酸中毒后室性心律失常仿真研究

本文旨在分析酸中毒对心脏电生理活动的影响,探讨其诱发室性心律失常的机制.首先建立了具有pH和钙/钙调素依赖蛋白激酶Ⅱ(calcium/calmodulin dependent protein kinaseⅡ,Ca MKⅡ)调控作用的人体心室酸中毒计算模型,然后模拟了酸中毒过程中细胞和组织电活动的变化,并定量分析了心电图的改变情况.实验结果表明:在酸中毒期间,细胞动作电位时程的缩短和复极离散度的降低导致心电图QT间期缩短、T波幅值和宽度减小.同时,细胞静息电位的抬高和最大去极化速率的降低也促进了组织电兴奋的缓慢传导和传导阻滞.另外,酸中毒后的初期,肌浆网钙超载促进钙释放增多,导致细胞产生延迟后除极(delayed afterdepolarization,DADs),使心电图上表现为室性早搏.而缓慢传导、传导阻滞和室性早搏有利于折返波的产生,进而发展为室速.因此,酸中毒后细胞的触发活动是诱发室性心律失常的主要原因之一.     

DNA甲基化与原发性高血压的研究进展

原发性高血压(简称高血压病)是遗传和环境因素相互作用所导致的一种复杂性疾病.近年来的研究发现,高血压病的发生和发展与DNA甲基化密切相关.11β-HSD-2、ECE-1和AT1b等基因发生甲基化和去甲基化会影响代谢酶和受体的表达,从而通过肾素-血管紧张素-醛固酮系统激活以及肾性水钠潴留等途径引起高血压的发生,这可能是高血压发病的一个重要分子机制.基因组低甲基化(如:高同型半胱氨酸所引起的)会诱发AT1b、ECE-1等受体和代谢酶基因发生去甲基化,从而参与高血压病的发生.深入了解DNA甲基化调控在原发性高血压发病过程中的分子机制及药物代谢酶和受体基因甲基化状态的改变对高血压患者降压疗效的影响,将为临床制定合理化的用药方案提供依据.     

晚钠电流在获得性心血管病合并心律失常发生中的作用及其意义

心肌细胞的晚钠电流出现于动作电位的复极期,正常心肌细胞存在内源性晚钠电流,幅度小;晚钠电流幅度增大可见于长QT综合征3、4、9、10和12型,也见于多种病理及药物作用下,导致动作电位时程延长,诱发恶性室性心律失常,如尖端扭转型室性心动过速等;同时由于平台期延长,钙离子内流时间延长,改变心肌收缩力并参与钙相关心律失常的发生。近年来,随着对心血管疾病及其合并心律失常发病机制的深入认识,发现越来越多的获得性心血管疾病患者心律失常的发生与晚钠电流异常增大相关,极大地扩大了晚钠电流相关心律失常的范畴,选择性晚钠电流抑制剂已成为抗心律失常药物新的亚类。     

电刺激杏仁复合体诱发心律失常及其下行神经通路的初步探讨

电刺激杏仁复合体能诱发心律失常。心律失常的类型为心动过缓伴室性或结性期外收缩。刺激杏仁复合体不同亚核均能诱发心律失常,不同类型的心律失常在核内具有相应的代表点。心律失常发作与杏仁局部区域诱发的爆发性后放电有关。推测杏仁复合体内神经元过度激活可能通过杏仁-迷走神经运动背核及杏仁-下丘脑外侧区等通路下行,使心率减慢、房室传导阻滞而导致心律失常。     

Ferroptosis与糖尿病性心肌病

糖尿病性心肌病(diabetic cardiomyopathy,DCM)是一种由长期糖尿病引起的心肌病，其发病不伴随高血压、冠心病等其他心脏危险因素，是糖尿病的一种常见临床并发症，由代谢紊乱引起，可产生心律失常和心力衰竭，严重时可导致死亡，并伴有微血管病变的广泛局灶性心肌细胞死亡。Ferroptosis是一种细胞程序性死亡方式，主要由氧化应激、铁代谢和脂质代谢异常等因素诱发。在DCM发病过程中，存在心肌细胞糖脂代谢异常，并伴随着氧化应激导致心肌细胞Ferroptosis。本文针对近些年来DCM Ferroptosis相关的研究，综述了Ferroptosis和DCM之间的关系以及可能的机制，为探究DCM发生机制和干预治疗提供一定的理论依据。     

