Mechanical stretch increases intracellular calcium concentration in cultured ventricular cells from neonatal rats

Short-term transcriptomic response to plasma membrane injury

Plasma membrane repair mechanisms are activated within seconds post-injury to promote rapid membrane resealing in eukaryotic cells and prevent cell death. However, less is known about the regeneration phase that follows and how cells respond to injury in the short-term. Here, we provide a genome-wide study into the mRNA expression profile of MCF-7 breast cancer cells exposed to injury by digitonin, a mild non-ionic detergent that permeabilizes the plasma membrane. We focused on the early transcriptional signature and found a time-dependent increase in the number of differentially expressed (> twofold, P < 0.05) genes (34, 114 and 236 genes at 20-, 40- and 60-min post-injury, respectively). Pathway analysis highlighted a robust and gradual three-part transcriptional response: (1) prompt activation of immediate-early response genes, (2) activation of specific MAPK cascades and (3) induction of inflammatory and immune pathways. Therefore, plasma membrane injury triggers a rapid and strong stress and immunogenic response. Our meta-analysis suggests that this is a conserved transcriptome response to plasma membrane injury across different cell and injury types. Taken together, our study shows that injury has profound effects on the transcriptome of wounded cells in the regeneration phase (subsequent to membrane resealing), which is likely to influence cellular status and has been previously overlooked.

Animal models of pulmonary hypertension: Getting to the heart of the problem

Despite recent therapeutic advances, pulmonary hypertension (PH) remains a fatal disease due to the development of right ventricular (RV) failure. At present, no treatments targeted at the right ventricle are available, and RV function is not widely considered in the preclinical assessment of new therapeutics. Several small animal models are used in the study of PH, including the classic models of exposure to either hypoxia or monocrotaline, newer combinational and genetic models, and pulmonary artery banding, a surgical model of pure RV pressure overload. These models reproduce selected features of the structural remodelling and functional decline seen in patients and have provided valuable insight into the pathophysiology of RV failure. However, significant reversal of remodelling and improvement in RV function remains a therapeutic obstacle. Emerging animal models will provide a deeper understanding of the mechanisms governing the transition from adaptive remodelling to a failing right ventricle, aiding the hunt for druggable molecular targets.

Wave intensity, an index of ventriculo-arterial interaction, increases in hypertensive subjects but decreases in normotensive subjects during the cold pressor test

Purpose

Cardiovascular reactivity to the cold pressor test (CPT) is considered to be a marker for apparent and potential hypertension. We aimed to elucidate the association between the changes in wave intensity (WI) during CPT and hypertension.

Methods

We recruited 85 volunteers, 33 of whom were hypertensive and 52 normotensive. Using ultrasonic equipment during CPT, we measured carotid arterial WI, which is defined in terms of blood pressure and velocity in the carotid artery.

Results

The peak WI (W₁) increased during CPT in 70.6% of hypertensive individuals, but decreased in 72.6% of normotensive individuals. The chi-square (χ²) test showed that the association between the direction of change in W₁ (increase or decrease) and the blood pressure (hypertensive or normotensive) was very strong (P < 0.0001).

Conclusion

Direction of change in W₁ during CPT is a clear marker to discriminate cardiovascular reactivity that does not vary depending on each investigator’s subjective point of view.

Minor impact of constraint from perivascular flow probes on wave intensity analysis

Perivascular flow probes are considered the gold-standard for measuring volumetric blood flow in animal studies. Although flow probes are generally placed non-constrictively around the vessel of interest, pressure-elevating interventions performed during an experiment may lead to vessel expansion and some probe-vessel impingement, particularly in highly compliant vessels such as adult sheep aorta or major pulmonary arteries in fetus lambs. This study assessed to what extent such mild flow probe constraint may impact on wave intensity analysis. We also investigated whether errors arising from flow probe constraint could explain apparent pressure reflection indices (R_p > 1) that have been observed in fetus lamb pulmonary arteries under some experimental conditions. These questions were investigated with one-dimensional models of an adult sheep aorta and fetus lamb pulmonary artery, with a virtual flow probe incorporated as a non-linear external constraint term in the vessel constitutive equation. Model-derived flow and pressure were subjected to standard analysis procedures that would be applied experimentally (correcting for apparent velocity lags and calculating wave speed via the PU-loop method). For the adult sheep model, simulations covering a wide range of haemodynamic conditions revealed a mostly minor effect (<10%) of probe constraint on the intensity and pressure effects of the three major waves (forward compression wave, forward decompression wave, backward compression wave). Moreover, flow probe constraint had essentially no impact on R_p in the fetus lamb model, suggesting that such constraint is unlikely to be responsible for an observed R_p > 1. Mild flow probe constraint is likely to have little impact on wave intensity analysis.

The slow force response to stretch: Controversy and contradictions

When exposed to an abrupt stretch, cardiac muscle exhibits biphasic active force enhancement. The initial, instantaneous, force enhancement is well explained by the Frank-Starling mechanism. However, the cellular mechanisms associated with the second, slower phase remain contentious. This review explores hypotheses regarding this "slow force response" with the intention of clarifying some apparent contradictions in the literature. The review is partitioned into three sections. The first section considers pathways that modify the intracellular calcium handling to address the role of the sarcoplasmic reticulum in the mechanism underlying the slow force response. The second section focuses on extracellular calcium fluxes and explores the identity and contribution of the stretch-activated, non-specific, cation channels as well as signalling cascades associated with G-protein coupled receptors. The final section introduces promising candidates for the mechanosensor(s) responsible for detecting the stretch perturbation.

Early dystrophin loss is coincident with the transition of compensated cardiac hypertrophy to heart failure

Hypertension causes cardiac hypertrophy, one of the most important risk factors for heart failure (HF). Despite the importance of cardiac hypertrophy as a risk factor for the development of HF, not all hypertrophied hearts will ultimately fail. Alterations of cytoskeletal and sarcolemma-associated proteins are considered markers cardiac remodeling during HF. Dystrophin provides mechanical stability to the plasma membrane through its interactions with the actin cytoskeleton and, indirectly, to extracellular matrix proteins. This study was undertaken to evaluate dystrophin and calpain-1 in the transition from compensated cardiac hypertrophy to HF. Wistar rats were subjected to abdominal aorta constriction and killed at 30, 60 and 90 days post surgery (dps). Cardiac function and blood pressure were evaluated. The hearts were collected and Western blotting and immunofluorescence performed for dystrophin, calpain-1, alpha-fodrin and calpastatin. Statistical analyses were performed and considered significant when p<0.05. After 90 dps, 70% of the animals showed hypertrophic hearts (HH) and 30% hypertrophic+dilated hearts (HD). Systolic and diastolic functions were preserved at 30 and 60 dps, however, decreased in the HD group. Blood pressure, cardiomyocyte diameter and collagen content were increased at all time points. Dystrophin expression was lightly increased at 30 and 60 dps and HH group. HD group showed decreased expression of dystrophin and calpastatin and increased expression of calpain-1 and alpha-fodrin fragments. The first signals of dystrophin reduction were observed as early as 60 dps. In conclusion, some hearts present a distinct molecular pattern at an early stage of the disease; this pattern could provide an opportunity to identify these failure-prone hearts during the development of the cardiac disease. We showed that decreased expression of dystrophin and increased expression of calpains are coincident and could work as possible therapeutic targets to prevent heart failure as a consequence of cardiac hypertrophy.

