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Shi RY, Wu R, Ran J, Tang LL, Wesemann L, Hu J, Du L, Zhang WJ, Xu JR, Zhou Y, Zhao L, Pu J, Wu LM. Fractal analysis of left ventricular trabeculae in post-STEMI: from acute to chronic phase. Insights Imaging 2024; 15:75. [PMID: 38499900 PMCID: PMC10948656 DOI: 10.1186/s13244-024-01641-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/09/2024] [Indexed: 03/20/2024] Open
Abstract
PURPOSE The temporal evolution of ventricular trabecular complexity and its correlation with major adverse cardiovascular events (MACE) remain indeterminate in patients presenting with acute ST elevation myocardial infarction (STEMI). METHODS This retrospective analysis enrolled patients undergoing primary percutaneous coronary intervention (pPCI) for acute STEMI, possessing cardiac magnetic resonance (CMR) data in the acute (within 7 days), subacute (1 month after pPCI), and chronic phases (6 months after pPCI) from January 2015 to January 2020 at the three participating sites. Fractal dimensions (FD) were measured for the global, infarct, and remote regions of left ventricular trabeculae during each phase. The potential association of FD with MACE was analyzed using multivariate Cox regression. RESULTS Among the 200 analyzed patients (182 men; median age, 61 years; age range, 50-66 years), 37 (18.5%) encountered MACE during a median follow-up of 31.2 months. FD exhibited a gradual decrement (global FD at acute, subacute, and chronic phases: 1.253 ± 0.049, 1.239 ± 0.046, 1.230 ± 0.045, p < 0.0001), with a more pronounced decrease observed in patients subsequently experiencing MACE (p < 0.001). The global FD at the subacute phase correlated with MACE (hazard ratio 0.89 (0.82, 0.97), p = 0.01), and a global FD value below 1.26 was associated with a heightened risk. CONCLUSION In patients post-STEMI, the global FD, serving as an indicator of left ventricular trabeculae complexity, independently demonstrated an association with subsequent major adverse cardiovascular events, beyond factors encompassing left ventricular ejection fraction, indexed left ventricular end-diastolic volume, infarct size, heart rate, NYHA class, and post-pPCI TIMI flow. CRITICAL RELEVANCE STATEMENT In patients who have had an ST-segment elevation myocardial infarction, global fractal dimension, as a measure of left ventricular trabeculae complexity, provided independent association with subsequent major adverse cardiovascular event. KEY POINTS • Global and regional FD decreased after STEMI, and more so in patients with subsequent MACE. • Lower global FD at the subacute phase and Δglobal FD from acute to subacute phase were associated with subsequent MACE besides clinical and CMR factors. • Global FD at the subacute phase independently correlated with MACE and global FD value below 1.26 was associated with higher risk.
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Affiliation(s)
- Ruo-Yang Shi
- Department of Radiology, School of Medicine, Ren Ji Hospital, Shanghai Jiao Tong University, No. 160, Pujian Road, Shanghai, 200127, China
- Jiading Branch, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rui Wu
- Department of Radiology, School of Medicine, Ren Ji Hospital, Shanghai Jiao Tong University, No. 160, Pujian Road, Shanghai, 200127, China
| | - Jinjun Ran
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lang-Lang Tang
- Department of Radiology, Longyan First Hospital of Fujian Medical University, Long Yan, Fu Jian, China
| | - Luke Wesemann
- Department of Radiology, Wayne State University, Detroit, MI, USA
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, MI, USA
| | - Liang Du
- Shanghai Robotics Institute, Shanghai University, Shanghai, China
| | - Wei-Jun Zhang
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jian-Rong Xu
- Department of Radiology, School of Medicine, Ren Ji Hospital, Shanghai Jiao Tong University, No. 160, Pujian Road, Shanghai, 200127, China
| | - Yan Zhou
- Department of Radiology, School of Medicine, Ren Ji Hospital, Shanghai Jiao Tong University, No. 160, Pujian Road, Shanghai, 200127, China
| | - Lei Zhao
- Department of Radiology, An Zhen Hospital, Capital Medical University, No. 2 Anzhen Road, Beijing, 100029, China.
| | - Jun Pu
- Department of Cardiology, School of Medicine, Ren Ji Hospital, Shanghai Jiao Tong University, No. 160, Pujian Road, Shanghai, 200127, China.
| | - Lian-Ming Wu
- Department of Radiology, School of Medicine, Ren Ji Hospital, Shanghai Jiao Tong University, No. 160, Pujian Road, Shanghai, 200127, China.
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2
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Evaluation of stimulus-effect relations in left ventricular growth using a simple multiscale model. Biomech Model Mechanobiol 2019; 19:263-273. [PMID: 31388869 PMCID: PMC7005098 DOI: 10.1007/s10237-019-01209-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022]
Abstract
Cardiac growth is the natural capability of the heart to change size in response to changes in blood flow demand of the growing body. Cardiac diseases can trigger the same process leading to an abnormal type of growth. Prediction of cardiac growth would be clinically valuable, but so far published models on cardiac growth differ with respect to the stimulus-effect relation and constraints used for maximum growth. In this study, we use a zero-dimensional, multiscale model of the left ventricle to evaluate cardiac growth in response to three valve diseases, aortic and mitral regurgitation along with aortic stenosis. We investigate how different combinations of stress- and strain-based stimuli affect growth in terms of cavity volume and wall volume and hemodynamic performance. All of our simulations are able to reach a converged state without any growth constraint, with the most promising results obtained while considering at least one stress-based stimulus. With this study, we demonstrate how a simple model of left ventricular mechanics can be used to have a first evaluation on a designed growth law.
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3
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Espe EK, Aronsen JM, Eriksen M, Sejersted OM, Zhang L, Sjaastad I. Regional Dysfunction After Myocardial Infarction in Rats. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005997. [DOI: 10.1161/circimaging.116.005997] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 07/07/2017] [Indexed: 11/16/2022]
Abstract
Background—
Detailed understanding of regional function after myocardial infarction (MI) is currently incomplete. We aimed at investigating regional myocardial strain and work in post-MI rats with and without heart failure.