氧化应激与糖尿病心血管并发症

心血管并发症如冠状动脉粥样硬化、心肌梗死和中风等是糖尿病患者致残和致死的主要原因之一。动物模型和临床研究均显示氧化应激加速了糖尿病心血管并发症的发生发展过程。活性氧可以通过多种机制产生,糖尿病患者的糖代谢和脂代谢紊乱能诱发活性氧的生成增多,引起氧化应激,最终导致糖尿病心血管并发症的发生。     

在体心脏后去极化及触发性心律失常的细胞电生理学研究

应用漂浮微电极记录跨膜动作电位(TAP)和接触电极记录单相动作电位(MAP)两项技术,研究了 CsCl 诱发的猫在体心脏的触发性活动。结果表明,静脉注射 CsCl(0.5mmol/kg)后10s,左心室外膜 TAP 和 MAP 的3相中晚期出现早期后去极化(EAD),在30s 时,TAP上 EAD 的振幅为25.6±9.3mV,MAP 上的 EAD 振幅为3.4±1.3mV。EAD 表现为拖尾、平台、凸起三种不同形态。在两例猫中出现延迟性后去极化 DAD,其在 TAP 和 MAP上的振幅分别为13.0±5.3mV 和3.3±0.omV。MAP 上后去极化的形态与 TAP 极为相似。CsCl 的重复注射可诱发室性早搏、室性心动过速等多种心律失常,根据后去极化的发生与否以及后去极化和室性心搏的耦联间期的关系,可将心律失常分为两种类型:一种是由记录部位的后去极化引起的触发性心律失常;另一类可能由非记录部位的后去极化或其它机制引起。     

信号蛋白中甲硫氨酸残基的可逆性氧化和甲硫氨酸亚砜还原酶

含硫氨基酸甲硫氨酸在体内易被胞内、外活性氧氧化为甲硫氨酸-R,S-亚砜。蛋白质肽链中的甲硫氨酸残基被氧化后,蛋白活性发生显著改变,如钙调素与钙调素结合蛋白亲和力的下降、钙离子/钙调素依赖性蛋白激酶Ⅱ的激活、钾离子通道ShC/B失活动力学的改变。多数生物都存在一个msrA基因和1～3个msrB基因,编码两种序列和结构都明显不同的酶:甲硫氨酸亚砜还原酶A(MsrA)和甲硫氨酸亚砜还原酶B(MsrB),分别还原甲硫氨酸-S-亚砜和甲硫氨酸-R-亚砜。两种酶的催化机制基本相同,其活性中心结构互为镜像。两种还原酶分布于体内不同器官及各种亚细胞结构。对于MsrA活性的研究,已有30年的历史,最初主要集中在低等生物,已发现MsrA对于延缓衰老和神经退行性疾病具有重要作用,也是致病菌的主要毒力因子。最近10年对MsrB也进行了系统研究,并取得了重要进展。人们正在逐渐认识到这些酶在细胞信号蛋白分子活性调节中的重要作用。     

CRT_D介导室性心动过速的研究进展

心室再同步心脏转复除颤器(CRT_D)可有效改善心力衰竭(CHF)患者的运动耐量和生活质量,预防猝死,提高生存率,但CRT_D植入后由于心室激动顺序的改变,使QT间期延长、跨室壁复极离散度(TDR)增加,潜在致室性心律失常风险;且CHF患者通常存在心肌解剖改变,传导的不均一性,也为折返性心动过速的发生提供了维持的机制;而多次电击也可导致肌钙蛋白升高,引起心肌损伤,局部心肌复极离散度增加(DRVR)和QT间期延长,以及电除颤后心肌纤维化和急性细胞损伤,反复室速、室颤也会引起进行性左心功能不全、心肌细胞凋亡、恶化心律失常基质和增加心律失常易感性。CRT_D潜在致室性心律失常作用逐渐引起人们的重视,本文就近年来CRT_D致室性心律失常的电生理机制与临床防治对策等做一综述。     