L-Type Calcium Channels Do Not Play a Critical Role in Chest Blow Induced Ventricular Fibrillation: Commotio Cordis

Background. In a commotio cordis swine model, ventricular fibrillation (VF) can be induced by a ball blow to the chest believed secondary to activation of mechanosensitive ion channels. The purpose of the current study is to evaluate whether stretch induced activation of the L-type calcium channel may cause intracellular calcium overload and underlie the VF in commotio cordis. Method and Results. Anesthetized juvenile swine received 6 chest wall strikes with a 17.9 m/s lacrosse ball timed to the vulnerable period for VF induction. Animals were randomized to IV verapamil (n = 6) or placebo (n = 6). There was no difference in the observed frequency of VF between verapamil (19/26: 73%) and placebo (20/36: 56%) treated animals (p = 0.16). There was also no significant difference in the combined endpoint of VF or nonsustained VF (21/26: 81% in verapamil versus 24/36: 67% in controls, p = 0.22). Conclusions. In this experimental model of commotio cordis, verapamil did not prevent VF induction. Thus, in commotio cordis it is unlikely that stretch activation of the L-type calcium channel with resultant intracellular calcium overload plays a prominent role.

Adaptive capacity of the right ventricle: why does it fail?

Only in recent years has the right ventricle (RV) function become appreciated to be equally important to the left ventricle (LV) function to maintain cardiac output. Right ventricular failure is, irrespectively of the etiology, associated with impaired exercise tolerance and poor survival. Since the anatomy and physiology of the RV is distinctly different than that of the LV, its adaptive mechanisms and the pathways involved are different as well. RV hypertrophy is an important mechanism of the RV to preserve cardiac output. This review summarizes the current knowledge on the right ventricle and its response to pathologic situations. We will focus on the adaptive capacity of the right ventricle and the molecular pathways involved, and we will discuss potential therapeutic interventions.

Noninvasive determination of local pulse wave velocity and wave intensity: changes with age and gender in the carotid and femoral arteries of healthy human

We recently introduced noninvasive methods to assess local pulse wave velocity (PWV) and wave intensity (ndI) in arteries based on measurements of flow velocity (U) and diameter (D). Although the methods were validated in an experimental setting, clinical application remains lacking. The aim of this study was therefore to investigate the effect of age and gender on PWV and ndI in the carotid and femoral arteries of an existing population. We measured D and U in the carotid and femoral arteries of 1,774 healthy subjects aged 35-55 yr, a subgroup of the Asklepios population. With the use of the lnDU-loop method, we calculated local PWV, which was used to determine arterial distensibility (nDs). We then used the new algorithm to determine maximum forward and backward wave intensities (ndI+max and ndI−min, respectively) and the reflection index (nRI). On average, PWV was higher, and nDs was lower in the femoral than at the carotid arteries. At the carotid artery, PWV increased with age, but nDs, ndI+max, and ndI−min decreased; nRI did not change with age. At the femoral artery, PWV was higher, and nDs was lower in male, but all parameters did not change significantly with age in both women and men. We conclude that the carotid artery is more affected by the aging process than the femoral artery, even in healthy subjects. The new techniques provide mechanical and hemodynamic parameters, requiring only D and U measurements, both of which can be acquired using ultrasound equipment widely available today, hence their advantage for potential use in the clinical setting.

Variable open-end wave reflection in the pulmonary arteries of anesthetized sheep

The aim of this study was to re-evaluate wave reflection in the healthy pulmonary arteries of sheep utilizing the time-domain-based method of wave intensity analysis. A thorough understanding of patterns of wave reflection during health and disease may provide future sensitive markers of early pulmonary vascular disease. Wave intensity was calculated from the simultaneous acquisition of proximal pulmonary arterial pressure and velocity in 12 anesthetized open-chest sheep. Normal pulmonary arterial wave speed was 2.1 ± 0.3 m s(-1). The incident forward compression wave generated by right ventricular systole was reflected in an open-end manner as a backward expansion wave from a site 3 cm downstream, corresponding to the main pulmonary bifurcation, and in a closed-end manner as a backward compression wave from a site 21 cm downstream, corresponding to the pulmonary microcirculation. The proximal open-end reflection site was not present throughout the entire cardiac cycle. Wave reflection was minimal with only 1% of the incident forward compression wave energy reflected as a backward expansion wave and 2% as a backward compression wave. The normal pulmonary artery in open-chest sheep is characterized by variable proximal open-end reflection from the main pulmonary bifurcation and fixed closed-end reflection from the microcirculation, generating backward-travelling waves of minimal intensity.

Preload-induced changes in isometric tension and [Ca2+]i in rat myocardium

Preload-induced changes of active tension and [Ca2+]i are “dissociated” in mammalian myocardium. This study aimed to describe the distinct effects of preload at low and physiological [Ca2+]o. Rat RV papillary muscles were studied in isometric conditions at 25‡C and 0.33 Hz at 1 mM (hypo-Ca group) and 2.5 mM [Ca2+]o (normal-Ca group). [Ca2+]i was monitored with fura-2/AM. Increase of preload caused a rise of active tension in hypo-Ca and normal-Ca groups whereas peak fluorescence rose significantly only at low [Ca2+]o. End-diastolic tension, end-diastolic level of fluorescence, time-to-peak tension, but not time-to-peak of Ca2+ transient, progressively increased with preload. Mechanical relaxation decelerated with preload while Ca2+ transient decay time decreased in the initial phase and increased in the late phase, resulting in a prominent “bump” configuration. The “bump” was assessed as a ratio of its area to the fluorescence trace area. It was a new finding that the preload-induced rise of this ratio was twice as large in hypo-Ca. Our results indicate that preload-induced changes in active tension and [Ca2+]i are “dissociated” in rat myocardium, with relatively higher expression at low [Ca2+]o. Ca-dependence of Ca-TnC association/dissociation kinetics is thought to be a main contributor to these preload-induced effects.

