Contractile properties of cardiac muscle in hyperthyroidism. Analysis of behavior of hyperthyroid cat papillary muscle in vitro relevant to thyrotoxic heart disease

Myocardial Rac1 exhibits partial involvement in thyroxin-induced cardiomyocyte hypertrophy and its inhibition is not sufficient to improve cardiac dysfunction or contractile abnormalities in mouse papillary muscles

: Development of cardiac hypertrophy after thyroxin (T4) treatment is well recognized. Recently, we observed that T4-induced cardiac hypertrophy is associated with increased cardiac Rac1 expression and activity. Whether this Rac1 increase has a role in inducing this cardiac phenotype is, however, still unknown. Here, we showed that T4 treatment (500 µg/kg/d) for 2 weeks resulted in increased myocardial Rac1 activity with subsequent hypertension, cardiac hypertrophy, and left ventricular systolic dysfunction in vivo. Isolated right ventricular papillary muscles of T4-treated mice maintained their peak isometric active developed tension but exhibited significant decreases in their corresponding time to peak and in relaxation times. Positive inotropic responses to increasing pacing rate and β-adrenergic stimulation were also depressed in these muscles. Pravastatin (10 mg/kg/d), a Rac1 inhibitor, significantly decreased myocardial Rac1 activity, hypertension, and cardiomyocyte size in T4-treated mice but could not attenuate gross heart weight or functional cardiac changes in these mice. Our data showed that T4 could activate different signaling pathways with distinct cardiovascular outcomes. We also provide the first mechanistic evidence for the partial involvement of Rac1 activation in T4-induced cardiomyocyte hypertrophy and reveal a putative role for Rac1 in the development of T4-induced hypertension.

RELATIONSHIP BETWEEN SELECTED ECHOCARDIOGRAPHIC VARIABLES BEFORE AND AFTER RADIOIODINE TREATMENT IN 91 HYPERTHYROID CATS

Ninety-one spontaneously hyperthyroid cats were studied by two-dimensional and M-mode echocardiography with in a week before and 2-3 months following oral radioiodine administration. A statistical search was made for a correlation between any of the linear echocardiographic variables (pre- or posttreatment) and the serum total thyroxine concentrations (pre- or posttreatment). No clinically useful relationships were found. Echocardiographic values were compared with a 95% confidence interval constructed from a previous multiinstitutional report on unsedated normal cats. Observed pretreatment abnormalities were primarily increases in interventricular septal and left ventricular wall thickness with reversion toward normal following treatment. The presence or absence of previous treatment with methimazole or concurrent treatment with cardiac-related drugs (beta-adrenergic blocker, calcium channel blocker, or angiotensin-converting enzyme inhibitor) had no statistically identifiable effect on the echocardiographic variables. About 37% of the cats had one or more echocardiographic variable(s) outside the calculated normal range before radioiodine treatment, but about 32% of the cats had one or more echocardiographic variable(s) outside that range after treatment (45% of these were normal before treatment). The conclusions are that pretreatment T-4 assessment was not useful in determining which cats may have potentially relevant echocardiographic abnormalities, that some echocardiographic abnormalities may emerge after treatment, and that less than 10% of the pre- or posttreatment abnormalities would be considered clinically relevant.

The effects of thyroxine treatment of rats on neuronal and extraneuronal uptake and metabolism of catecholamines in the heart

The effects of thyroxine (T4) treatment of rats on the neuronal and extraneuronal uptake and subsequent metabolism of catecholamines in the heart were examined, to determine whether changes in the local dissipation of catecholamines might contribute to the enhanced sympathetic cardiac responses that occur when thyroid hormone levels are elevated. T4-treated rats were injected subcutaneously with L-thyroxine sodium 1 mg kg(-1) on days 1, 3 and 5, and controls were injected with the normal saline vehicle on the same days. The experiments on isolated, perfused hearts were carried out on day 8. The T4-treated rats had only 50% of the growth rate of the controls and their heart weights were 18% greater than the controls. The experimental data were adjusted to allow for the increase in heart weight caused by the T4 treatment. The initial rates of neuronal uptake of noradrenaline and of extraneuronal uptake of noradrenaline and isoprenaline in the hearts from T4-treated rats were not significantly different from those in hearts from control rats. The steady-state rates of extraneuronal O-methylation of isoprenaline and of extraneuronal deamination of noradrenaline in hearts from T4-treated rats were not significantly different from those in hearts from control rats. The steady-state rate of neuronal deamination of noradrenaline was significantly lower and the accumulation of unmetabolized noradrenaline in the hearts was significantly greater in T4-treated rats than in the controls. These findings could be explained by a decrease in neuronal monoamine oxidase activity or by an increase in intraneuronal binding of noradrenaline in hearts from T4-treated rats. 6 The study has shown that it is unlikely that increased plasma thyroid hormone levels cause cardiac supersensitivity to catecholamines by affecting the local dissipation processes for those amines in the heart.