活性氧在脊髓损伤性中枢疼痛敏化中作用机制的研究进展

活性氧是指氧的某些代谢产物和一些反应的含氧产物,研究证实脊髓损伤后继发产生的活性氧与中枢疼痛敏化关系密切。它可能通过激活兴奋性氨基酸受体,继而激活背角神经元中参与敏化的第二信使系统发挥作用,亦与胶质细胞活化和细胞因子、神经营养因子释放有关。本文对活性氧诱发脊髓损伤性中枢疼痛敏化的作用机制作一综述。     

Electrocardiogram abnormalities in captive chimpanzees (Pan troglodytes)

Although cardiovascular disease is the leading cause of death in the captive chimpanzee population, little is known about the prevalence and etiology of heart disease in this species. We reviewed the physical exam records of 265 common chimpanzees (Pan troglodytes) for electrocardiogram abnormalities. During the 24-mo period reviewed (August 2003 through August 2005), 34 animals were diagnosed with cardiac arrhythmias consisting of ventricular arrhythmias, supraventricular arrhythmias, conduction disturbances, mixed arrhythmias, and bradycardia. The incidence of cardiac arrhythmia was significantly higher in male animals, chimpanzees 20 to 39 y old, and those with structural heart disease. Incidence of cardiac arrhythmia was not significantly higher in animals with hypertension, hyperlipidemia, or chronic viral infections. During the retrospective period, 7 animals with cardiac arrhythmias died or were euthanized. Mortality was significantly higher in animals with ventricular arrhythmias compared with those without ventricular arrhythmias. We conclude that in the common chimpanzee, age, male gender, and structural heart disease are risk factors for developing cardiac arrhythmias and that ventricular arrhythmias are risk factors for mortality.     

Molecular mechanisms of cardiac protection by adaptation to chronic hypoxia

Effective protection of the heart against ischemia/reperfusion injury is one of the most important goals of experimental and clinical research in cardiology. Besides ischemic preconditioning as a powerful temporal protective phenomenon, adaptation to chronic hypoxia also increases cardiac tolerance to all major deleterious consequences of acute oxygen deprivation such as myocardial infarction, contractile dysfunction and ventricular arrhythmias. Although many factors have been proposed to play a potential role, the detailed mechanism of this long-term protection remains poorly understood. This review summarizes current limited evidence for the involvement of ATP-sensitive potassium channels, reactive oxygen species, nitric oxide and various protein kinases in cardioprotective effects of chronic hypoxia.     

Sevoflurane postconditioning attenuates reperfusion-induced ventricular arrhythmias in isolated rat hearts exposed to ischemia/reperfusion injury

Sevoflurane postconditioning has been proven to protect the hearts against ischemia/reperfusion injury, manifested mainly by improved cardiac function, reduced myocardial specific biomarker release, and decreased infarct size. This study is to observe the effects of sevoflurane postconditioning on reperfusion-induced ventricular arrhythmias and reactive oxygen species generation in Langendorff perfused rat hearts. Compared with the unprotected hearts subjected to 25 min of global ischemia followed by 30 min of reperfusion, exposure of 3% sevoflurane during the first 15 min of reperfusion significantly improved cardiac function, reduced cardiac troponin I release, decreased infarct size and attenuated reperfusion-induced ventricular arrhythmia. Further analysis on arrhythmia during the 30 min of reperfusion showed that, sevoflurane postconditioning decreased both the duration and incidence of ventricular tachycardia and ventricular fibrillation. In the meantime, intracellular malondialdehyde and reactive oxygen species levels were also reduced. These above results demonstrate that sevoflurane postconditioning protects the hearts against ischemia/reperfusion injury and attenuates reperfusion-induced arrhythmia, which may be associated with the regulation of lipid peroxidation and reactive oxygen species generation.     

Intracellular mechanisms of cardioprotection during adaptation to hypoxia. Triggers and kinase cascades

Adaptation to chronic hypoxia increases myocardial ischemic tolerance to injury caused by acute ischemia-reperfusion. In this article, we provide a brief overview of current literary data dealing with signalling mechanisms that can play a certain role in chronic hypoxia-induced cardioprotection. It has been shown that reactive oxygen species are major contributors to induction of the protective cardiac phenotype. In this context, we discuss the role of cytochromes, NADPH oxidase, heme oxygenase-1, mitochondrial monoamme oxidase, and prolyl 4-hydroxylase in triggering adaptive responses resulting in myocardial salvage. Moreover, we point to other cytoprotective proteins that can be involved in the protection from chronic hypoxia, such as protein kinase C, mitogen-activated protein kinases, 5'AMP-activated protein kinase, NO-synthases, mitochondrial ATP-sensitive K+ channels, Ca(2+)-activated large-conductance K+ channels, and MPT pore. Understanding the molecular mechanism of this long-lasting form of cardioprotection may help in providing basis for development of future therapeutic strategies to protect ischemic heart.     