Effects of acute cold exposure on carotid and femoral wave intensity indexes: evidence for reflection coefficient as a measure of distal vascular resistance

Our aim was to investigate the effects of acute cold pressor test (CPT) on augmentation index (AI) and wave intensity (WI) indexes from right common carotid artery (RCCA) and right common femoral artery (RCFA) and to test whether the reflection coefficient (RC) from wave intensity analysis can reflect the distal vascular resistance (DVR) accurately. Forty-three healthy males were randomly selected for measurements at baseline and 1 min after CPT at RCCA or RCFA. CPT induced similar increases of heart rate and blood pressure in RCCA and RCFA groups with their pulse pressures unchanged. The W(2) (the second peak of WI) was too obscure in RCFA to be analyzed. The W(1) (the first peak of WI) of both arteries, W(1)-W(2) (interval between W(1) and W(2)), and NA (negative area between W(1) and W(2), indicating reflected waves) of RCCA and the R-W(1) (interval between the R wave of ECG and W(1)) of RCFA decreased obviously, whereas the W(2) and R-W(1) of RCCA and the RC (calculated as NA/W(1)) of RCFA increased with no changes in the RC of RCCA and the NA of RCFA during CPT compared with baseline. The AIs from both arteries increased significantly after CPT. These results suggested that acute CPT has opposing effects on cerebral and peripheral vascular resistances, with the former decreased and the latter increased. The RCs from RCCA and RCFA are more associated with the changes of cerebral and peripheral vascular resistances, respectively, than the NA and AI, and the RC is of guiding value in assessing DVR.

Wave intensity analysis of right ventricular and pulmonary vascular contributions to higher pulmonary than aortic blood pressure in fetal lambs

Although fetal pulmonary trunk (PT) blood pressure may exceed aortic trunk (AoT) pressure, the specific mechanism(s) underlying this pressure difference remain undefined. To evaluate the potential role of ventricular and vascular factors in the generation of a fetal PT-AoT pressure difference, nine anesthetized late-gestation fetal sheep were instrumented with PT and AoT micromanometer catheters to measure high-fidelity pressure and transit-time flow probes to obtain blood velocity. The PT-AoT instantaneous pressure difference (IPD(PT-AoT)) was calculated from PT and AoT pressure profiles. PT and AoT wave intensity (WI) was derived from the product of the appropriate pressure and velocity rates of change. While diastolic pressures were near identical, systolic PT pressure exceeded AoT pressure (P < 0.001), with a maximal IPD(PT-AoT) of 6.5 +/- 2.5 mmHg. The comparison of IPD(PT-AoT) with wave-related PT and AoT pressure changes indicated that 1) a greater pressure-generating effect of the PT forward-running compression wave arising from impulsive right ventricular contraction in early and midsystole accounted for 2.3 +/- 2.3 mmHg (35%) of the maximal IPD(PT-AoT) and 2) a larger pressure-generating effect of a large midsystolic backward-running compression wave transmitted into the PT from the pulmonary vasculature contributed 4.0 +/- 1.5 mmHg ( approximately 60%) of the maximal IPD(PT-AoT). These results indicate that the higher PT than AoT blood pressure observed in fetal lambs is a systolic phenomenon principally related to the combination of a relatively higher level of right ventricular pump function manifest in early and midsystole and a pressure-increasing energy wave arising from the fetal pulmonary vasculature in midsystole.

Increased myofilament Ca2+-sensitivity and arrhythmia susceptibility

Increased myofilament Ca(2+) sensitivity is a common attribute of many inherited and acquired cardiomyopathies that are associated with cardiac arrhythmias. Accumulating evidence supports the concept that increased myofilament Ca(2+) sensitivity is an independent risk factor for arrhythmias. This review describes and discusses potential underlying molecular and cellular mechanisms how myofilament Ca(2+) sensitivity affects cardiac excitation and leads to the generation of arrhythmias. Emphasized are downstream effects of increased myofilament Ca(2+) sensitivity: altered Ca(2+) buffering/handling, impaired energy metabolism and increased mechanical stretch, and how they may contribute to arrhythmogenesis.

Structural heterogeneity in the ventricular wall plays a significant role in the initiation of stretch-induced arrhythmias in perfused rabbit right ventricular tissues and whole heart preparations

RATIONALE

Mechanical stress is known to alter the electrophysiological properties of the myocardium and may trigger fatal arrhythmias when an abnormal load is applied to the heart.

OBJECTIVE

We tested the hypothesis that the structural heterogeneity of the ventricular wall modulates globally applied stretches to create heterogeneous strain distributions that lead to the initiation of arrhythmias.

METHODS AND RESULTS

We applied global stretches to arterially perfused rabbit right ventricular tissue preparations. The distribution of strain (determined by marker tracking) and the transmembrane potential (measured by optical mapping) were simultaneously recorded while accounting for motion artifacts. The 3D structure of the preparations was also examined using a laser displacement meter. To examine whether such observations can be translated to the physiological condition, we performed similar measurements in whole heart preparations while applying volume pulses to the right ventricle. At the tissue level, larger stretches (> or = 20%) caused synchronous excitation of the entire preparation, whereas medium stretches (10% and 15%) induced focal excitation. We found a significant correlation between the local strain and the local thickness, and the probability for focal excitation was highest for medium stretches. In the whole heart preparations, we observed that such focal excitations developed into reentrant arrhythmias.

CONCLUSIONS

Global stretches of intermediate strength, rather than intense stretches, created heterogeneous strain (excitation) distributions in the ventricular wall, which can trigger fatal arrhythmias.

Discerning aortic waves during intra-aortic balloon pumping and their relation to benefits of counterpulsation in humans

An explanation of the mechanisms leading to the beneficial hemodynamic effects of the intra-aortic balloon pump (IABP) is lacking. We hypothesized that inflation and deflation of the balloon would generate a compression (BCW) and an expansion (BEW) wave, respectively, which, when analyzed with wave intensity analysis, could be used to explain the hemodynamic benefits of IABP support. Simultaneous ascending aortic pressure (P_ao) and flow rate (Q_ao) were recorded in 25 patients during control conditions and with IABP support of 1:1 and 1:2. Diastolic aortic pressure augmentation (P_aug) and end-diastolic aortic pressure (ED P_ao) reduction were calculated from P_ao. Energies of the BCW and BEW were obtained by integrating the wave intensity contour over time. P_aug was 19.1 mmHg (SD 13.6) during 1:2 support. During 1:1 support significantly higher P_aug of 21.1 mmHg (SD 13.4) was achieved (P < 0.001). ED P_ao decreased from 50.9 mmHg (SD 15.1) to 43.9 mmHg (SD 15.7) (P < 0.0001) during 1:1 assistance and the decrease was not statistically different with 1:2. During 1:1 support the energy of BCW was correlated positively to P_aug (r = 0.83, P < 0.0001) and energy of the BEW correlated negatively to ED P_ao (r = 0.78, P < 0.005); these relationships were not statistically different during 1:2. In conclusion, the energies of the BCW and BEW are directly related to P_aug and ED P_ao, which are the conventional hemodynamic parameters indicating IABP benefits. These findings imply a cause and effect mechanism between the energies of BCW and BEW, and IABP hemodynamic effects.

