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Bouwmeester S, van Loon T, Ploeg M, Mast TP, Verzaal NJ, van Middendorp LB, Strik M, van Nieuwenhoven FA, Dekker LR, Prinzen FW, Lumens J, Houthuizen P. Left atrial remodeling in mitral regurgitation: A combined experimental-computational study. PLoS One 2022; 17:e0271588. [PMID: 35839240 PMCID: PMC9286246 DOI: 10.1371/journal.pone.0271588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 07/05/2022] [Indexed: 11/18/2022] Open
Abstract
Aims
Progressive changes to left atrial (LA) structure and function following mitral regurgitation (MR) remain incompletely understood. This study aimed to demonstrate potential underlying mechanisms using experimental canine models and computer simulations.
Methods
A canine model of MR was created by cauterization of mitral chordae followed by radiofrequency ablation-induced left bundle-branch block (LBBB) after 4 weeks (MR-LBBB group). Animals with LBBB alone served as control. Echocardiography was performed at baseline, acutely after MR induction, and at 4 and 20 weeks, and correlated with histology and computer simulations.
Results
Acute MR augmented LA reservoir and contractile strain (40±4 to 53±6% and -11±5 to -22±9% respectively, p<0.05). LA fractional area change increased significantly (47±4 to 56±4%, p<0.05) while LA end-systolic area remained unchanged (7.2±1.1 versus 7.9±1.1 cm2 respectively, p = 0.08). LA strain ‘pseudonormalized’ after 4 weeks and decompensated at 20 weeks with both strains decreasing to 25±6% and -3±2% respectively (p<0.05) together with a progressive increase in LA end-systolic area (7.2±1.1 to 14.0±6.3 cm2, p<0.05). In the LBBB-group, LA remodeling was less pronounced. Histology showed a trend towards increased interstitial fibrosis in the LA of the MR-LBBB group. Computer simulations indicated that the progressive changes in LA structure and function are a combination of progressive eccentric remodeling and fibrosis.
Conclusion
MR augmented LA strain acutely to supranormal values without significant LA dilation. However, over time, LA strain gradually decreases (pseudornormal and decompensated) with LA dilation. Histology and computer simulations indicated a correlation to a varying degree of LA eccentric remodeling and fibrosis.
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Affiliation(s)
- Sjoerd Bouwmeester
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
- * E-mail:
| | - Tim van Loon
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Meike Ploeg
- Department of Physiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Thomas P. Mast
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Nienke J. Verzaal
- Department of Physiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Lars B. van Middendorp
- Department of Physiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Marc Strik
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France
| | - Frans A. van Nieuwenhoven
- Department of Physiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Lukas R. Dekker
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
- Department of Biomedical Technology, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Frits W. Prinzen
- Department of Physiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Joost Lumens
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Patrick Houthuizen
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
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Verzaal NJ, van Deursen CJM, Pezzuto S, Wecke L, van Everdingen WM, Vernooy K, Delhaas T, Auricchio A, Prinzen FW. Synchronization of repolarization after cardiac resynchronization therapy: a combined clinical and modeling study. J Cardiovasc Electrophysiol 2022; 33:1837-1846. [PMID: 35662306 PMCID: PMC9539692 DOI: 10.1111/jce.15581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022]
Abstract
Introduction The changes in ventricular repolarization after cardiac resynchronization therapy (CRT) are poorly understood. This knowledge gap is addressed using a multimodality approach including electrocardiographic and echocardiographic measurements in patients and using patient‐specific computational modeling. Methods In 33 patients electrocardiographic and echocardiographic measurements were performed before and at various intervals after CRT, both during CRT‐ON and temporary CRT‐OFF. T‐wave area was calculated from vectorcardiograms, and reconstructed from the 12‐lead electrocardiography (ECG). Computer simulations were performed using a patient‐specific eikonal model of cardiac activation with spatially varying action potential duration (APD) and repolarization rate, fit to a patient's ECG. Results During CRT‐ON T‐wave area diminished within a day and remained stable thereafter, whereas QT‐interval did not change significantly. During CRT‐OFF T‐wave area doubled within 5 days of CRT, while QT‐interval and peak‐to‐end T‐wave interval hardly changed. Left ventricular (LV) ejection fraction only increased significantly increased after 1 month of CRT. Computer simulations indicated that the increase in T‐wave area during CRT‐OFF can be explained by changes in APD following chronic CRT that are opposite to the change in CRT‐induced activation time. These APD changes were associated with a reduction in LV dispersion in repolarization during chronic CRT. Conclusion T‐wave area during CRT‐OFF is a sensitive marker for adaptations in ventricular repolarization during chronic CRT that may include a reduction in LV dispersion of repolarization.
