Catecholamine-induced cardiac hypertrophy in a denervated,hemodynamically non-stressed heart transplant

Studies of stress-induced cardiac hypertrophy suggest that myocardial mass is regulated by the circulating level of epinephrine. The trophic effect is mediated by cardiac beta-adrenergic receptors, and in the murine, rat, and dog heart, specifically by beta₂-adrenergic receptors. The well-characterized functional effects of catecholamines on heart have obscured their role as myocardial trophic hormones. Therefore, we compared the effect of beta-adrenergic receptor stimulation on the myocardial mass of both a working innervated heart and an essentially nonworking denervated heterotopically transplanted heart in the same rat; in this model, the neural and stretch parameters are nonoperational in the transplanted heart. Ornithine decarboxylase (ODC), an enzyme elevated in a dose-dependent manner in heart by isoproterenol, was assayed in both hearts to determine the relationship between ODC activity and myocardial mass in response to isoproterenol administration in workin, innervated heart compared to denervated, nonworking heart. In both recipient and donor heart, the myocardial mass paralleled the ability of an isoproterenol bolus to stimulate ODC in the respective heart. However, beta-adrenergic receptor activity in the donor heart was decreased 5 days after transplantation as assessed by the differential ability of a single dose of isoproterenol to stimulate ODC activity. Beta-receptor coupling to ODC activity in the donor heart exceeded that of the recipient heart at 10 days posttransplantation suggesting a time-dependent elevation of beta-adrenergic receptor activity in donor heart. At all times, alterations in myocardial mass paralleled beta-adrenoceptor activity as assessed by the ability of isoproterenol administration to elevate ODC activity. The results support the concept that myocardial mass is regulated by the level of circulating hormones, particularly epinephrine.     

Imaging heart development using high-resolution episcopic microscopy

Development of the heart in vertebrate embryos is a complex process in which the organ is continually remodelled as chambers are formed, valves sculpted and connections established to the developing vascular system. Investigating the genetic programmes driving these changes and the environmental factors that may influence them is critical for our understanding of congenital heart disease. A recurrent challenge in this work is how to integrate studies as diverse as those of cardiac gene function and regulation with an appreciation of the localised interactions between cardiac tissues not to mention the manner in which both may be affected by cardiac function itself. Meeting this challenge requires an accurate way to analyse the changes in 3D morphology of the developing heart, which can be swift or protracted and both dramatic or subtle in consequence. Here we review the use of high-resolution episcopic microscopy as a simple and effective means to examine organ structure and one that allows modern computing methods pioneered by clinical imaging to be applied to the embryonic heart.     

Spectral analysis of heart sounds: Relationships between some physical characteristics and frequency spectra of first and second heart sounds in normals and hypertensives

Frequency analysis of heart sounds has been gaining recognition as a possible indicator of several heart and valve diseases, although a comprehensive study of normal heart sounds has not been published. Relating the frequency content of normal heart sounds to certain physical characteristics surrounding the generation of these sounds could lead to a valuable diagnostic tool and give a better understanding of the mechanism of heart sounds production. In this study, the first and second heart sounds from seventy-four normal, and seven hypertensive volunteers were recorded, digitized and analysed using a Fast Fourier Transform algorithm. Statistical analysis was used to relate physical characteristicss (sex, blood pressure, and body surface area) of the subjects to the frequency content of normal heart sounds and to compare normal and hypertensive heart sounds. Statistical analysis showed that the major concentration of energy, for both first heart sound (S1) and second heart sound (S2), is below 150 Hertz (Hz) which may indicate that both sounds are caused by vibrations within the same structure, possibly the entire heart. However S2 spectra have greater amplitude than S1 spectra above 150 Hz, which may be due to vibrations within the aorta and pulmonary artery. Relationships observed between body surface area, sex, blood pressure, and the frequency content of heart sounds indicate that as heart size increases, the amplitude of the frequency coefficients above 150 Hz decreases. These observations were more identifiable in the S1 spectra than in the S2 spectra, possibly because the S2 higher frequency components may mask subtle changes in the S2 spectra caused by heart size changes. However, when the changes in heart size are significant, as in hypertension or increased body surface area, trends in the S2 spectra can be observed.     