Methods and Results—
Six weeks after induction of MI, 62 male Wistar-Hannover rats with a range of infarct sizes, plus 14 sham-operated rats, were examined by cine and phase-contrast magnetic resonance imaging. After magnetic resonance imaging, the rats were catheterized, and left ventricular pressures were recorded. Regional strain and work were calculated from the magnetic resonance imaging and pressure data. On the basis of end-diastolic left ventricular pressure, 34 MI rats were classified as nonfailing (MI
NF
) and 28 MI rats as failing (MI
CHF
). In the region remote to the infarct, the MI
NF
rats exhibited preserved strain and increased work compared with sham, whereas MI
CHF
had reduced longitudinal strain and no increase in work in this region. In the noninfarcted region adjacent to the infarct, MI
CHF
demonstrated substantially reduced work because of high levels of negative work.
Conclusions—
We have demonstrated a distinct difference in regional work between nonfailing and failing hearts after MI and offer novel insight into the relation between regional function and presence of congestion. Work analysis provided significant added value over strain analysis alone.
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Affiliation(s)
- Emil K.S. Espe
- From the Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Norway (E.K.S.E., J.M.A., O.M.S., L.Z., I.S.); Bjørknes College, Oslo, Norway (J.M.A.); and Respinor AS, Oslo, Norway (M.E.)
| | - Jan Magnus Aronsen
- From the Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Norway (E.K.S.E., J.M.A., O.M.S., L.Z., I.S.); Bjørknes College, Oslo, Norway (J.M.A.); and Respinor AS, Oslo, Norway (M.E.)
| | - Morten Eriksen
- From the Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Norway (E.K.S.E., J.M.A., O.M.S., L.Z., I.S.); Bjørknes College, Oslo, Norway (J.M.A.); and Respinor AS, Oslo, Norway (M.E.)
| | - Ole M. Sejersted
- From the Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Norway (E.K.S.E., J.M.A., O.M.S., L.Z., I.S.); Bjørknes College, Oslo, Norway (J.M.A.); and Respinor AS, Oslo, Norway (M.E.)
| | - Lili Zhang
- From the Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Norway (E.K.S.E., J.M.A., O.M.S., L.Z., I.S.); Bjørknes College, Oslo, Norway (J.M.A.); and Respinor AS, Oslo, Norway (M.E.)
| | - Ivar Sjaastad
- From the Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Norway (E.K.S.E., J.M.A., O.M.S., L.Z., I.S.); Bjørknes College, Oslo, Norway (J.M.A.); and Respinor AS, Oslo, Norway (M.E.)
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4
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Ma SP, Vunjak-Novakovic G. Tissue-Engineering for the Study of Cardiac Biomechanics. J Biomech Eng 2016; 138:021010. [PMID: 26720588 PMCID: PMC4845250 DOI: 10.1115/1.4032355] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Indexed: 12/13/2022]
Abstract
The notion that both adaptive and maladaptive cardiac remodeling occurs in response to mechanical loading has informed recent progress in cardiac tissue engineering. Today, human cardiac tissues engineered in vitro offer complementary knowledge to that currently provided by animal models, with profound implications to personalized medicine. We review here recent advances in the understanding of the roles of mechanical signals in normal and pathological cardiac function, and their application in clinical translation of tissue engineering strategies to regenerative medicine and in vitro study of disease.
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Affiliation(s)
- Stephen P. Ma
- Department of Biomedical Engineering,
Columbia University,
622 West 168th Street,
VC12-234,
New York, NY 10032
e-mail:
| | - Gordana Vunjak-Novakovic
- Department of Biomedical Engineering
and Department of Medicine,
Columbia University,
622 West 168th Street,
VC12-234,
New York, NY 10032
e-mail:
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5
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Abstract
Myocardial infarction, commonly known as heart attack, is caused by reduced blood supply and damages the heart muscle because of a lack of oxygen. Myocardial infarction initiates a cascade of biochemical and mechanical events. In the early stages, cardiomyocytes death, wall thinning, collagen degradation, and ventricular dilation are the immediate consequences of myocardial infarction. In the later stages, collagenous scar formation in the infarcted zone and hypertrophy of the non-infarcted zone are auto-regulatory mechanisms to partly correct for these events. Here we propose a computational model for the short-term adaptation after myocardial infarction using the continuum theory of multiplicative growth. Our model captures the effects of cell death initiating wall thinning, and collagen degradation initiating ventricular dilation. Our simulations agree well with clinical observations in early myocardial infarction. They represent a first step toward simulating the progression of myocardial infarction with the ultimate goal to predict the propensity toward heart failure as a function of infarct intensity, location, and size.
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Affiliation(s)
- P Sáez
- a Mathematical Institute, University of Oxford , Oxford , UK
| | - E Kuhl
- b Department of Mechanical Engineering , Stanford University , Stanford , CA , USA
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6
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Dong H, Mosca H, Gao E, Akins RE, Gidding SS, Tsuda T. Integrated wall stress: a new methodological approach to assess ventricular workload and myocardial contractile reserve. J Transl Med 2013; 11:183. [PMID: 23919327 PMCID: PMC3750700 DOI: 10.1186/1479-5876-11-183] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 07/29/2013] [Indexed: 11/16/2022] Open
Abstract
Background Wall stress is a useful concept to understand the progression of ventricular remodeling. We measured cumulative LV wall stress throughout the cardiac cycle over unit time and tested whether this “integrated wall stress (IWS)” would provide a reliable marker of total ventricular workload. Methods and results We applied IWS to mice after experimental myocardial infarction (MI) and sham-operated mice, both at rest and under dobutamine stimulation. Small infarcts were created so as not to cause subsequent overt hemodynamic decompensation. IWS was calculated over one minute through simultaneous measurement of LV internal diameter and wall thickness by echocardiography and LV pressure by LV catheterization. At rest, the MI group showed concentric LV hypertrophy pattern with preserved LV cavity size, LV systolic function, and IWS comparable with the sham group. Dobutamine stimulation induced a dose-dependent increase in IWS in MI mice, but not in sham mice; MI mice mainly increased heart rate, whereas sham mice increased LV systolic and diastolic function. IWS showed good correlation with a product of peak-systolic wall stress and heart rate. We postulate that this increase in IWS in post-MI mice represents limited myocardial contractile reserve. Conclusion We hereby propose that IWS provides a useful estimate of total ventricular workload in the mouse model and that increased IWS indicates limited LV myocardial contractile reserve.