Hormone regulation of cardiac energy metabolism. I. Creatine transport across cell membranes of euthyroid and hyperthyroid rat heart

Hyperthyroid rat heart was studied with the purpose of identifying the mechanism for the significant decrease in total creatine (free creatine plus phosphocreatine) observed in this pathology and its consequences on heart function. Administration of L-thyroxine in doses of 50-100 micrograms/100 g of body weight during a week resulted in a reversible decrease of the total creatine by 40-50%. Simultaneously, remarkable changes in the creatine transport system across the cardiac cell membranes were observed: both the maximal rate of its active uptake and its passive movement along its concentration gradient were enhanced. In euthyroid hearts, the parameters of creatine uptake (Km approximately or equal to 0.05 mM, Vmax = 20 nmole/min/g dry weight) were similar to those for skeletal muscle and the passive movement of creatine was negligible. In hyperthyroid hearts the latter rate was enhanced to 0.4 mumole min/g dry weight, this showing reversible damages in the cell membrane structure induced by L-thyroxine. This conclusion is consistent with observed penetration of colloidal lanthanum into the cells of hyperthyroid hearts. Perfusion of hyperthyroid rat hearts with 50 mM creatine significantly restored creatine content in the cells, Hyperthyroid hearts with decreased creatine content were found to develop ischemic contracture more rapidly and in higher extent than the euthyroid hearts. Increased sensitivity to ischemic damage may be related to decreased efficiency of energy channeling via phosphocreatine pathway.

Hyperthyroid heart disease

The importance of cardiovascular system involvement in hyperthyroidism has been recognized for many years. In the middle-aged and elderly patient, often with mild but prolonged elevation of plasma thyroid hormones, symptoms and signs of heart failure and complicating atrial fibrillation may dominate the clinical picture and mask the more classical endocrine manifestations of the disease. Pitfalls in diagnosis and the importance of early recognition and treatment are discussed. Despite experimental evidence for a short-term inotropic action of thyroid hormone excess, clinical data support the existence of a reversible cardiomyopathy in hyperthyroidism with impaired contractile reserve. Enhanced myocardial performance at rest primarily reflects the peripheral actions of thyroid hormone excess. Most, if not all, of the cardiac abnormalities return to normal once a euthyroid state has been achieved, although atrial fibrillation may persist in a minority. Optimum treatment requires rapid and definitive antithyroid therapy, usually using a large dose of radio-iodine, and rapid control of heart failure. Systemic anticoagulation is indicated in the presence of atrial fibrillation and should be continued until sinus rhythm has been present for at least three months, either spontaneously or after cardioversion.

Delayed recovery of left ventricular function after antithyroid treatment. Further evidence for reversible abnormalities of contractility in hyperthyroidism

Sequential measurements of systolic time intervals, left ventricular dimensions, and the derived indices of contractility were undertaken at rest and during isometric exercise in 15 hyperthyroid patients before, during, and after antithyroid treatment. At rest hyperthyroidism was characterised by a shortened pre-ejection period and increased velocity of circumferential shortening of the left ventricle. During isometric exercise, however, the pre-ejection period increased significantly beyond that predicted for normal subjects, and the velocity of circumferential fibre shortening fell by 30%. In contrast, both the pre-ejection period and the velocity of circumferential fibre shortening were unchanged during exercise after a stable euthyroid state had been achieved for at least three months. Comparison between exercise responses and thyroid status during antithyroid treatment showed that a biochemical euthyroid state may be achieved many weeks before normalisation of contractile response to exercise. These findings support the hypothesis of reversible depression of left ventricular function in hyperthyroidism. Responses at rest principally reflect the peripheral actions of thyroid hormone excess.

The diminished cardiac performance in severe thyrotoxicosis. Parabolic correlation of LVET/PEP to the circulating levels of thyroid hormones

Fifteen patients with thyrotoxicosis, 8 patients with primary hypothyroidism and 15 normal subjects were studied to assess the correlation between systolic time intervals and serum levels of thyroid hormones. In hypothyroid patients, prolongation of PEPc (corrected pre-ejection period), shortening of LVETc (corrected left ventricular ejection time) and low values of LVET/PEP ratio and cardiac output were improved after restoration of thyroid function. In thyrotoxic patients, shortening of PEPc, high values of LVET/PEP ratio and cardiac output were normalized after correction of thyroid function. As contrasted with these observations, in 5 severely thyrotoxic patients, low values of LVET/PEP ratio and cardiac output for thyrotoxicosis were observed; these were not significantly decreased after antithyroid drug treatment, but appeared to have a tendency to increase. Performing polynomial regression analysis, a significant parabolic correlation was found between LVET/PEP and serum T4 or T3 (p less than 0.0001). From these results, it might be concluded that large amounts of thyroid hormones suppress cardiac performance.

Experimental hyperthyroidism I. Hemodynamics and contractility in situ

The influence of experimental hyperthyroidism (intraperitoneal injection of crystalline L-thyroxine 1 mg/kg/day, 8-18 days) on cardiac mechanics in contractility in situ were studied in 30 hyperthyroid cats and compared with an euthyroid control group (n equals 30). 1. In hyperthyroidism left ventricular weight was considerably increased. Hypertrophy in hyperthyroidism represents a special case of myocardial hypertrophy, associated with an increase of myocardial performance. 2. Heart rate, systolic pressure, cardiac index, external cardiac work and tension time index were increased by 60-180 per cent. 3. Indices of contractility (dp/dtmax, t-dp/dtmax, dp/dtmax/IP) as well as isovolumetric force velocity relationships and VCE-max and Vmax demonstrated a considerable increase of contractility. Maximum rate isovolumetric pressure fall was increased by 120 per cent. Experimental hyperthyroidism is characterized by hypercirculation associated with increases of pressure, volume and velocity factors. The results are discussed with regards to the effects of increased cardiac mechanics on myocardial energy balance.