A chronobiological study on the relation between heart rate and QT interval duration in newborn infants

The relation between heart rate and QT interval is the result of the autonomic nervous system control on cardiac function in healthy adults; accordingly, chronobiological studies have shown that adult subjects have circadian rhythms of heart rate (expressed as R-R interval) and QT interval in phase. We have employed chronobiological methods to study heart rate and QT interval relation in 10 newborn infants, who are known to have an immature cardiac control. Findings from this study indicate that not all the newborns show circadian rhythms of heart rate and QT interval and that when both rhythms are present they do not correlate like in the adults. Likely, this lack of relationship between heart rate and QT interval in newborns is due to different maturational stages of the newborns studied. As a practical implication, in newborn infants, mathematical correction of QT interval by heart rate is not a reliable method.     

Beta-adrenergic receptors of the normal heart and in heart failure

The heart is often refereed to as an "beta-adrenergic organ" because beta-adrenergic agonists are powerful stimulants of cardiac contractility. Catecholamines acting through beta-adrenoceptors produce both positive inotropic and chronotropic effects in human heart. It is now generally accepted that in human heart both beta 1- and beta 2-adrenoceptors coexist. beta-Adrenergic transduction system consist of membrane-bound beta-receptors, the effector enzyme adenylyl cyclase and guanine nucleotide-binding transduction (G) proteins. Repeated long-lasting agonist stimulus evokes homologous or heterologous desensitization of transduction system. Chronic heart failure accompanies with decreased responsiveness to beta-adrenoceptor agonists and is thought to exacerbate the loss of cardiac contractility. Depending on the etiology of heart failure abnormalities of the beta-receptor-G protein-adenylyl cyclase system result from a reduced of beta 1-receptors, uncoupling of beta 1- or beta 2-receptors, alteration of G-protein function, or decreased catalytic subunit activity of adenylyl cyclase and enhanced expression of beta-adrenoceptor kinase. The model most widely used is that of circulating lymphocytes that contain a homogeneous population of beta 2-adrenoceptors. The biochemical and pharmacological properties of human lymphocyte beta 2-adrenoceptors are quite comparable to those of heart beta 2-receptors. The analysis of lymphocyte beta 2-adrenoceptor-adenylyl cyclase system can be used as a model for long-term regulation of human cardiac beta 1- and beta 2-adrenoceptors only if serial changes in response to administration of non-selective beta-adrenergic agonists or antagonists are being investigated. This review concentrates on beta-adrenoceptors in human healthy heart and in heart failure and also on lymphocyte beta 2-adrenoceptors and on the changes of these receptors properties under the influence of some cardiotropic drugs.     

Differential regulation of cardiac ANP and BNP mRNA in different stages of experimental heart failure

Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are cardiac hormones that are involved in water and electrolyte homeostasis in heart failure. Although both hormones exert almost identical biological actions, the differential regulation of cardiac ANP and BNP mRNA in compensated and overt heart failure is not known. To study the hypothesis that cardiac BNP is more specifically induced in overt heart failure, a large aortocaval shunt of 30 days duration was produced in rats and compared with compensated heart failure. Compensated heart failure was induced either by a small shunt of 30 days duration or by a large shunt of 3 days duration. Both heart failure models were characterized by increased cardiac weight, which was significantly higher in the large-shunt model, and central venous pressure. Left ventricular end-diastolic pressure was elevated only in the overt heart failure group (control: 5.7 +/- 0. 7; small shunt: 8.6 +/- 0.9; large shunt 3 days: 8.5 +/- 1.7; large shunt 30 days: 15.9 +/- 2.6 mmHg; P < 0.01). ANP and BNP plasma concentrations were elevated in both heart failure models. In compensated heart failure, ANP mRNA expression was induced in both ventricles. In contrast, ventricular BNP mRNA expression was not upregulated in any of the compensated heart failure models, whereas it increased in overt heart failure (left ventricle: 359 +/- 104% of control, P < 0.001; right ventricle: 237 +/- 33%, P < 0.01). A similar pattern of mRNA regulation was observed in the atria. These data indicate that, in contrast to ANP, cardiac BNP mRNA expression might be induced specifically in overt heart failure, pointing toward the possible role of BNP as a marker of the transition from compensated to overt heart failure.     