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Affiliation(s)
- Hailong Dong
- Nemours Cardiac Center and Nemours Biomedical Research, Alfred I, duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE 19103, USA
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7
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Mokashi SA, Lee LS, Schmitto JD, Ghanta RK, McGurk S, Laurence RG, Bolman RM, Cohn LH, Chen FY. Restraint to the left ventricle alone is superior to standard restraint. J Thorac Cardiovasc Surg 2013; 146:192-7. [DOI: 10.1016/j.jtcvs.2012.09.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 09/04/2012] [Accepted: 09/13/2012] [Indexed: 10/27/2022]
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8
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Diastolic ventricular support with cardiac support devices: an alternative approach to prevent adverse ventricular remodeling. Heart Fail Rev 2013; 18:55-63. [PMID: 22527015 DOI: 10.1007/s10741-012-9312-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Heart failure is a global epidemic with limited therapy. Abnormal left ventricular wall stress in the diseased myocardium results in a biochemical positive feedback loop that results in global ventricular remodeling and further deterioration of myocardial function. Mechanical myocardial restraints such as the Acorn CorCap and Paracor HeartNet ventricular restraints have attempted to minimize diastolic ventricular wall stress and limit adverse ventricular remodeling. Unfortunately, these therapies have not yielded viable clinical therapies for heart failure. Cellular and novel biopolymer-based therapies aimed at stabilizing pathologic myocardium hold promise for translation to clinical therapy in the future.
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9
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Lee LS, Ghanta RK, Mokashi SA, Coelho-Filho O, Kwong RY, Kwon M, Guan J, Liao R, Chen FY. Optimized ventricular restraint therapy: adjustable restraint is superior to standard restraint in an ovine model of ischemic cardiomyopathy. J Thorac Cardiovasc Surg 2012; 145:824-31. [PMID: 22698557 DOI: 10.1016/j.jtcvs.2012.05.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 04/09/2012] [Accepted: 05/09/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The effects of ventricular restraint level on left ventricular reverse remodeling are not known. We hypothesized that restraint level affects the degree of reverse remodeling and that restraint applied in an adjustable manner is superior to standard, nonadjustable restraint. METHODS This study was performed in 2 parts using a model of chronic heart failure in the sheep. In part I, restraint was applied at control (0 mm Hg, n = 3), low (1.5 mm Hg, n = 3), and high (3.0 mm Hg, n = 3) levels with an adjustable and measurable ventricular restraint (AMVR) device. Restraint level was not altered throughout the 2-month treatment period. Serial restraint level measurements and transthoracic echocardiography were performed. In part II, restraint was applied with the AMVR device set at 3.0 mm Hg (n = 6) and adjusted periodically to maintain that level. This was compared with restraint applied in a standard, nonadjustable manner using a mesh wrap (n = 6). All subjects were followed up for 2 months with serial magnetic resonance imaging. RESULTS In part I, there was greater and earlier reverse remodeling in the high restraint group. In both groups, the rate of reverse remodeling peaked and then declined as the measured restraint level decreased with progression of reverse remodeling. In part II, adjustable restraint resulted in greater reverse remodeling than standard restraint. Left ventricular end diastolic volume decreased by 12.7% (P = .005) with adjustable restraint and by 5.7% (P = .032) with standard restraint. Left ventricular ejection fraction increased by 18.9% (P = .014) and 14.4% (P < .001) with adjustable and standard restraint, respectively. CONCLUSIONS Restraint level affects the rate and degree of reverse remodeling and is an important determinant of therapy efficacy. Adjustable restraint is more effective than nonadjustable restraint in promoting reverse remodeling.
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Affiliation(s)
- Lawrence S Lee
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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10
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MacIver DH, Dayer MJ, Harrison AJI. A general theory of acute and chronic heart failure. Int J Cardiol 2012; 165:25-34. [PMID: 22483252 DOI: 10.1016/j.ijcard.2012.03.093] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Revised: 03/07/2012] [Accepted: 03/08/2012] [Indexed: 12/13/2022]
Abstract
Current concepts of heart failure propose multiple heterogeneous pathophysiological mechanisms. Recently a theoretical framework for understanding chronic heart failure was suggested. This paper develops this framework to include acute heart failure syndromes. We propose that all acute heart failure syndromes may be understood in terms of a relative fall in left ventricular stroke volume. The initial compensatory mechanism is frequently a tachycardia often resulting in a near normal cardiac output. In more severe forms a fall in cardiac output causes hypotension or cardiogenic shock. In chronic heart failure the stroke volume and cardiac output is returned to normal predominantly through ventricular remodeling or dilatation. Ejection fraction is simply the ratio of stroke volume and end-diastolic volume. The resting stroke volume is predetermined by the tissue's needs; therefore, if the ejection fraction changes, the end-diastolic volume must change in a reciprocal manner. The potential role of the right heart in influencing the presentation of left heart disease is examined. We propose that acute pulmonary edema occurs when the right ventricular stroke volume exceeds left ventricular stroke volume leading to fluid accumulation in the alveoli. The possible role of the right heart in determining pulmonary hypertension and raised filling pressures in left-sided heart disease are discussed. Different clinical scenarios are presented to help clarify these proposed mechanisms and the clinical implications of these theories are discussed. Finally an alternative definition of heart failure is proposed.
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Affiliation(s)
- David H MacIver
- Department of Cardiology, Taunton & Somerset Hospital, Musgrove Park, Taunton TA1 5DA, UK.