Ductus arteriosus wave intensity analysis in fetal lambs: midsystolic ductal flow augmentation is due to antegrade pulmonary arterial wave transmission

In midsystole, fetal pulmonary trunk (PT) and arterial (PA) blood flows characteristically fall, despite pulmonary blood pressure increasing, while ductus arteriosus (DA) flow continues to rise to a delayed peak. Wave intensity (WI) analysis indicates that midsystolic fetal PT and PA flow reductions are related to a very large midsystolic PA backward-running compression wave (BCW(ms)), which originates in the pulmonary microvasculature and is partially transmitted into the PT. This study tested the hypothesis that midsystolic augmentation of DA blood flow was related to transmission of the PA BCW(ms) into the DA. DA, PT, and PA WI analysis was performed in eight anesthetized late-gestation fetal sheep instrumented with DA, PT, and left PA micromanometer catheters to measure pressure (P) and transit-time flow probes to obtain blood velocity (U). In a subgroup (n = 5), the main PA was briefly occluded to abolish wave transmission from the lungs. WI was calculated as the product of P and U rates of change. PA and PT WI profiles both contained a prominent BCW(ms), approximately 5-fold larger in the PA (P < 0.005), which increased P but decreased U. By contrast, the DA WI profile demonstrated a large midsystolic forward-running compression wave (FCW(ms)), which increased DA P and U, and occurred 5 ms after PA BCW(ms). Furthermore, both DA FCW(ms) and PT BCW(ms) were abolished by main PA occlusion. These results suggest that the fetal PA BCW(ms) undergoes retrograde transmission into the PT as a BCW(ms), but antegrade transmission into the DA as a FCW(ms) that augments midsystolic DA flow.

Dynamic characterization and hemodynamic effects of pulmonary waves in fetal lambs using cardiac extrasystoles and beat-by-beat wave intensity analysis

Steady-state wave intensity ( WI) analysis indicates that characteristic midsystolic falls in fetal pulmonary trunk (PT) and artery (PA) blood flow are due to an extremely large backward-running compression wave (BCWms) that 1) originates from the pulmonary microvasculature by a combination of cyclical pulmonary vasoconstriction and vascular reflection of the forward-running compression wave (FCWis) associated with impulsive right ventricular ejection, and 2) is transmitted into the PT. However, no information is available about the dynamic properties of PA BCWms and its contribution to beat-to-beat regulation of pulmonary hemodynamics. Accordingly, beat-by-beat WI analysis was performed during brief increases in ventricular contractility accompanying an extrasystole (ES) in nine anesthetized late-gestation fetal sheep instrumented with PT and left PA micromanometer catheters to measure pressure (P) and transit-time flow probes to obtain blood velocity ( U). WI was calculated as the product of P and U rates of change. At steady state, the magnitude of PA BCWms, and its associated P and U changes (ΔP and Δ U, respectively), were similar to those of FCWis. The PA FCWis and BCWms, and their accompanying ΔP and Δ U, were all transiently potentiated after an ES. Beat-by-beat PA FCWis-BCWms wave area, ΔP and Δ U relationships were highly linear ( R2 ≥ 0.91) with slopes of 1.36–1.47 ( P < 0.001), consistent with the presence of a vasoconstrictor component in PA BCWms. PA-PT BCWms area and ΔP and Δ U relationships were also linear ( R2 ≥ 0.77) with slopes of 0.23–0.64 ( P < 0.001). These results indicate that the fetal PA BCWms contributes to beat-to-beat regulation of not only PA but also PT hemodynamics.

Clinical usefulness of wave intensity analysis

Wave intensity (WI) is a hemodynamic index, which can evaluate the working condition of the heart interacting with the arterial system. It can be defined at any site in the circulatory system and provides a great deal of information. However, we need simultaneous measurements of blood pressure and velocity to obtain wave intensity, which has limited the clinical application of wave intensity, in spite of its potential. To expand the application of wave intensity in the clinical setting, we developed a real-time non-invasive measurement system for wave intensity based on a combined color Doppler and echo-tracking system. We measured carotid arterial WI in normal subjects and patients with various cardiovascular diseases. In the coronary artery disease group, the magnitude of the first peak of carotid arterial WI (W (1)) increased with LV max. dP/dt (r = 0.74, P < 0.001), and the amplitude of the second peak (W (2)) decreased with an increase in the time constant of LV pressure decay (r = -0.77, P < 0.001). In the dilated cardiomyopathy group, the values of W (1) were much lower than those in the normal group (P < 0.0001). In the hypertrophic cardiomyopathy group, the values of W (2) were much smaller than those in the normal group (P < 0.0001). In mitral regurgitation before surgery, W (2) decreased or disappeared, but after surgery W (2) appeared clearly. In the hypertension group, the magnitude of reflection from the head was considerably greater than that in the normal group (P < 0.0001). We also evaluated hemodynamic effects of sublingual nitroglycerin in normal subjects. Nitroglycerin increased W (1) significantly (P < 0.001). WI can be obtained non-invasively using an echo-Doppler system in the clinical setting. This method will increase the clinical usefulness of wave intensity.

Differences in cardiac microcirculatory wave patterns between the proximal left mainstem and proximal right coronary artery

Despite having almost identical origins and similar perfusion pressures, the flow-velocity waveforms in the left and right coronary arteries are strikingly different. We hypothesized that pressure differences originating from the distal (microcirculatory) bed would account for the differences in the flow-velocity waveform. We used wave intensity analysis to separate and quantify proximal- and distal-originating pressures to study the differences in velocity waveforms. In 20 subjects with unobstructed coronary arteries, sensor-tipped intra-arterial wires were used to measure simultaneous pressure and Doppler velocity in the proximal left main stem (LMS) and proximal right coronary artery (RCA). Proximal- and distal-originating waves were separated using wave intensity analysis, and differences in waves were examined in relation to structural and anatomic differences between the two arteries. Diastolic flow velocity was lower in the RCA than in the LMS (35.1 +/- 21.4 vs. 56.4 +/- 32.5 cm/s, P < 0.002), and, consequently, the diastolic-to-systolic ratio of peak flow velocity in the RCA was significantly less than in the LMS (1.00 +/- 0.32 vs. 1.79 +/- 0.48, P < 0.001). This was due to a lower distal-originating suction wave (8.2 +/- 6.6 x 10(3) vs. 16.0 +/- 12.2 x 10(3) W.m(-2).s(-1), P < 0.01). The suction wave in the LMS correlated positively with left ventricular pressure (r = 0.6, P < 0.01) and in the RCA with estimated right ventricular systolic pressure (r = 0.7, P = 0.05) but not with the respective diameter in these arteries. In contrast to the LMS, where coronary flow velocity was predominantly diastolic, in the proximal RCA coronary flow velocity was similar in systole and diastole. This difference was due to a smaller distal-originating suction wave in the RCA, which can be explained by differences in elastance and pressure generated between right and left ventricles.