Caloric excess or restriction mediated modulation of metabolic enzyme acetylation—proposed effects on cardiac growth and function

Caloric excess has been postulated to disrupt cardiac function via (i) the generation of toxic intermediates, (ii) via protein glycosylation and (iii) through the generation of reactive oxygen species. It is now increasingly being recognized that the nutrient intermediates themselves may modulate metabolic pathways through the post-translational modifications of metabolic enzymes. In light of the high energy demand of the heart, these nutrient mediated modulations in metabolic pathway functioning may play an important role in cardiac function and in the capacity of the heart to adapt to biomechanical stressors. In this review the role of protein acetylation and deacetylation in the control of metabolic programs is explored. Although not extensively investigated directly in the heart, the emerging data support that these nutrient mediated post-translational regulatory events (i) modulate cardiac metabolic pathways, (ii) integrate nutrient flux mediated post-translational effects with cardiac function and (iii) may be important in the development of cardiac pathology. Areas of investigation that need to be explored are highlighted. This article is part of a Special Issue entitled: Mitochondria and Cardioprotection.     

Caloric excess or restriction mediated modulation of metabolic enzyme acetylation-proposed effects on cardiac growth and function

Caloric excess has been postulated to disrupt cardiac function via (i) the generation of toxic intermediates, (ii) via protein glycosylation and (iii) through the generation of reactive oxygen species. It is now increasingly being recognized that the nutrient intermediates themselves may modulate metabolic pathways through the post-translational modifications of metabolic enzymes. In light of the high energy demand of the heart, these nutrient mediated modulations in metabolic pathway functioning may play an important role in cardiac function and in the capacity of the heart to adapt to biomechanical stressors. In this review the role of protein acetylation and deacetylation in the control of metabolic programs is explored. Although not extensively investigated directly in the heart, the emerging data support that these nutrient mediated post-translational regulatory events (i) modulate cardiac metabolic pathways, (ii) integrate nutrient flux mediated post-translational effects with cardiac function and (iii) may be important in the development of cardiac pathology. Areas of investigation that need to be explored are highlighted. This article is part of a Special Issue entitled: Mitochondria and Cardioprotection.     

Ketone bodies alter dinitrophenol-induced glucose uptake through AMPK inhibition and oxidative stress generation in adult cardiomyocytes

In aerobic conditions, the heart preferentially oxidizes fatty acids. However, during metabolic stress, glucose becomes the major energy source, and enhanced glucose uptake has a protective effect on heart function and cardiomyocyte survival. Thus abnormal regulation of glucose uptake may contribute to the development of cardiac disease in diabetics. Ketone bodies are often elevated in poorly controlled diabetics and are associated with increased cellular oxidative stress. Thus we sought to determine the effect of the ketone body beta-hydroxybutyrate (OHB) on cardiac glucose uptake during metabolic stress. We used 2,4-dinitrophenol (DNP), an uncoupler of the mitochondrial oxidative chain, to mimic hypoxia in cardiomyocytes. Our data demonstrated that chronic exposure to OHB provoked a concentration-dependent decrease of DNP action, resulting in 56% inhibition of DNP-mediated glucose uptake at 5 mM OHB. This was paralleled by a diminution of DNP-mediated AMP-activated protein kinase (AMPK) and p38 MAPK phosphorylation. Chronic exposure to OHB also increased reactive oxygen species (ROS) production by 1.9-fold compared with control cells. To further understand the role of ROS in OHB action, cardiomyocytes were incubated with H(2)O(2). Our results demonstrated that this treatment diminished DNP-induced glucose uptake without altering activation of the AMPK/p38 MAPK signaling pathway. Incubation with the antioxidant N-acetylcysteine partially restored DNP-mediated glucose but not AMPK/p38 MAPK activation. In conclusion, these results suggest that ketone bodies, through inhibition of the AMPK/p38 MAPK signaling pathway and ROS overproduction, regulate DNP action and thus cardiac glucose uptake. Altered glucose uptake in hyperketonemic states during metabolic stress may contribute to diabetic cardiomyopathy.     