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11
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Tsamis A, Cheng A, Nguyen TC, Langer F, Miller DC, Kuhl E. Kinematics of cardiac growth: in vivo characterization of growth tensors and strains. J Mech Behav Biomed Mater 2012; 8:165-77. [PMID: 22402163 PMCID: PMC3298662 DOI: 10.1016/j.jmbbm.2011.12.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Revised: 11/29/2011] [Accepted: 12/16/2011] [Indexed: 12/22/2022]
Abstract
Progressive growth and remodeling of the left ventricle are part of the natural history of chronic heart failure and strong clinical indicators for survival. Accompanied by changes in cardiac form and function, they manifest themselves in alterations of cardiac strains, fiber stretches, and muscle volume. Recent attempts to shed light on the mechanistic origin of heart failure utilize continuum theories of growth to predict the maladaptation of the heart in response to pressure or volume overload. However, despite a general consensus on the representation of growth through a second order tensor, the precise format of this growth tensor remains unknown. Here we show that infarct-induced cardiac dilation is associated with a chronic longitudinal growth, accompanied by a chronic thinning of the ventricular wall. In controlled in vivo experiments throughout a period of seven weeks, we found that the lateral left ventricular wall adjacent to the infarct grows longitudinally by more than 10%, thins by more than 25%, lengthens in fiber direction by more than 5%, and decreases its volume by more than 15%. Our results illustrate how a local loss of blood supply induces chronic alterations in structure and function in adjacent regions of the ventricular wall. We anticipate our findings to be the starting point for a series of in vivo studies to calibrate and validate constitutive models for cardiac growth. Ultimately, these models could be useful to guide the design of novel therapies, which allow us to control the progression of heart failure.
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12
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Dixon JA, Gorman RC, Stroud RE, Mukherjee R, Meyer EC, Baker NL, Morita M, Hamamoto H, Ryan LP, Gorman JH, Spinale FG. Targeted regional injection of biocomposite microspheres alters post-myocardial infarction remodeling and matrix proteolytic pathways. Circulation 2011; 124:S35-45. [PMID: 21911817 DOI: 10.1161/circulationaha.111.035774] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although localized delivery of biocomposite materials, such as calcium hydroxyapatite (CHAM), have been demonstrated to potentially attenuate adverse left ventricular (LV) remodeling after myocardial infarction (MI), the underlying biological mechanisms for this effect remain unclear. This study tested the hypothesis that targeted CHAM injections would alter proteolytic pathways (matrix metalloproteinases [MMPs] and tissue inhibitors of MMPs [TIMPs]) and would be associated with parameters of post-MI LV remodeling. METHODS AND RESULTS MI was induced in adult sheep followed by 20 targeted injections of a total volume of 1.3 mL (n=6) or 2.6 mL of CHAM (n=5) or saline (n=13) and LV end-diastolic volume (EDV) and MMP/TIMP profiles in the MI region were measured at 8 weeks after MI. LV EDV decreased with 2.6 mL CHAM versus MI only (105.4 ± 7.5 versus 80.6 ± 4.2 respectively, P<0.05) but not with 1.3 mL CHAM (94.5 ± 5.0, P=0.32). However, MI thickness increased by 2-fold in both CHAM groups compared with MI only (P<0.05). MMP-13 increased 40-fold in the MI only group (P<0.05) but fell by >6-fold in both CHAM groups (P<0.05). MMP-7 increased approximately 1.5-fold in the MI only group (P<0.05) but decreased to referent control values in both CHAM groups in the MI region (P<0.05). Collagen content was reduced by approximately 30% in the CHAM groups compared with MI only (P<0.05). CONCLUSIONS Differential effects on LV remodeling and MMP/TIMP profiles occurred with CHAM. Thus, targeted injection of a biocomposite material can favorably affect the post-MI remodeling process and therefore holds promise as a treatment strategy in and of itself, or as a matrix with potentially synergistic effects with localized pharmacological or cellular therapies.
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Affiliation(s)
- Jennifer A Dixon
- Cardiothoracic Surgery, Medical University of SouthCarolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
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Tsamis A, Bothe W, Kvitting JPE, Swanson JC, Miller DC, Kuhl E. Active contraction of cardiac muscle: in vivo characterization of mechanical activation sequences in the beating heart. J Mech Behav Biomed Mater 2011; 4:1167-76. [PMID: 21783125 DOI: 10.1016/j.jmbbm.2011.03.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Revised: 03/22/2011] [Accepted: 03/29/2011] [Indexed: 11/27/2022]
Abstract
Progressive alterations in cardiac wall strains are a classic hallmark of chronic heart failure. Accordingly, the objectives of this study are to establish a baseline characterization of cardiac strains throughout the cardiac cycle, to quantify temporal, regional, and transmural variations of active fiber contraction, and to identify pathways of mechanical activation in the healthy beating heart. To this end, we insert two sets of twelve radiopaque beads into the heart muscle of nine sheep; one in the anterior-basal and one in the lateral-equatorial left ventricular wall. During three consecutive heartbeats, we record the bead coordinates via biplane videofluoroscopy. From the resulting four-dimensional data sets, we calculate the temporally and transmurally varying Green-Lagrange strains in the anterior and lateral wall. To quantify active contraction, we project the strains onto the local muscle fiber directions. We observe that mechanical activation is initiated at the endocardium slightly after end diastole and progresses transmurally outward, reaching the epicardium slightly before end systole. Accordingly, fibers near the outer wall are in contraction for approximately half of the cardiac cycle while fibers near the inner wall are in contraction almost throughout the entire cardiac cycle. In summary, cardiac wall strains display significant temporal, regional, and transmural variations. Quantifying wall strain profiles might be of particular clinical significance when characterizing stages of left ventricular remodeling, but also of engineering relevance when designing new biomaterials of similar structure and function.
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Affiliation(s)
- Alkiviadis Tsamis
- Department of Mechanical Engineering, 496 Lomita Mall, Stanford, CA-94305, USA
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14
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Zhong X, Spottiswoode BS, Meyer CH, Kramer CM, Epstein FH. Imaging three-dimensional myocardial mechanics using navigator-gated volumetric spiral cine DENSE MRI. Magn Reson Med 2011; 64:1089-97. [PMID: 20574967 DOI: 10.1002/mrm.22503] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A navigator-gated 3D spiral cine displacement encoding with stimulated echoes (DENSE) pulse sequence for imaging 3D myocardial mechanics was developed. In addition, previously described 2D postprocessing algorithms including phase unwrapping, tissue tracking, and strain tensor calculation for the left ventricle (LV) were extended to 3D. These 3D methods were evaluated in five healthy volunteers, using 2D cine DENSE and historical 3D myocardial tagging as reference standards. With an average scan time of 20.5 ± 5.7 min, 3D data sets with a matrix size of 128 × 128 × 22, voxel size of 2.8 × 2.8 × 5.0 mm(3), and temporal resolution of 32 msec were obtained with displacement encoding in three orthogonal directions. Mean values for end-systolic mid-ventricular mid-wall radial, circumferential, and longitudinal strain were 0.33 ± 0.10, -0.17 ± 0.02, and -0.16 ± 0.02, respectively. Transmural strain gradients were detected in the radial and circumferential directions, reflecting high spatial resolution. Good agreement by linear correlation and Bland-Altman analysis was achieved when comparing normal strains measured by 2D and 3D cine DENSE. Also, the 3D strains, twist, and torsion results obtained by 3D cine DENSE were in good agreement with historical values measured by 3D myocardial tagging.