Simultaneous pulmonary trunk and pulmonary arterial wave intensity analysis in fetal lambs: evidence for cyclical, midsystolic pulmonary vasoconstriction

The physiological basis of a characteristically low blood flow to the fetal lungs is incompletely understood. To determine the potential role of pulmonary vascular interaction in this phenomenon, simultaneous wave intensity analysis (WIA) was performed in the pulmonary trunk (PT) and left pulmonary artery (LPA) of 10 anesthetized late-gestation fetal sheep instrumented with PT and LPA micromanometer catheters to measure pressure (P) and transit-time flow probes to obtain blood velocity (U). Studies were performed at rest and during brief complete occlusion of the ductus arteriosus to augment pulmonary vasoconstriction (n = 4) or main pulmonary artery to abolish wave transmission from the lungs (n = 3). Wave intensity (dI(W)) was calculated as the product of the P and U rates of change. Forward and backward components of dI(W) were determined after calculation of wave speed. PT and LPA WIA displayed an early systolic forward compression wave (FCW(is)) increasing P and U, and a late systolic forward expansion wave decreasing P and U. However, a marked midsystolic fall in LPA U to near-zero was related to an extremely prominent midsystolic backward compression wave (BCW(ms)) that arose approximately 5 cm distal to the LPA, was threefold larger than the PT BCW(ms) (P < 0.001), of similar size to FCW(is) at rest (P > 0.6), larger than FCW(is) following ductal occlusion (P < 0.05) and abolished after main pulmonary artery occlusion. These findings suggest that the absence of pulmonary arterial midsystolic forward flow which accompanies a low fetal lung blood flow is due to a BCW(ms) generated in part by cyclical vasoconstriction within the pulmonary microcirculation.

Aortic wave intensity analysis of ventricular-vascular interaction during incremental dobutamine infusion in adult sheep

This study undertook a detailed examination of the ventricular-vascular interaction of the predominant beta-adrenergic agonist dobutamine using wave intensity analysis. Eight anesthetized open-chest ewes were instrumented with an aortic micromanometer to measure central aortic blood pressure (P) and an ultrasonic flow probe to obtain ascending aortic blood velocity (U). Hemodynamics were recorded during incremental dobutamine infusion (0.5, 1, 2.5, 5, 7.5, and 10 microg.kg(-1).min(-1)). Wave intensity (dI(W)) was calculated as the product of the rates of change of P and U with customized software using ensemble-averaged signals. Forward and backward components of dI(W), P, and U were determined after calculation of wave speed. As well as the typical initial forward compression wave (FCW), midsystolic backward compression wave (BCW), and late-systolic forward expansion wave (FEW(es)), two minor and previously unheralded waves were also detectable in the wave intensity profile at baseline. The first was an early systolic backward expansion wave (BEW), which reduced P but increased peak U. The second was a mid-systolic forward expansion wave (FEW(ms)), which reduced P and U. During dobutamine infusion FCW dI(W) increased 18-fold (P < 0.001), but BCW dI(W) rose 12-fold (P < 0.001) while FEW(es) dI(W) fell by 70% (P < 0.001). However, the latter changes were accompanied by a 44-fold increase in BEW dI(W) (P = 0.005) that augmented the initial aortic forward flow and a >100-fold rise in FEW(ms) dI(W) (P < 0.001) that produced earlier and enhanced aortic blood deceleration. These findings provide new insights into the ventricular-vascular interaction of dobutamine.

A simple device to apply equibiaxial strain to cells cultured on flexible membranes

The biomechanical environment to which cells are exposed is important to their normal growth, development, interaction, and function. Accordingly, there has been much interest in studying the role of biomechanical forces in cell biology and pathophysiology. This has led to the introduction and even commercialization of many experimental devices. Many of the early devices were limited by the heterogeneity of deformation of cells cultivated in different locations of the culture plate membranes and were also attached with complicated technical/electronic efforts resulting in a restriction of the reproducibility of these devices. The objective of this study was to design and build a simple device to allow the application of dose-dependent homogeneous equibiaxial static stretch to cells cultured on flexible silicone membranes to investigate biological and biomedical questions. In addition, cultured neonatal rat atrial cardiomyocytes were stretched with the proposed device with different strain gradients. For the first time with this study we could demonstrate that stretch up to 21% caused dose-dependent changes in biological markers such as the calcineurin activity, modulatory calcineurin-interacting protein-1, voltage-gated potassium channel isoform 4.2, and voltage-gated K(+) channel-interacting proteins-2 gene expression and transient outward potassium current densities but not the protein-to-DNA ratio and atrial natriuretic peptide mRNA. With both markers mentioned last, dose-dependent stretch alterations could only be achieved with stretch up to 13%. The simple and low-cost device presented here might be applied to a wide range of experimental settings in different fields of research.

Mechanisms of Ca2+-Dependent Calcineurin Activation in Mechanical Stretch-Induced Hypertrophy

Pressure overload is the major stimulus for cardiac hypertrophy. Accumulating evidence suggests an important role for calcium-induced activation of calcineurin in mediating hypertrophic signaling. Hypertrophy is an important risk factor for cardiovascular morbidity and mortality. We therefore employed an in vitro mechanical stretch model of cultured neonatal cardiomyocytes to evaluate proposed mechanisms of calcium-induced calcineurin activation in terms of inhibition of calcineurin activity and hypertrophy. The protein/DNA ratio and ANP gene expression were used as markers for stretch-induced hypertrophy. Stretch increased the calcineurin activity, MCIP1 gene expression and DNA binding of NFATc as well as the protein/DNA ratio and ANP mRNA in a significant manner. The specific inhibitor of calcineurin, cyclosporin A, inhibited the stretch-induced increase in calcineurin activity, MCIP1 gene expression and hypertrophy. The L-type Ca2+ channel blocker nifedipine and a blocker of the Na+/H+ exchanger (cariporide) both suppressed stretch-dependent enhanced calcineurin activity and hypertrophy. Also application of a blocker of the Na+/Ca2+ exchanger (KB-R7943) was effective in preventing calcineurin activation and increases in the protein/DNA ratio. Inhibition of capacitative Ca2+ entry with SKF 96365 was also sufficient to abrogate calcineurin activation and hypertrophy. The blocker of stretch-activated ion channels, streptomycin, was without effect on stretch-induced hypertrophy and calcineurin activity. The present work suggests that of the proposed mechanisms for the calcium-induced activation of calcineurin (L-type Ca2+ channels, capacitative Ca2+ entry, Na+/H+ exchanger, Na+/Ca2+ exchanger and stretch-activated channels) all but stretch-activated channels are possible targets for the inhibition of hypertrophy.

Genetic bases of arrhythmogenic right ventricular Cardiomyopathy

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a heart muscle disease in which the pathological substrate is a fibro-fatty replacement of the right ventricular myocardium. The major clinical features are different types of arrhythmias with a left branch block pattern. ARVC shows autosomal dominant inheritance with incomplete penetrance. Recessive forms were also described, although in association with skin disorders.