Progression of thanatophagy in cadaver brain and heart tissues

Autophagy is an evolutionarily conserved catabolic process for maintaining cellular homeostasis during both normal and stress conditions. Metabolic reprogramming in tissues of dead bodies is inevitable due to chronic ischemia and nutrient deprivation, which are well-known features that stimulate autophagy. Currently, it is not fully elucidated whether postmortem autophagy, also known as thanatophagy, occurs in dead bodies is a function of the time of death. In this study, we tested the hypothesis that thanatophagy would increase in proportion to time elapsed since death for tissues collected from cadavers. Brain and heart tissue from corpses at different time intervals after death were analyzed by Western blot. Densitometry analysis demonstrated that thanatophagy occurred in a manner that was dependent on the time of death. The autophagy-associated proteins, LC3 II, p62, Beclin-1 and Atg7, increased in a time-dependent manner in heart tissues. A potent inducer of autophagy, BNIP3, decreased in the heart tissues as time of death increased, whereas the protein levels increased in brain tissues. However, there was no expression of BNIP3 at extended postmortem intervals in both brain and heart samples. Collectively, the present study demonstrates for the first time that thanatophagy occurs in brain and heart tissues of cadavers in a time-dependent manner. Further, our data suggest that cerebral thanatophagy may occur in a Beclin-1- independent manner. This unprecedented study provides potential insight into thanatophagy as a novel method for the estimation of the time of death in criminal investigationsAbstract: Autophagy is an evolutionarily conserved catabolic process for maintaining cellular homeostasis during both normal and stress conditions. Metabolic reprogramming in tissues of dead bodies is inevitable due to chronic ischemia and nutrient deprivation, which are well-known features that stimulate autophagy. Currently, it is not fully elucidated whether postmortem autophagy, also known as thanatophagy, occurs in dead bodies is a function of the time of death. In this study, we tested the hypothesis that thanatophagy would increase in proportion to time elapsed since death for tissues collected from cadavers. Brain and heart tissue from corpses at different time intervals after death were analyzed by Western blot. Densitometry analysis demonstrated that thanatophagy occurred in a manner that was dependent on the time of death. The autophagy-associated proteins, LC3 II, p62, Beclin-1 and Atg7, increased in a time-dependent manner in heart tissues. A potent inducer of autophagy, BNIP3, decreased in the heart tissues as time of death increased, whereas the protein levels increased in brain tissues. However, there was no expression of BNIP3 at extended postmortem intervals in both brain and heart samples. Collectively, the present study demonstrates for the first time that thanatophagy occurs in brain and heart tissues of cadavers in a time-dependent manner. Further, our data suggest that cerebral thanatophagy may occur in a Beclin-1- independent manner. This unprecedented study provides potential insight into thanatophagy as a novel method for the estimation of the time of death in criminal investigations     

Towards Active Tracking of Beating Heart Motion in the Presence of Arrhythmia for Robotic Assisted Beating Heart Surgery

In robotic assisted beating heart surgery, the control architecture for heart motion tracking has stringent requirements in terms of bandwidth of the motion that needs to be tracked. In order to achieve sufficient tracking accuracy, feed-forward control algorithms, which rely on estimations of upcoming heart motion, have been proposed in the literature. However, performance of these feed-forward motion control algorithms under heart rhythm variations is an important concern. In their past work, the authors have demonstrated the effectiveness of a receding horizon model predictive control-based algorithm, which used generalized adaptive predictors, under constant and slowly varying heart rate conditions. This paper extends these studies to the case when the heart motion statistics change abruptly and significantly, such as during arrhythmias. A feasibility study is carried out to assess the motion tracking capabilities of the adaptive algorithms in the occurrence of arrhythmia during beating heart surgery. Specifically, the tracking performance of the algorithms is evaluated on prerecorded motion data, which is collected in vivo and includes heart rhythm irregularities. The algorithms are tested using both simulations and bench experiments on a three degree-of-freedom robotic test bed. They are also compared with a position-plus-derivative controller as well as a receding horizon model predictive controller that employs an extended Kalman filter algorithm for predicting future heart motion.     