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Affiliation(s)
- Xiaodong Zhong
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
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15
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Jhun CS, Wenk JF, Zhang Z, Wall ST, Sun K, Sabbah HN, Ratcliffe MB, Guccione JM. Effect of adjustable passive constraint on the failing left ventricle: a finite-element model study. Ann Thorac Surg 2010; 89:132-7. [PMID: 20103222 DOI: 10.1016/j.athoracsur.2009.08.075] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 08/27/2009] [Accepted: 08/31/2009] [Indexed: 12/20/2022]
Abstract
BACKGROUND Passive constraint is used to prevent left ventricular dilation and subsequent remodeling. However, there has been concern about the effect of passive constraint on diastolic left ventricular chamber stiffness and pump function. This study determined the relationship between constraint, diastolic wall stress, chamber stiffness, and pump function. We tested the hypothesis that passive constraint at 3 mm Hg reduces wall stress with minimal change in pump function. METHODS A three-dimensional finite-element model of the globally dilated left ventricle based on left ventricular dimensions obtained in dogs that had undergone serial intracoronary microsphere injection was created. The model was adjusted to match experimentally observed end-diastolic left ventricular volume and midventricular wall thickness. The experimental results used to create the model were previously reported. A pressure of 3, 5, 7, and 9 mm Hg was applied to the epicardium. Fiber stress, end-diastolic pressure-volume relationship, end-systolic pressure-volume relationship, and the stroke volume-end-diastolic pressure (Starling) relationship were calculated. RESULTS As epicardial constraint pressure increased, fiber stress decreased, the end-diastolic pressure-volume relationship shifted to the left, and the Starling relationship shifted down and to the right. The end-systolic pressure-volume relationship did not change. A constraining pressure of 2.3 mm Hg was associated with a 10% reduction in stroke volume, and mean end-diastolic fiber stress was reduced by 18.3% (inner wall), 15.3% (mid wall), and 14.2% (outer wall). CONCLUSIONS Both stress and cardiac output decrease in a linear fashion as the amount of passive constraint is increased. If the reduction in cardiac output is to be less than 10%, passive constraint should not exceed 2.3 mm Hg. On the other hand, this amount of constraint may be sufficient to reverse eccentric hypertrophy after myocardial infarction.
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Affiliation(s)
- Choon-Sik Jhun
- Department of Surgery, University of California, San Francisco, California, USA
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Kvitting JPE, Sigfridsson A, Wigström L, Bolger AF, Karlsson M. Analysis of human myocardial dynamics using virtual markers based on magnetic resonance imaging. Clin Physiol Funct Imaging 2009; 30:23-9. [PMID: 19780762 DOI: 10.1111/j.1475-097x.2009.00900.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
SUMMARY BACKGROUND Myocardial dynamics are three-dimensional (3D) and time-varying. Cineradiography of surgically implanted makers in animals or patients is accurate for assessing these events, but this invasive method potentially alters myocardial motion. The aim of the study was to quantify myocardial motion using magnetic resonance imaging (MRI) and hence to provide a non-invasive approach to characterize 3D myocardial dynamics. METHODS Myocardial motion was quantified in ten normal volunteers by tracking the Lagrangian motion of individual points (i.e. virtual markers), based on time-resolved 3D phase-contrast MRI data and Fourier tracking. Nine points in the myocardium were tracked over the entire cardiac cycle, allowing a wire frame model to be generated and systolic and diastolic events identified. RESULTS Radius of curvature of the left ventricular (LV) wall was calculated from the virtual markers; the ratio between the anterior-posterior (AP) and septal-lateral (SL) walls in the LV shows an oval shape of the apical short axis plane at end systole (ES) and more circular at end diastole (ED). The AP/SL ratio for the basal plane shows an oval shape at ES and ED. We found that the rotation of the basal plane in ES was less compared to the apical plane [-2.0 +/- 2.2 versus 4.1 +/- 2.6 degrees (P<0.005)]. The apical plane rotated counter clock wise as viewed from the apex. CONCLUSION This new non-invasive tool, despite current limitations in temporal and spatial resolution, may provide a comprehensive set of virtual myocardial markers throughout the entire LV without the confounding effects introduced by surgical implantation.
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Dorn GW. Apoptotic and non-apoptotic programmed cardiomyocyte death in ventricular remodelling. Cardiovasc Res 2009; 81:465-73. [PMID: 18779231 PMCID: PMC2721651 DOI: 10.1093/cvr/cvn243] [Citation(s) in RCA: 219] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 08/26/2008] [Accepted: 08/28/2008] [Indexed: 12/25/2022] Open
Abstract
A defining cellular event in the transition from compensated hypertrophy to dilated cardiomyopathy is cardiomyocyte drop-out due to apoptosis, programmed necrosis, and autophagy. The importance of apoptosis in heart failure has been recognized for over a decade, while other forms of programmed cell death have more recently been appreciated, and their pathophysiological roles continue to be defined in experimental and clinical heart failure. The major focus of this review is on apoptosis in heart failure, with a discussion of molecular cross-talk between apoptosis, autophagy, and programmed necrosis.
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Affiliation(s)
- Gerald W Dorn
- Center for Pharmacogenomics and Cardiovascular Division, Department of Internal Medicine, Washington University, 660 S. Euclid Ave., Campus Box 8086, St Louis, MO 63110, USA.