Ten genetic loci have been discovered so far and mutations were reported in five different genes. ARVD1 was associated with regulatory mutations of transforming growth factor beta-3 (TGFβ3), whereas ARVD2, characterized by effort-induced polymorphic arrhythmias, was associated with mutations in cardiac ryanodine receptor-2 (RYR2). All other mutations identified to date have been detected in genes encoding desmosomal proteins: plakoglobin (JUP) which causes Naxos disease (a recessive form of ARVC associated with palmoplantar keratosis and woolly hair); desmoplakin (DSP) which causes the autosomal dominant ARVD8 and plakophilin-2 (PKP2) involved in ARVD9. Desmosomes are important cell-to-cell adhesion junctions predominantly found in epidermis and heart; they are believed to couple cytoskeletal elements to plasma membrane in cell-to-cell or cell-to-substrate adhesions.

Hemodynamics of a Pulsatile Left Ventricular Assist Device Driven by a Counterpulsation Pump in a Mock Circulation

The BCM (CardialCare, Minneapolis, MN, U.S.A.) is a pusher-plate pulsatile left ventricular assist device (LVAD) that is operated by counterpulsation pumps. The purpose of this work was to assess the fluid dynamics associated with operating the BCM in a mock circulation, and also to examine the similarities between hemodynamic parameters produced by this device in vitro and those produced by the left ventricle (LV) in vivo. The BCM was connected to a true size silicon rubber aorta and operated by an intra-aortic balloon pump. We examined the performance of the device at two system pressures (6.5 and 8 kPa); at three heart rates (60, 80, and 100 bpm); and at three pumping frequencies (1:1, 1:2, 1:3). Pressure and flow were measured in the upper descending aorta, and wave intensity analysis was used to calculate the peak intensity and energy of the compression and expansion waves. Pressure and flow waveforms produced by the BCM LVAD in vitro under different loading conditions were similar to those observed in vivo under similar loadings. Pusher-plate-type LVADs can produce compression and expansion waves similar to those generated by healthy LV in vivo.

Integrin stimulation induces calcium signalling in rat cardiomyocytes by a NO-dependent mechanism

The myocardial stretch-induced increase in intracellular [Ca(2+)] ([Ca(2+)](i)) is considered to be caused by integrin stimulation. Myocardial stretch is also associated with increased nitric oxide (NO) formation. We hypothesised that NO is implicated in calcium signalling following integrin stimulation. Integrins of neonatal rat cardiomyocytes were stimulated with a pentapeptide containing the Arg-Gly-Asp (RGD) sequence. [Ca(2+)](i) was measured with Fura2, [NO](i) was measured with DAF2 and phosphorylation of focal adhesion kinase (FAK) was monitored with immunofluorescence techniques. Integrin stimulation increased both [NO](i) and [Ca(2+)](i), the latter response being inhibited by ryanodine receptor-2 (RyR2) blockers and by N(G)-monomethyl-L-arginine (L-NMMA), an inhibitor of NOS, but resistant to GdCl(3), diltiazem and wortmannin. Integrin-induced intracellular Ca(2+) release thus appears to be independent of the influx of extracellular Ca(2+) and phosphatidylinositol-3 kinase activity. In addition, integrin stimulation induced phosphorylation of FAK. Our results provide evidence for an integrin-induced Ca(2+) release from RyR2 which is mediated by NO formation, probably via FAK-induced NOS activation.

Wave-energy patterns in carotid, brachial, and radial arteries: a noninvasive approach using wave-intensity analysis

The study of wave propagation at different points in the arterial circulation may provide useful information regarding ventriculoarterial interactions. We describe a number of hemodynamic parameters in the carotid, brachial, and radial arteries of normal subjects by using noninvasive techniques and wave-intensity analysis (WIA). Twenty-one normal adult subjects (14 men and 7 women, mean age 44 ± 6 yr) underwent applanation tonometry and pulsed-wave Doppler studies of the right common carotid, brachial, and radial arteries. After ensemble averaging of the pressure and flow-velocity data, local hydraulic work was determined and a pressure-flow velocity loop was used to determine local wave speed. WIA was then applied to determine the magnitude, timings, and energies of individual waves. At all sites, forward-traveling (S) and backward-traveling (R) compression waves were observed in early systole. In mid- and late systole, forward-traveling expansion waves (X and D) were also seen. Wave speed was significantly higher in the brachial (6.97 ± 0.58 m/s) and radial (6.78 ± 0.62 m/s) arteries compared with the carotid artery (5.40 ± 0.34 m/s; P < 0.05). S-wave energy was greatest in the brachial artery (993.5 ± 87.8 mJ/m2), but R-wave energy was greatest in the radial artery (176.9 ± 19.9 mJ/m2). X-wave energy was significantly higher in the brachial and radial arteries (176.4 ± 32.7 and 163.2 ± 30.5 mJ/m2, respectively) compared with the carotid artery (41.0 ± 9.4 mJ/m2; P < 0.001). WIA illustrates important differences in wave patterns between peripheral arteries and may provide a method for understanding ventriculo-arterial interactions in the time domain.

Molecular Mechanism of Apoptosis Induced by Mechanical Forces

In all biological systems, a balance between cell proliferation/growth and death is required for normal development as well as for adaptation to a changing environment. To affect their fate, it is essential for cells to integrate signals from the environment. Recently, it has been recognized that physical forces such as stretch, strain, and tension play a critical role in regulating this process. Despite intensive investigation, the pathways by which mechanical signals are converted to biochemical responses is yet to be completely understood. In this review, we will examine our current understanding of how mechanical forces induce apoptosis in a variety of biological systems. Rather than being a degenerative event, physical forces act through specific receptor-like molecules such as integrins, focal adhesion proteins, and the cytoskeleton. These molecules in turn activate a limited number of protein kinase pathways (p38 MAPK and JNK/SAPK), which amplify the signal and activate enzymes (caspases) that promote apoptosis. Physical forces concurrently activate other signaling pathways such as PIK-3 and Erk 1/2 MAPK, which modulate the apoptotic response. The cell phenotype and the character of the physical stimuli determine which pathways are activated and, consequently, allow for variability in response to a specific stimulus in different cell types.

Mechanotransduction in cardiac myocytes

Cardiac myocytes react to diverse mechanical demands with a multitude of transient and long-term responses to normalize the cellular mechanical environment. Several stretch-activated signaling pathways have been identified, most prominently guanine nucleotide binding proteins (G-proteins), mitogen-activated protein kinases (MAPK), Janus-associated kinase/signal transducers and activators of transcription (JAK/STAT), protein kinase C (PKC), calcineurin, intracellular calcium regulation, and several autocrine and paracrine factors. Multiple levels of crosstalk exist between pathways. The cellular response to changes in the mechanical environment can lead to cardiac myocyte hypertrophy, cellular growth that can be accompanied by pathological myocyte dysfunction, and tissue fibrosis. Several candidates for the primary mechanosensor in cardiac myocytes have been identified, ranging from stretch-activated ion channels in the membrane to yet-unknown mechanosensitive mechanisms in the nucleus. New and refined experimental techniques will exploit advances in molecular biology and biological imaging to study mechanotransduction in isolated cells and genetically engineered mice to explore the function of individual proteins.