Stretch-induced changes in heart rate and rhythm: clinical observations, experiments and mathematical models

Clinical and research data indicate that active and passive changes in the mechanical environment of the heart are capable of influencing both the initiation and the spread of cardiac excitation via pathways that are intrinsic to the heart. This direction of the cross-talk between cardiac electrical and mechanical activity is referred to as mechano-electric feedback (MEF). MEF is thought to be involved in the adjustment of heart rate to changes in mechanical load and would help to explain the precise beat-to-beat regulation of cardiac performance as it occurs even in the recently transplanted (and, thus, denervated) heart. Furthermore, there is clinical evidence that MEF may be involved in mechanical initiation of arrhythmias and fibrillation, as well as in the re-setting of disturbed heart rhythm by 'mechanical' first aid procedures. This review will outline the clinical relevance of cardiac MEF, describe cellular correlates to the responses observed in situ, and discuss the role that quantitative mathematical models may play in identifying the involvement of cardiac MEF in the regulation of heart rate and rhythm.     

Nitric oxide and the enigma of cardiac hypertrophy

In pathological conditions associated with persistent increases in hemodynamic workload (old myocardial infarction, high blood pressure, valvular heart disease), a number of signalling pathways are activated in the heart, all of which promote hypertrophic growth of the heart, characterised at the cellular level by increases in individual cardiac myocyte size. Some of these pathways are required for a successful adaptation to cardiac injury. Other pathways are maladaptive, however, as they lead to progressive contractile dysfunction and heart failure. The free radical gas nitric oxide and natriuretic peptides, both of which are produced in the heart, have emerged as endogenous inhibitors of maladaptive hypertrophy signalling. Overall, it appears that cardiac hypertrophy is controlled by an interplay of pro- and antihypertrophic signalling networks. This delicate balance can tip towards adaptation or heart failure. In the future, patients living with cardiac disease may benefit from therapeutic strategies targeting maladaptive hypertrophy signalling pathways.     

Effect of black widow spider venom on the cockroach heart

The effect of black widow spider venom [crude gland extract (CGE), gland lumen venom (GLV), or from direct bite] on the cardiac activity of Periplaneta americana was assayed both in vivo and in vitro. It was shown that these different forms of venom in all cases blocked the cockroach heart-beat. Both CGE and GLV showed a selective activity on the heart function compared with their effect on the CNS. It is suggested that cardiac block is due to impairment of either the cardiac nerve ganglia function or the myocardial neuromuscular junctions, or of both of them. The mode of action of the toxic effects on the heart is discussed. Experiments with antiserum from CGE indicate that the antigenic fractions of CGE and GLV affecting the heart function, as well as those affecting the insect motor functions, are common to both toxic materials.     

Calcium measurements in perfused mouse heart: quantitating fluorescence and absorbance of Rhod-2 by application of photon migration theory

Both theoretical and experimental results are presented for the quantitative detection of calcium transients in the perfused mouse heart loaded with the calcium-sensitive fluorescent dye Rhod-2. Analytical models are proposed to calculate both the reflected absorbance and fluorescence spectra detected from the mouse heart. These models allow correlation of the measured spectral intensities with the relative quantity of Rhod-2 in the heart and measurement of the changes in quantum yield of Rhod-2 upon binding calcium in the heart in which multiple scattering effects are predominant. Theoretical modeling and experimental results demonstrate that both reflected absorbance and fluorescence emission are attenuated linearly with Rhod-2 washout. According to this relation, a ratiometric method using fluorescence and absorbance is validated as a measure of the quantum yield of calcium-dependent fluorescence, enabling determination of the dynamics of cytosolic calcium in the perfused mouse heart. The feasibility of this approach is confirmed by experiments quantifying calcium transients in the perfused mouse heart stimulated at 8 Hz. The calculated cytosolic calcium concentrations are 368 +/- 68 nM and 654 +/- 164 nM in diastole and systole, respectively. Spectral distortions induced by tissue scattering and absorption and errors induced by the geometry of the detection optics in the calcium quantification are shown to be eliminated by using the ratio method. Methods to effectively minimize motion-induced artifacts and to monitor the oxygenation status of the whole perfused heart are also discussed.     

The relative efficiency of ‘swing through’ gait on axillary,elbow and Canadian crutches compared to normal walking

The subjective impression of many patients using ‘swing through’ gait, in which the body is swung over the crutches with both feet clear of the ground, is that elbow crutches are less stable and more difficult to use than conventional underarm crutches (known as axillary crutches). A study was undertaken on ten normal subjects to see if objective measurements of speed and relative energy expenditure by means of heart rate monitoring via radio telemetry could confirm these impressions when both types of crutch were compared to normal walking. The results unexpectedly showed that heart rates were higher for axillary crutches, even though all subjects considered them easier to use than elbow crutches. The increase in heart rate using axillary crutches requires further study, but it was considered that it might in part be due to pressure on the thoracic cage. Because of this, Canadian crutches, which are a compromise between the two former types and do not bear on the thorax, were similarly monitored. Results from this third trial showed a marked decrease in heart rate with a marginal increase in speed over both axillary and elbow crutches. Because of this a recommendation is made for Canadian crutches to be used more frequently.     