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18
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Ennis DB, Nguyen TC, Itoh A, Bothe W, Liang DH, Ingels NB, Miller DC. Reduced systolic torsion in chronic "pure" mitral regurgitation. Circ Cardiovasc Imaging 2009; 2:85-92. [PMID: 19808573 DOI: 10.1161/circimaging.108.785923] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Global left ventricular (LV) torsion declines with chronic ischemic mitral regurgitation (MR), which may accelerate the LV remodeling spiral toward global cardiomyopathy; however, it has not been definitively established whether this torsional decline is attributable to the infarct, the MR, or their combined effect. We tested the hypothesis that chronic "pure" MR alone reduces global LV torsion. METHODS AND RESULTS Chronic "pure" MR was created in 13 sheep by surgically punching a 3.5- to 4.8-mm hole (HOLE) in the mitral valve posterior leaflet. Nine control (CNTL) sheep were operated on concurrently. At 1 (WK-01) and 12 weeks (WK-12) postoperatively, the 4D motion of implanted radiopaque markers was used to calculate global LV torsion. MR-grade in HOLE was greater than CNTL at WK-01 and WK-12 (2.5+/-1.1 versus 0.6+/-0.5, P<0.001 at WK-12). HOLE LV mass index was larger at WK-12 compared with CNTL (195+/-14 versus 170+/-17 g/m(2), P<0.01), indicating LV remodeling. Global LV systolic torsion decreased in HOLE from WK-01 to WK-12 (4.1+/-2.8 degrees versus 1.7+/-1.7 degrees , P<0.01), but did not change in CNTL (5.5+/-1.8 degrees versus 4.2+/-2.7 degrees , P=NS). Global LV torsion was lower in HOLE relative to CNTL at WK-12 (P<0.05) but not at WK-01 (P=NS). CONCLUSIONS Twelve weeks of chronic "pure" MR resulting in mild global LV remodeling is associated with significantly increased LV mass index and reduced global LV systolic torsion, but no other significant changes in hemodynamics. MR alone is a major component of torsional deterioration in "pure" MR and may be an important factor in chronic ischemic mitral regurgitation.
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Affiliation(s)
- Daniel B Ennis
- Department of Cardiothoracic Surgery and the Division of Cardiovascular Medicine, Stanford University, Stanford, California 94305-5488, USA.
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Ryan LP, Matsuzaki K, Noma M, Jackson BM, Eperjesi TJ, Plappert TJ, St John-Sutton MG, Gorman JH, Gorman RC. Dermal filler injection: a novel approach for limiting infarct expansion. Ann Thorac Surg 2009; 87:148-55. [PMID: 19101288 DOI: 10.1016/j.athoracsur.2008.09.028] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Revised: 09/08/2008] [Accepted: 09/10/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND Early infarct expansion after coronary occlusion compromises contractile function in perfused myocardial regions and promotes adverse long-term left ventricular (LV) remodeling. We hypothesized that injection of a tissue-expanding dermal filler material into a myocardial infarction (MI) would attenuate infarct expansion and limit LV remodeling. METHODS Fifteen sheep were subjected to an anteroapical MI involving approximately 20% of the LV followed by the injection of 1.3 mL of a calcium hydroxyapatite-based dermal filler into the infarct. Real-time three-dimensional echocardiography was performed at baseline, 30 minutes after MI, and 15 minutes after injection to assess infarct expansion. Sixteen additional sheep were subjected to the same infarction and followed echocardiographically and hemodynamically for 4 weeks after MI to assess chronic remodeling. Eight animals had injection with dermal filler as described above immediately after MI, and 8 animals were injected with an equal amount of saline solution. RESULTS All animals exhibited infarct expansion soon after coronary occlusion. The regional ejection fraction of the apex became negative after infarction, consistent with systolic dyskinesia. Injection of the dermal filler converted the apical wall motion from dyskinetic to akinetic and resulted immediately in significant decreases in global, regional, and segmental LV volumes. Chronically, relative to saline control, dermal filler injection significantly reduced LV end-systolic volume (62.2 +/- 3.6 mL versus 44.5 +/- 3.9 mL; p < 0.05) and improved global ejection fraction (0.295 +/- 0.016 versus 0.373 +/- 0.017; p < 0.05) at 4 weeks after infarction. CONCLUSIONS Injection of an acellular dermal filler into an MI immediately after coronary occlusion reduces early infarct expansion and limits chronic LV remodeling.
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Affiliation(s)
- Liam P Ryan
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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20
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Carlhäll CJ, Nguyen TC, Itoh A, Ennis DB, Bothe W, Liang D, Ingels NB, Miller DC. Alterations in transmural myocardial strain: an early marker of left ventricular dysfunction in mitral regurgitation? Circulation 2008; 118:S256-62. [PMID: 18824764 DOI: 10.1161/circulationaha.107.753525] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In asymptomatic patients with severe isolated mitral regurgitation (MR), identifying the onset of early left ventricular (LV) dysfunction can guide the timing of surgical intervention. We hypothesized that changes in LV transmural myocardial strain represent an early marker of LV dysfunction in an ovine chronic MR model. METHODS AND RESULTS Sheep were randomized to control (CTRL, n=8) or experimental (EXP, n=12) groups. In EXP, a 3.5- or 4.8-mm hole was created in the posterior mitral leaflet to generate "pure" MR. Transmural beadsets were inserted into the lateral and anterior LV wall to radiographically measure 3-dimensional transmural strains during systole and diastolic filling, at 1 and 12 weeks postoperatively. MR grade was higher in EXP than CTRL at 1 and 12 weeks (3.0 [2-4] versus 0.5 [0-2]; 3.0 [1-4] versus 0.5 [0-1], respectively, both P<0.001). At 12 weeks, LV mass index was greater in EXP than CTRL (201+/-18 versus 173+/-17 g/m(2); P<0.01). LVEDVI increased in EXP from 1 to 12 weeks (P=0.015). Between the 1 and 12 week values, the change in BNP (-4.5+/-4.4 versus -3.0+/-3.6 pmol/L), PRSW (9+/-13 versus 23+/-18 mm Hg), tau (-3+/-11 versus -4+/-7 ms), and systolic strains was similar between EXP and CTRL. The changes in longitudinal diastolic filling strains between 1 and 12 weeks, however, were greater in EXP versus CTRL in the subendocardium (lateral: -0.08+/-0.05 versus 0.02+/-0.14; anterior: -0.10+/-0.05 versus -0.02+/-0.07, both P<0.01). CONCLUSIONS Twelve weeks of ovine "pure" MR caused LV remodeling with early changes in LV function detected by alterations in transmural myocardial strain, but not by changes in BNP, PRSW, or tau.