Cardiac mechanotransduction and implications for heart disease

Mechanotransduction, the conversion of a mechanical stimulus into a cellular response, plays a fundamental role in cell volume regulation, fertilization, gravitaxis, proprioception, and the senses of hearing, touch, and balance. Mechanotransduction also fills important functions in the myocardium, where each cycle of contraction and relaxation leads to dynamic deformations. Since the initial observation of stretch induced muscle growth, our understanding of this complex field has been steadily growing, but remains incomplete. For example, the mechanism by which myocytes sense mechanical forces is still unknown. It is also unknown which mechanism converts such a stimulus into an electrochemical signal, and how this information is transferred to the nucleus. Is there a subpopulation of mechanosensing myocytes or mechanosensing cells in the myocardium? The following article offers an overview of the fundamental processes of mechanical stretch sensing in myocytes and recent advances in our understanding of this increasingly important field. Special emphasis is placed on the unique cardiac cytoskeletal structure and related Z-disc proteins.

Role of Ca2+ signaling in initiation of stretch-induced apoptosis in neonatal heart cells

Abnormal mechanical load, as seen in hypertension, is found to induce heart cell apoptosis, yet the signaling link between cell stretch and apoptotic pathways is not known. Using an in vitro stretch model mimicking diastolic pressure stress, here we show that Ca(2+) signaling participates essentially in the early stage of stretch-induced apoptosis. In neonatal rat cardiomyocytes, the moderate 20% stretch resulted in tonic elevation of intracellular free Ca(2+) ([Ca(2+)](i)). Buffering [Ca(2+)](i) by EGTA-AM, suppressing ryanodine-sensitive Ca(2+) release, and blocking L-type Ca(2+) channels all prevented the stretch-induced apoptosis as assessed by phosphatidylserine exposure and nuclear fragmentation. Notably, Ca(2+) suppression also prevented known stretch-activated apoptotic events, including caspase-3/-9 activation, mitochondrial membrane potential corruption, and reactive oxygen species production, suggesting that Ca(2+) signaling is the upstream of these events. Since [Ca(2+)](i) did not change without activating mechanosensitive Ca(2+) entry, we conclude that stretch-induced Ca(2+) entry, via the Ca(2+)-induced Ca(2+) release mechanism, plays an important role in initiating apoptotic signaling during mechanical stress.

Coronary perfusion and muscle lengthening increase cardiac contraction: different stretch-triggered mechanisms

An increase in coronary perfusion, transversal stretch of the myocardium, increases developed force (F(dev)) (Gregg effect) through activation of stretch-activated ion channels (SACs). Lengthening of the muscle, longitudinal stretch of the myocardium, causes an immediate increase in F(dev) followed by a slow F(dev) increase (Anrep effect). In isometrically contracting perfused papillary muscles of Wistar rats, we investigated whether both effects were based on similar stretch-induced mechanisms by measuring F(dev) and intracellular Ca(2+) concentration ([Ca(2+)](i)) after a muscle length increase from 85% to 95% L(max) (length at which maximal isometric force develops) at low and high coronary perfusion before and after inhibition of SACs with gadolinium (10 micromol/l Gd(3+)). The increase of F(dev) and peak [Ca(2+)](i) by the Gregg effect was of similar magnitude as the Anrep effect (from 3.5 +/- 0.8 to 3.9 +/- 1.2 mN/mm(2) and from 3.0 +/- 0.7% to 3.8 +/- 0.9% normalized [Ca(2+)](i), means +/- SE). SAC blockade completely blunted the increase of F(dev) and peak [Ca(2+)](i) by the Gregg effect; however, it did not affect the Anrep effect. The slow force response, but not the calcium response, was augmented by an increase in coronary perfusion. Therefore, increased coronary perfusion, transversal stretch of the myocardium, and muscle lengthening, longitudinal stretch of the myocardium, increase myocardial contraction in the rat through different stretch-triggered mechanisms.

Increased coronary perfusion augments cardiac contractility in the rat through stretch-activated ion channels

The role of stretch-activated ion channels (SACs) in coronary perfusion-induced increase in cardiac contractility was investigated in isolated isometrically contracting perfused papillary muscles from Wistar rats. A brief increase in perfusion pressure (3-4 s, perfusion pulse, n = 7), 10 repetitive perfusion pulses (n = 4), or a sustained increase in perfusion pressure (150-200 s, perfusion step, n = 7) increase developed force by 2.7 +/- 1.1, 7.7 +/- 2.2, and 8.3 +/- 2.5 mN/mm(2) (means +/- SE, P < 0.05), respectively. The increase in developed force after a perfusion pulse is transient, whereas developed force during a perfusion step remains increased by 5.1 +/- 2.5 mN/mm(2) (P < 0.05) in the steady state. Inhibition of SACs by addition of gadolinium (10 micromol/l) or streptomycin (40 and 100 micromol/l) blunts the perfusion-induced increase in developed force. Incubation with 100 micromol/l N(omega)-nitro-L-arginine [nitric oxide (NO) synthase inhibition], 10 micromol/l sodium nitroprusside (NO donation) and 0.1 micromol/l verapamil (L-type Ca(2+) channel blockade) are without effect on the perfusion-induced increase of developed force. We conclude that brief, repetitive, or sustained increases in coronary perfusion augment cardiac contractility through activation of stretch-activated ion channels, whereas endothelial NO release and L-type Ca(2+) channels are not involved.

Basic experimental studies and clinical aspects of gadolinium salts and chelates

Gadolinium is a lanthanide that has in recent years become more commonly present in our society. Organic chelates of gadolinium are increasingly used as contrast agents for the imaging of body fluids. Although adverse reactions to these agents are uncommon, it is known that gadolinium salts can bring about a wide variety of changes in physiology. Gadolinium chloride is widely used experimentally as an inhibitor of stretch-activated ion channels and physiological responses of tissues to mechanical stimulation. It is also employed as a selective inhibitor of macrophages in vivo. In this review, the known biochemical actions of gadolinium are brought together with its in vivo pharmacology and toxicology.