CaMKII: new tricks for an old dog

Calcium/calmodulin-dependent protein kinase II (CaMKII) is a pivotal signaling molecule in both the brain and the heart. In this issue of Cell, Erickson et al. (2008) demonstrate a mechanism for CaMKII activation by reactive oxygen species that provides a direct link between kinase activation and cardiac dysfunction.     

NADPH Oxidase 4 Induces Cardiac Arrhythmic Phenotype in Zebrafish

Oxidative stress has been implicated in cardiac arrhythmia, although a causal relationship remains undefined. We have recently demonstrated a marked up-regulation of NADPH oxidase isoform 4 (NOX4) in patients with atrial fibrillation, which is accompanied by overproduction of reactive oxygen species (ROS). In this study, we investigated the impact on the cardiac phenotype of NOX4 overexpression in zebrafish. One-cell stage embryos were injected with NOX4 RNA prior to video recording of a GFP-labeled (myl7:GFP zebrafish line) beating heart in real time at 24–31 h post-fertilization. Intriguingly, NOX4 embryos developed cardiac arrhythmia that is characterized by irregular heartbeats. When quantitatively analyzed by an established LQ-1 program, the NOX4 embryos displayed much more variable beat-to-beat intervals (mean S.D. of beat-to-beat intervals was 0.027 s/beat in control embryos versus 0.038 s/beat in NOX4 embryos). Both the phenotype and the increased ROS in NOX4 embryos were attenuated by NOX4 morpholino co-injection, treatments of the embryos with polyethylene glycol-conjugated superoxide dismutase, or NOX4 inhibitors fulvene-5, 6-dimethylamino-fulvene, and proton sponge blue. Injection of NOX4-P437H mutant RNA had no effect on the cardiac phenotype or ROS production. In addition, phosphorylation of calcium/calmodulin-dependent protein kinase II was increased in NOX4 embryos but diminished by polyethylene glycol-conjugated superoxide dismutase, whereas its inhibitor KN93 or AIP abolished the arrhythmic phenotype. Taken together, our data for the first time uncover a novel pathway that underlies the development of cardiac arrhythmia, namely NOX4 activation, subsequent NOX4-specific NADPH-driven ROS production, and redox-sensitive CaMKII activation. These findings may ultimately lead to novel therapeutics targeting cardiac arrhythmia.     

Arrhythmic Heartbeat Classification Using 2D Convolutional Neural Networks

BackgroundElectrocardiogram (ECG) is a method of recording the electrical activity of the heart and it provides a diagnostic means for heart-related diseases. Arrhythmia is any irregularity of the heartbeat that causes an abnormality in the heart rhythm. Early detection of arrhythmia has great importance to prevent many diseases. Manual analysis of ECG recordings is not practical for quickly identifying arrhythmias that may cause sudden deaths. Hence, many studies have been presented to develop computer-aided-diagnosis (CAD) systems to automatically identify arrhythmias.MethodsThis paper proposes a novel deep learning approach to identify arrhythmias in ECG signals. The proposed approach identifies arrhythmia classes using Convolutional Neural Network (CNN) trained by two-dimensional (2D) ECG beat images. Firstly, ECG signals, which consist of 5 different arrhythmias, are segmented into heartbeats which are transformed into 2D grayscale images. Afterward, the images are used as input for training a new CNN architecture to classify heartbeats.ResultsThe experimental results show that the classification performance of the proposed approach reaches an overall accuracy of 99.7%, sensitivity of 99.7%, and specificity of 99.22% in the classification of five different ECG arrhythmias. Further, the proposed CNN architecture is compared to other popular CNN architectures such as LeNet and ResNet-50 to evaluate the performance of the study.ConclusionsTest results demonstrate that the deep network trained by ECG images provides outstanding classification performance of arrhythmic ECG signals and outperforms similar network architectures. Moreover, the proposed method has lower computational costs compared to existing methods and is more suitable for mobile device-based diagnosis systems as it does not involve any complex preprocessing process. Hence, the proposed approach provides a simple and robust automatic cardiac arrhythmia detection scheme for the classification of ECG arrhythmias.