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Affiliation(s)
- Carl J Carlhäll
- Department of Cardiothoracic Surgery, Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, CA 94305-5247, USA
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21
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Freedberg NA. Passive ventricular restraint device with defibrillation capabilities: is there a panacea for heart failure on the horizon? J Cardiovasc Electrophysiol 2008; 19:858-60. [PMID: 18479323 DOI: 10.1111/j.1540-8167.2008.01198.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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Diwan A, Krenz M, Syed FM, Wansapura J, Ren X, Koesters AG, Li H, Kirshenbaum LA, Hahn HS, Robbins J, Jones WK, Dorn GW. Inhibition of ischemic cardiomyocyte apoptosis through targeted ablation of Bnip3 restrains postinfarction remodeling in mice. J Clin Invest 2007; 117:2825-33. [PMID: 17909626 PMCID: PMC1994631 DOI: 10.1172/jci32490] [Citation(s) in RCA: 236] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Accepted: 07/25/2007] [Indexed: 01/14/2023] Open
Abstract
Following myocardial infarction, nonischemic myocyte death results in infarct expansion, myocardial loss, and ventricular dysfunction. Here, we demonstrate that a specific proapoptotic gene, Bnip3, minimizes ventricular remodeling in the mouse, despite having no effect on early or late infarct size. We evaluated the effects of ablating Bnip3 on cardiomyocyte death, infarct size, and ventricular remodeling after surgical ischemia/reperfusion (IR) injury in mice. Immediately following IR, no significant differences were observed between Bnip3(-/-) and WT mice. However, at 2 days after IR, apoptosis was diminished in Bnip3(-/-) periinfarct and remote myocardium, and at 3 weeks after IR, Bnip3(-/-) mice exhibited preserved LV systolic performance, diminished LV dilation, and decreased ventricular sphericalization. These results suggest myocardial salvage by inhibition of apoptosis. Forced cardiac expression of Bnip3 increased cardiomyocyte apoptosis in unstressed mice, causing progressive LV dilation and diminished systolic function. Conditional Bnip3 overexpression prior to coronary ligation increased apoptosis and infarct size. These studies identify postischemic apoptosis by myocardial Bnip3 as a major determinant of ventricular remodeling in the infarcted heart, suggesting that Bnip3 may be an attractive therapeutic target.
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Affiliation(s)
- Abhinav Diwan
- Center for Molecular Cardiovascular Research and
Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.
Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Pharmacology, University of Cincinnati, Cincinnati, Ohio, USA.
Institute of Cardiovascular Sciences, St. Boniface General Hospital Research Centre, Winnipeg, Manitoba, Canada.
Charles F. Kettering Memorial Hospital, Dayton, Ohio, USA
| | - Maike Krenz
- Center for Molecular Cardiovascular Research and
Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.
Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Pharmacology, University of Cincinnati, Cincinnati, Ohio, USA.
Institute of Cardiovascular Sciences, St. Boniface General Hospital Research Centre, Winnipeg, Manitoba, Canada.
Charles F. Kettering Memorial Hospital, Dayton, Ohio, USA
| | - Faisal M. Syed
- Center for Molecular Cardiovascular Research and
Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.
Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Pharmacology, University of Cincinnati, Cincinnati, Ohio, USA.
Institute of Cardiovascular Sciences, St. Boniface General Hospital Research Centre, Winnipeg, Manitoba, Canada.
Charles F. Kettering Memorial Hospital, Dayton, Ohio, USA
| | - Janaka Wansapura
- Center for Molecular Cardiovascular Research and
Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.
Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Pharmacology, University of Cincinnati, Cincinnati, Ohio, USA.
Institute of Cardiovascular Sciences, St. Boniface General Hospital Research Centre, Winnipeg, Manitoba, Canada.
Charles F. Kettering Memorial Hospital, Dayton, Ohio, USA
| | - Xiaoping Ren
- Center for Molecular Cardiovascular Research and
Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.
Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Pharmacology, University of Cincinnati, Cincinnati, Ohio, USA.
Institute of Cardiovascular Sciences, St. Boniface General Hospital Research Centre, Winnipeg, Manitoba, Canada.
Charles F. Kettering Memorial Hospital, Dayton, Ohio, USA
| | - Andrew G. Koesters
- Center for Molecular Cardiovascular Research and
Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.
Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Pharmacology, University of Cincinnati, Cincinnati, Ohio, USA.
Institute of Cardiovascular Sciences, St. Boniface General Hospital Research Centre, Winnipeg, Manitoba, Canada.
Charles F. Kettering Memorial Hospital, Dayton, Ohio, USA
| | - Hairong Li
- Center for Molecular Cardiovascular Research and
Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.
Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Pharmacology, University of Cincinnati, Cincinnati, Ohio, USA.
Institute of Cardiovascular Sciences, St. Boniface General Hospital Research Centre, Winnipeg, Manitoba, Canada.
Charles F. Kettering Memorial Hospital, Dayton, Ohio, USA
| | - Lorrie A. Kirshenbaum
- Center for Molecular Cardiovascular Research and
Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.
Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Pharmacology, University of Cincinnati, Cincinnati, Ohio, USA.
Institute of Cardiovascular Sciences, St. Boniface General Hospital Research Centre, Winnipeg, Manitoba, Canada.
Charles F. Kettering Memorial Hospital, Dayton, Ohio, USA
| | - Harvey S. Hahn
- Center for Molecular Cardiovascular Research and
Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.
Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Pharmacology, University of Cincinnati, Cincinnati, Ohio, USA.
Institute of Cardiovascular Sciences, St. Boniface General Hospital Research Centre, Winnipeg, Manitoba, Canada.
Charles F. Kettering Memorial Hospital, Dayton, Ohio, USA
| | - Jeffrey Robbins
- Center for Molecular Cardiovascular Research and
Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.
Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Pharmacology, University of Cincinnati, Cincinnati, Ohio, USA.