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Affiliation(s)
- Nienke J Verzaal
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - Caroline J M van Deursen
- Department of Cardiology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Simone Pezzuto
- Center for Computational Medicine in Cardiology, Euler Institute, Università della Svizzera Italiana, via via Buffi 13, 6900, Lugano, Switzerland
| | - Liliane Wecke
- Heart Clinic, Capio St. Göran's Hospital, Sankt Göransplan 1, 11281, Stockholm, Sweden
| | | | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - Angelo Auricchio
- Center for Computational Medicine in Cardiology, Euler Institute, Università della Svizzera Italiana, via via Buffi 13, 6900, Lugano, Switzerland.,Department of Cardiology, Istituto Cardiocentro Ticino, Lugano, Switzerland
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
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Centa M, Jin H, Hofste L, Hellberg S, Busch A, Baumgartner R, Verzaal NJ, Lind Enoksson S, Perisic Matic L, Boddul SV, Atzler D, Li DY, Sun C, Hansson GK, Ketelhuth DFJ, Hedin U, Wermeling F, Lutgens E, Binder CJ, Maegdesfessel L, Malin SG. Germinal Center-Derived Antibodies Promote Atherosclerosis Plaque Size and Stability. Circulation 2020; 139:2466-2482. [PMID: 30894016 DOI: 10.1161/circulationaha.118.038534] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Atherosclerosis progression is modulated by interactions with the adaptive immune system. Humoral immunity can help protect against atherosclerosis formation; however, the existence, origin, and function of putative atherogenic antibodies are controversial. How such atherosclerosis-promoting antibodies could affect the specific composition and stability of plaques, as well as the vasculature generally, remains unknown. METHODS We addressed the overall contribution of antibodies to atherosclerosis plaque formation, composition, and stability in vivo (1) with mice that displayed a general loss of antibodies, (2) with mice that had selectively ablated germinal center-derived IgG production, or (3) through interruption of T-B-cell interactions and further studied the effects of antibody deficiency on the aorta by transcriptomics. RESULTS Here, we demonstrate that atherosclerosis-prone mice with attenuated plasma cell function manifest reduced plaque burden, indicating that antibodies promote atherosclerotic lesion size. However, the composition of the plaque was altered in antibody-deficient mice, with an increase in lipid content and decreases in smooth muscle cells and macrophages, resulting in an experimentally validated vulnerable plaque phenotype. Furthermore, IgG antibodies enhanced smooth muscle cell proliferation in vitro in an Fc receptor-dependent manner, and antibody-deficient mice had decreased neointimal hyperplasia formation in vivo. These IgG antibodies were shown to be derived from germinal centers, and mice genetically deficient for germinal center formation had strongly reduced atherosclerosis plaque formation. mRNA sequencing of aortas revealed that antibodies are required for the sufficient expression of multiple signal-induced and growth-promoting transcription factors and that aortas undergo large-scale metabolic reprograming in their absence. Using an elastase model, we demonstrated that absence of IgG results in an increased severity of aneurysm formation. CONCLUSIONS We propose that germinal center-derived IgG antibodies promote the size and stability of atherosclerosis plaques, through promoting arterial smooth muscle cell proliferation and maintaining the molecular identity of the aorta. These results could have implications for therapies that target B cells or B-T-cell interactions because the loss of humoral immunity leads to a smaller but less stable plaque phenotype.
