C El Hajj
- LSU Health Sciences Center, Department of Physiology, 1901 Perdido Street, New Orleans, LA 70112, United States.
| | - Milad C El Hajj
- LSU Health Sciences Center, Department of Physiology, 1901 Perdido Street, New Orleans, LA 70112, United States.
| | - Nicholas W Gilpin
- LSU Health Sciences Center, Department of Physiology, 1901 Perdido Street, New Orleans, LA 70112, United States.
| | - Jason D Gardner
- LSU Health Sciences Center, Department of Physiology, 1901 Perdido Street, New Orleans, LA 70112, United States.
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Guidelines for translational research in heart failure. J Cardiovasc Transl Res 2015; 8:3-22. [PMID: 25604959 DOI: 10.1007/s12265-015-9606-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 01/06/2015] [Indexed: 12/11/2022]
Abstract
Heart failure (HF) remains a major cause of death and hospitalization worldwide. Despite medical advances, the prognosis of HF remains poor and new therapeutic approaches are urgently needed. The development of new therapies for HF is hindered by inappropriate or incomplete preclinical studies. In these guidelines, we present a number of recommendations to enhance similarity between HF animal models and the human condition in order to reduce the chances of failure in subsequent clinical trials. We propose different approaches to address safety as well as efficacy of new therapeutic products. We also propose that good practice rules are followed from the outset so that the chances of eventual approval by regulatory agencies increase. We hope that these guidelines will help improve the translation of results from animal models to humans and thereby contribute to more successful clinical trials and development of new therapies for HF.
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Morris DA, Otani K, Bekfani T, Takigiku K, Izumi C, Yuda S, Sakata K, Ohte N, Tanabe K, Friedrich K, Kühnle Y, Nakatani S, Otsuji Y, Haverkamp W, Boldt LH, Takeuchi M. Multidirectional Global Left Ventricular Systolic Function in Normal Subjects and Patients with Hypertension: Multicenter Evaluation. J Am Soc Echocardiogr 2014; 27:493-500. [DOI: 10.1016/j.echo.2014.01.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Indexed: 01/07/2023]
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Chemaly ER, Kang S, Zhang S, McCollum L, Chen J, Bénard L, Purushothaman KR, Hajjar RJ, Lebeche D. Differential patterns of replacement and reactive fibrosis in pressure and volume overload are related to the propensity for ischaemia and involve resistin. J Physiol 2013; 591:5337-55. [PMID: 24018949 DOI: 10.1113/jphysiol.2013.258731] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Pathological left ventricle (LV) hypertrophy (LVH) results in reactive and replacement fibrosis. Volume overload LVH (VOH) is less profibrotic than pressure overload LVH (POH). Studies attribute subendocardial fibrosis in POH to ischaemia, and reduced fibrosis in VOH to collagen degradation favouring dilatation. However, the mechanical origin of the relative lack of fibrosis in VOH is incompletely understood. We hypothesized that reduced ischaemia propensity in VOH compared to POH accounted for the reduced replacement fibrosis, along with reduced reactive fibrosis. Rats with POH (ascending aortic banding) evolved into either compensated-concentric POH (POH-CLVH) or dilated cardiomyopathy (POH-DCM); they were compared to VOH (aorta-caval fistula). We quantified LV fibrosis, structural and haemodynamic factors of ischaemia propensity, and the activation of profibrotic pathways. Fibrosis in POH-DCM was severe, subendocardial and subepicardial, in contrast with subendocardial fibrosis in POH-CLVH and nearly no fibrosis in VOH. The propensity for ischaemia was more important in POH versus VOH, explaining different patterns of replacement fibrosis. LV collagen synthesis and maturation, and matrix metalloproteinase-2 expression, were more important in POH. The angiotensin II-transforming growth-factor β axis was enhanced in POH, and connective tissue growth factor (CTGF) was overexpressed in all types of LVH. LV resistin expression was markedly elevated in POH, mildly elevated in VOH and independently reflected chronic ischaemic injury after myocardial infarction. In vitro, resistin is induced by angiotensin II and induces CTGF in cardiomyocytes. Based on these findings, we conclude that a reduced ischaemia propensity and attenuated upstream reactive fibrotic pathways account for the attenuated fibrosis in VOH versus POH.
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Affiliation(s)
- Elie R Chemaly
- D. Lebeche: Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029, USA.
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14
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Arias T, Chen J, Fayad ZA, Fuster V, Hajjar RJ, Chemaly ER. Comparison of echocardiographic measurements of left ventricular volumes to full volume magnetic resonance imaging in normal and diseased rats. J Am Soc Echocardiogr 2013; 26:910-8. [PMID: 23706342 PMCID: PMC3725209 DOI: 10.1016/j.echo.2013.04.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Clinical two-dimensional (2D) and clinical three-dimensional echocardiography are validated against cardiac magnetic resonance imaging (CMR), the gold standard for left ventricular (LV) volume measurement. In rodents, there is no widely accepted echocardiographic measure of whole LV volumes, and CMR measurements vary among studies. The aim of this study was to compare LV volumes by 2D echocardiography (using a hemisphere-cylinder [HC] model) with HC and full-volume (FV) CMR in normal and diseased rats to measure the impact of geometric models and imaging modalities. METHODS Rats (n = 27) underwent ascending aortic banding, myocardial infarction induction by either permanent left anterior descending coronary artery ligation or ischemia-reperfusion, and sham thoracotomy. Subsequently, end-diastolic volume, end-systolic volume, and ejection fraction were measured using an HC 2D echocardiographic model combining parasternal short-axis and long-axis measurements, and these were compared with HC and FV CMR. RESULTS Diseased groups showed LV dilatation and dysfunction. HC echocardiographic and FV CMR measures of end-diastolic volume, end-systolic volume, and ejection fraction were correlated. On Bland-Altman plots, end-diastolic volumes were concordant between both methods, while HC echocardiography underestimated end-systolic volumes, resulting in a modest overestimation of ejection fractions compared with FV CMR. Other 2D echocardiographic geometric models offered less concordance with FV CMR than HC. HC CMR overestimated LV volumes compared with FV CMR, while HC echocardiography underestimated HC CMR volumes. Echocardiography underestimated corresponding LV dimensions by CMR, particularly short axis. CONCLUSIONS Concordant measures of LV volume and function were obtained using (1) a relatively simple HC model of the left ventricle inclusive of two orthogonal 2D echocardiographic planes and (2) FV CMR in normal and diseased rats. The HC model appeared to compensate for the underestimation of LV dimensions by echocardiography.
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Affiliation(s)
- Teresa Arias
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at
Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández
Almagro, 3, Madrid, 28029, Spain
| | - Jiqiu Chen
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at
Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA
| | - Zahi A. Fayad
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at
Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA
| | - Valentin Fuster
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at
Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández
Almagro, 3, Madrid, 28029, Spain
| | - Roger J. Hajjar
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at
Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA
| | - Elie R. Chemaly
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at
Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA
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