Institute of Cardiovascular Sciences, St. Boniface General Hospital Research Centre, Winnipeg, Manitoba, Canada.
Charles F. Kettering Memorial Hospital, Dayton, Ohio, USA
| | - W. Keith Jones
- Center for Molecular Cardiovascular Research and
Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.
Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Pharmacology, University of Cincinnati, Cincinnati, Ohio, USA.
Institute of Cardiovascular Sciences, St. Boniface General Hospital Research Centre, Winnipeg, Manitoba, Canada.
Charles F. Kettering Memorial Hospital, Dayton, Ohio, USA
| | - Gerald W. Dorn
- Center for Molecular Cardiovascular Research and
Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.
Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Pharmacology, University of Cincinnati, Cincinnati, Ohio, USA.
Institute of Cardiovascular Sciences, St. Boniface General Hospital Research Centre, Winnipeg, Manitoba, Canada.
Charles F. Kettering Memorial Hospital, Dayton, Ohio, USA
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Spinale FG. Myocardial Matrix Remodeling and the Matrix Metalloproteinases: Influence on Cardiac Form and Function. Physiol Rev 2007; 87:1285-342. [DOI: 10.1152/physrev.00012.2007] [Citation(s) in RCA: 855] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
It is now becoming apparent that dynamic changes occur within the interstitium that directly contribute to adverse myocardial remodeling following myocardial infarction (MI), with hypertensive heart disease and with intrinsic myocardial disease such as cardiomyopathy. Furthermore, a family of matrix proteases, the matrix metalloproteinases (MMPs) and the tissue inhibitors of MMPs (TIMPs), has been recognized to play an important role in matrix remodeling in these cardiac disease states. The purpose of this review is fivefold: 1) to examine and redefine the myocardial matrix as a critical and dynamic entity with respect to the remodeling process encountered with MI, hypertension, or cardiomyopathic disease; 2) present the remarkable progress that has been made with respect to MMP/TIMP biology and how it relates to myocardial matrix remodeling; 3) to evaluate critical translational/clinical studies that have provided a cause-effect relationship between alterations in MMP/TIMP regulation and myocardial matrix remodeling; 4) to provide a critical review and analysis of current diagnostic, prognostic, and pharmacological approaches that utilized our basic understanding of MMP/TIMPs in the context of cardiac disease; and 5) most importantly, to dispel the historical belief that the myocardial matrix is a passive structure and supplant this belief that the regulation of matrix protease pathways such as the MMPs and TIMPs will likely yield a new avenue of diagnostic and therapeutic strategies for myocardial remodeling and the progression to heart failure.
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French BA, Kramer CM. Mechanisms of Post-Infarct Left Ventricular Remodeling. ACTA ACUST UNITED AC 2007; 4:185-196. [PMID: 18690295 DOI: 10.1016/j.ddmec.2007.12.006] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Heart failure secondary to myocardial infarction (MI) remains a major source of morbidity and mortality. Long-term outcome after MI can be largely be defined in terms of its impact on the size and shape of the left ventricle (i.e., LV remodeling). Three major mechanisms contribute to LV remodeling: 1) early infarct expansion, 2) subsequent infarct extension into adjacent noninfarcted myocardium, and 3) late hypertrophy in the remote LV. Future developments in preventing post-MI heart failure will depend not only on identifying drugs targeting each of these individual mechanisms, but also on diagnostic techniques capable of assessing efficacy against each mechanism.
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Affiliation(s)
- Brent A French
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA 22908
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Abstract
Heart failure is a progressive condition which begins after an inciting event that leads to neurohormonal activation and cardiac remodeling. Medical therapy with beta-blockers and angiotensin-converting enzyme inhibitors has been shown to attenuate neurohormonal changes and left ventricular remodeling. Despite optimal medical therapy, patients often progress, and other therapeutic modalities have been sought to interrupt and reverse the process of remodeling. Various devices have been developed and entered into clinical trials with the intent of promoting reverse remodeling by directly altering the mechanical properties or shape of the left ventricle. This article reviews devices currently undergoing clinical trials.
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Ghanta RK, Rangaraj A, Umakanthan R, Lee L, Laurence RG, Fox JA, Bolman RM, Cohn LH, Chen FY. Adjustable, Physiological Ventricular Restraint Improves Left Ventricular Mechanics and Reduces Dilatation in an Ovine Model of Chronic Heart Failure. Circulation 2007; 115:1201-10. [PMID: 17339543 DOI: 10.1161/circulationaha.106.671370] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ventricular restraint is a nontransplantation surgical treatment for heart failure. The effect of varying restraint level on left ventricular (LV) mechanics and remodeling is not known. We hypothesized that restraint level may affect therapy efficacy. METHODS AND RESULTS We studied the immediate effect of varying restraint levels in an ovine heart failure model. We then studied the long-term effect of restraint applied over a 2-month period. Restraint level was quantified by use of fluid-filled epicardial balloons placed around the ventricles and measurement of balloon luminal pressure at end diastole. At 4 different restraint levels (0, 3, 5, and 8 mm Hg), transmural myocardial pressure (P(tm)) and indices of myocardial oxygen consumption (MVO2) were determined in control (n=5) and ovine heart failure (n=5). Ventricular restraint therapy decreased P(tm) and MVO2, and improved mechanical efficiency. An optimal physiological restraint level of 3 mm Hg was identified to maximize improvement without an adverse affect on systemic hemodynamics. At this optimal level, end-diastolic P(tm) and MVO2 indices decreased by 27% and 20%, respectively. The serial longitudinal effects of optimized ventricular restraint were then evaluated in ovine heart failure with (n=3) and without (n=3) restraint over 2 months. Optimized ventricular restraint prevented and reversed pathological LV dilatation (130+/-22 mL to 91+/-18 mL) and improved LV ejection fraction (27+/-3% to 43+/-5%). Measured restraint level decreased over time as the LV became smaller, and reverse remodeling slowed. CONCLUSIONS Ventricular restraint level affects the degree of decrease in P(tm), the degree of decrease in MVO2, and the rate of LV reverse remodeling. Periodic physiological adjustments of restraint level may be required for optimal restraint therapy efficacy.
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Affiliation(s)
- Ravi K Ghanta
- Division of Cardiac Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA
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