Serendipitous discovery of a novel protein signaling mechanism in heart failure

A number of protein signaling mechanisms are known to be involved in the progression of heart failure, yet the mechanism(s) by which the heart fails remains poorly understood. Therefore, we undertook a global approach to this question and used an antibody microarray to identify proteins differentially expressed in dysfunctional right ventricles in a bovine model of heart failure and the results were validated using cardiac tissue from both bovine and human heart failure. We found that protein disulfide isomerase 3, PDIA3, a protein that resides in the lumen of the endoplasmic reticulum, is significantly upregulated in both animal and human models of right and left heart failure. Altered expression of this protein has not previously been described in models of heart failure. In our initial microarray analysis, we found that CSK (c-Src kinase) was among the proteins upregulated in failing bovine ventricle. To further elucidate the role of CSK in heart failure, we studied the expression of its downstream target, Src, and found that Src expression and phosphorylation were markedly upregulated in failing ventricles. However, we also noted a smaller immunologically reactive protein that was only seen in experimental animals. In order to positively identify the smaller, Src-reactive protein, we used 2-dimensional gel electrophoresis and mass spectrophotometry. Surprisingly, we identified this protein as PDIA3, a protein that did not belong to the Src family of proteins. Upon sequence examination we found that PDIA3 contains a short C-terminal sequence with strong homology to Src and that it was this short sequence to which the antibody was generated. PDIA3 participates in MHC class I presentation and is implicated in the progression of valvular dysfunction in rheumatic heart disease, as well as calcium modulation in the sarcoplasmic reticulum. The molecule resides in the lumen of the endoplasmic reticulum and participates in disulfide bond formation during protein folding by interacting with calnexin and calreticulin. This interaction may indirectly effect SERCA (sarco/endoplasmic reticulum Ca(2+)-transport ATPase) activity and by extension contribute to the calcium dysregulation that characterizes progressive heart failure. Further studies are needed to elucidate the role that PDIA3 may play in the progression of heart failure.     

Cardiovascular Responses Elicited by Intragastric Administration of BDL and GHB

Gamma-hydroxybutyrate (GHB) and its metabolic precursor, 1,4-butanediol (BDL), are widely used recreational drugs. Although most commonly described as CNS depressants, GHB and BDL elicit significant sympathomimetic cardiovascular responses [increases in mean arterial pressure (MAP) and heart rate] when administered parenterally. Given that humans most commonly ingest both drugs orally, we examined the dose-response relationships for intragastrically administered GHB and BDL on MAP and heart rate in conscious rats using radiotelemetry. The intragastric administration of GHB increased MAP. BDL increased both MAP and heart rate and was approximately 10-fold more potent as a cardiovascular stimulant than GHB when administered intragastrically. Pretreatment with ethanol prevented the lethality of BDL. These data indicate that 1) both GHB and BDL produce cardiovascular responses when administered intragastrically and 2) BDL is more potent and potentially more dangerous than GHB when administered via this route.     

Cardiovascular responses elicited by intragastric administration of BDL and GHB

Gamma-hydroxybutyrate (GHB) and its metabolic precursor, 1,4-butanediol (BDL), are widely used recreational drugs. Although most commonly described as CNS depressants, GHB and BDL elicit significant sympathomimetic cardiovascular responses [increases in mean arterial pressure (MAP) and heart rate] when administered parenterally. Given that humans most commonly ingest both drugs orally, we examined the dose-response relationships for intragastrically administered GHB and BDL on MAP and heart rate in conscious rats using radiotelemetry. The intragastric administration of GHB increased MAP. BDL increased both MAP and heart rate and was approximately 10-fold more potent as a cardiovascular stimulant than GHB when administered intragastrically. Pretreatment with ethanol prevented the lethality of BDL. These data indicate that 1) both GHB and BDL produce cardiovascular responses when administered intragastrically and 2) BDL is more potent and potentially more dangerous than GHB when administered via this route.