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Affiliation(s)
- Monica Centa
- Departments of Medicine and Center for Molecular Medicine (M.C., H.J., L.H., S.H., A.B., R.B., N.J.V., S.L.E., S.V.B, D.Y.L., C.S., G.K.H., D.F.J.K., F.W., L.M., S.G.M.), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Hong Jin
- Departments of Medicine and Center for Molecular Medicine (M.C., H.J., L.H., S.H., A.B., R.B., N.J.V., S.L.E., S.V.B, D.Y.L., C.S., G.K.H., D.F.J.K., F.W., L.M., S.G.M.), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Lisa Hofste
- Departments of Medicine and Center for Molecular Medicine (M.C., H.J., L.H., S.H., A.B., R.B., N.J.V., S.L.E., S.V.B, D.Y.L., C.S., G.K.H., D.F.J.K., F.W., L.M., S.G.M.), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Sanna Hellberg
- Departments of Medicine and Center for Molecular Medicine (M.C., H.J., L.H., S.H., A.B., R.B., N.J.V., S.L.E., S.V.B, D.Y.L., C.S., G.K.H., D.F.J.K., F.W., L.M., S.G.M.), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Albert Busch
- Departments of Medicine and Center for Molecular Medicine (M.C., H.J., L.H., S.H., A.B., R.B., N.J.V., S.L.E., S.V.B, D.Y.L., C.S., G.K.H., D.F.J.K., F.W., L.M., S.G.M.), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Roland Baumgartner
- Departments of Medicine and Center for Molecular Medicine (M.C., H.J., L.H., S.H., A.B., R.B., N.J.V., S.L.E., S.V.B, D.Y.L., C.S., G.K.H., D.F.J.K., F.W., L.M., S.G.M.), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Nienke J Verzaal
- Departments of Medicine and Center for Molecular Medicine (M.C., H.J., L.H., S.H., A.B., R.B., N.J.V., S.L.E., S.V.B, D.Y.L., C.S., G.K.H., D.F.J.K., F.W., L.M., S.G.M.), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Sara Lind Enoksson
- Departments of Medicine and Center for Molecular Medicine (M.C., H.J., L.H., S.H., A.B., R.B., N.J.V., S.L.E., S.V.B, D.Y.L., C.S., G.K.H., D.F.J.K., F.W., L.M., S.G.M.), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Ljubica Perisic Matic
- Molecular Medicine and Surgery (L.P.M., U.H.), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.,Center for Molecular Medicine (L.P.M., U.H.), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Sanjay V Boddul
- Departments of Medicine and Center for Molecular Medicine (M.C., H.J., L.H., S.H., A.B., R.B., N.J.V., S.L.E., S.V.B, D.Y.L., C.S., G.K.H., D.F.J.K., F.W., L.M., S.G.M.), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Dorothee Atzler
- Walther Straub Institute of Pharmacology and Toxicology, Medical Faculty, Ludwig-Maximilians-Universtät Munich (D.A.).,Institute for Cardiovascular Prevention, University Hospital Munich, Ludwig Maximilians University (D.A., E.L.)
| | - Daniel Y Li
- Departments of Medicine and Center for Molecular Medicine (M.C., H.J., L.H., S.H., A.B., R.B., N.J.V., S.L.E., S.V.B, D.Y.L., C.S., G.K.H., D.F.J.K., F.W., L.M., S.G.M.), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Changyan Sun
- Departments of Medicine and Center for Molecular Medicine (M.C., H.J., L.H., S.H., A.B., R.B., N.J.V., S.L.E., S.V.B, D.Y.L., C.S., G.K.H., D.F.J.K., F.W., L.M., S.G.M.), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Göran K Hansson
- Departments of Medicine and Center for Molecular Medicine (M.C., H.J., L.H., S.H., A.B., R.B., N.J.V., S.L.E., S.V.B, D.Y.L., C.S., G.K.H., D.F.J.K., F.W., L.M., S.G.M.), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Daniel F J Ketelhuth
- Departments of Medicine and Center for Molecular Medicine (M.C., H.J., L.H., S.H., A.B., R.B., N.J.V., S.L.E., S.V.B, D.Y.L., C.S., G.K.H., D.F.J.K., F.W., L.M., S.G.M.), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Ulf Hedin
- Molecular Medicine and Surgery (L.P.M., U.H.), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.,Center for Molecular Medicine (L.P.M., U.H.), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Wermeling
- Departments of Medicine and Center for Molecular Medicine (M.C., H.J., L.H., S.H., A.B., R.B., N.J.V., S.L.E., S.V.B, D.Y.L., C.S., G.K.H., D.F.J.K., F.W., L.M., S.G.M.), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Esther Lutgens
- Institute for Cardiovascular Prevention, University Hospital Munich, Ludwig Maximilians University (D.A., E.L.).,Department of Medical Biochemistry, Amsterdam University Medical Centers, Amsterdam Cardiovascular Sciences, University of Amsterdam, The Netherlands (E.L.)
| | - Christoph J Binder
- Department of Laboratory Medicine, Medical University of Vienna (C.J.B.).,Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria (C.J.B.)
| | - Lars Maegdesfessel
- Departments of Medicine and Center for Molecular Medicine (M.C., H.J., L.H., S.H., A.B., R.B., N.J.V., S.L.E., S.V.B, D.Y.L., C.S., G.K.H., D.F.J.K., F.W., L.M., S.G.M.), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.,Technical University Munich, Department of Vascular and Endovascular Surgery and DZHK Partner Site, Germany (L.M.)
| | - Stephen G Malin
- Departments of Medicine and Center for Molecular Medicine (M.C., H.J., L.H., S.H., A.B., R.B., N.J.V., S.L.E., S.V.B, D.Y.L., C.S., G.K.H., D.F.J.K., F.W., L.M., S.G.M.), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
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