Helium inhalation enhances vasodilator effect of inhaled nitric oxide on pulmonary vessels in hypoxic dogs

There are theoretical and experimental indications that the presence of He as a balance gas markedly increase the diffusion velocity of other gases contained in a gas mixture. We allowed dogs with pulmonary vasoconstriction induced by hypoxia to inhale a mixture of 5 parts per million (ppm) of nitric oxide (NO) and O(2) balanced with He (NO in He) instead of N(2) (NO in N(2)). The dilating effect of NO in He and NO in N(2) on the pulmonary artery was evaluated by determining conventional pulmonary hemodynamic parameters, mean pulmonary artery (PA) pressure (MPAP), and pulmonary vascular resistance indexed to body surface area (PVRI), pulmonary impedance (Z), and the recently developed hemodynamic index, time-corrected wave intensity (WI). The main findings in this study were as follows: 1) hypoxia increased MPAP, PVRI, Z at 0 Hz (Z(0)), Z at the first harmonics, characteristic impedance (Z(c)), the reflection coefficient (Gamma), and the first peak of WI; 2) NO in N(2) reduced Z(0) and Gamma; and 3) NO in He reduced the first peak of WI and reduced Z(0) and Gamma more than NO in N(2). The enhanced vasodilatory effect of NO in He might be associated with facilitated diffusion of NO diluted in the gas mixture with He. In conclusion, increased efficacy of NO in He offers the possibility to reduce the inhaled NO concentration.

Mechanical stress stimulates phospholipase C activity and intracellular calcium ion levels in neonatal rat cardiomyocytes

To investigate how mechanical stress is sensed by cardiomyocytes and translated to cardiac hypertrophy, cardiomyocytes were subjected to stretch while measuring phospholipase C (PLC) and phospholipase D (PLD) activities and levels of intracellular calcium ions ([Ca2+]i) and pH. In stretched cardiomyocytes, PLC activity increased 2-fold after 30 min, whereas PLD activity hardly increased at all. Mechanical stress induced by prodding or by cell stretch increased [Ca2+](i)by a factor 5.2 and 4, respectively. Gadolinium chloride (stretch-activated channel blocker) attenuated the prodding-induced and stretch-induced [Ca2+](i)rise by about 50%. Blockade of ryanodine receptors by a combination of Ruthenium Red and procaine reduced the [Ca2+](i)rise only partially. Diltiazem (L-type Ca2+ channel antagonist) blocked the prodding-induced [Ca2+](i)rise completely, and reduced the stretch-induced [Ca2+](i)rise by about 50%. The stretch-induced [Ca2+](i)rise was unaffected by U73122, an inhibitor of PLC activity. Stretch did not cause cellular alkalinization. In conclusion, in cardiomyocytes, PLC and [Ca2+](i)levels are involved in the stretch-induced signal transduction, whereas PLD plays apparently no role. The stretch-induced rise in [Ca2+](i)in cardiomyocytes is most probably caused by [Ca2+](i)influx through L-type Ca2+ channels and stretch-activated channels, leading to Ca2+-induced Ca2+ -release from the SR via the ryanodine receptor.

A noninvasive method of measuring wave intensity, a new hemodynamic index: application to the carotid artery in patients with mitral regurgitation before and after surgery

Wave intensity (WI) is a new hemodynamic index, which is defined as (dP/dt)(dU/dt) at any site of the circulation, where dP/dt and dU/dt are the time derivatives of blood pressure and velocity, respectively. Arterial WI in normal subjects has two positive sharp peaks. The first peak occurs during early systole when a forward-traveling compression wave is generated by the left ventricle. The magnitude of this peak increases markedly with an increase in cardiac contractility. The second peak, which occurs towards the end of systole, is caused by generation of a forward-traveling expansion wave by the ability of the left ventricle to actively stop aortic blood flow. The interval between the R wave of the ECG and the first peak of WI (R-1st peak interval) and the interval between the first and second peaks (1st-2nd interval) are approximately equal to the preejection period and left ventricular ejection time, respectively. Using a combined Doppler and echo-tracking system, we obtained carotid arterial WI noninvasively. We examined the characteristics of WI in 11 patients with mitral regurgitation (MR) before and after surgery, and 24 normal volunteers. In the MR group before surgery, the second peak was decreased and the (1st-2nd interval)/(R-R interval) ratio was reduced, compared with the normal group (140 +/- 130 vs 750 +/- 290mmHg m/s3. P < 0.0083; 20.7% +/- 3.4% vs 26.7% +/- 2.8%, P < 0.083). There were no significant differences in the first peak between the normal group and the MR group before and after surgery. The second peak in the MR group was increased significantly (P < 0.016 vs before surgery) to 1,150 +/- 830mmHg m/s3 in the early period after surgery (stage I), and to 1,090 +/- 580mmHgm/s3 in the late period after surgery (stage II). These values did not differ significantly from that of the normal group. At stage I, the (R-1st peak interval)/ (R-R interval) ratio was increased from 13.4% +/- 2.7% to 20.6% +/- 5.6% (P < 0.016 vs before surgery). At stage II, this ratio decreased to 16.2% +/- 2.8% (P < 0.016 vs stage I). but was still significantly higher than that before surgery. The (1st-2nd interval)/(R-R interval) ratio increased significantly after surgery (P < 0.016 vs before surgery) to values (27.0% +/- 4.5% at stage I and 28.9% +/- 2.6% at stage II) which did not differ significantly from that of the normal group. The recovery of the second peak after surgery suggests that the left ventricle had recovered the ability to actively stop aortic blood flow. Wave intensity is useful for analyzing changes in the working condition of the heart.

Analysis of wave reflections in the arterial system using wave intensity: a novel method for predicting the timing and amplitude of reflected waves

The timing and amplitude of reflected arterial waves in the ascending aorta were studied by analysis of the aortic pressure waveform and were compared with those derived using wave intensity analysis. Wave intensity analysis considers aortic pressure changes to be the result of forward and backward wavelets carrying energy. Wave intensity (dI = dPdU) is calculated from changes in pressure (dP) and flow velocity (dU), and its sign indicates the direction of travel of propagating wavelets (positive for forward-traveling waves and vice versa). We measured aortic pressure and flow velocity in 14 patients, mean age 60+/-9 years, with three-vessel coronary artery disease at the time of surgical revascularization. The travel time of the reflected wave derived from analysis of the aortic pressure waveform (tp) was measured from the foot of the aortic pressure waveform to the inflection point of the aortic pressure (derived objectively from the zero of second derivative of aortic pressure). From wave intensity analysis, the travel time of the reflected wave was measured to the onset of the wave intensity of the backward-traveling wave dI_ (t(i)), and to the onset of the separated backward pressure wave (t(b)). All patients showed an aortic pressure waveform characterized by an inflection point on the rising limb of the aortic pressure, followed by a secondary rise in pressure, representing the return of reflected waves. Wave intensity analysis consistently showed a negative peak in mid systole, the timing of its onset corresponding closely to the inflection point of the aortic pressure. The travel time of the reflected wave derived from the analysis of the aortic pressure waveform (t(p)) was 121+/-21ms and showed close agreement with ti (118+/-28 ms) and t(b) (115+/-29ms), with mean differences of 4 and 6ms, and 95% confidence intervals of difference (-2 to 7 ms) and (1 to 12ms), respectively. The augmentation index, a measure of the secondary increase in aortic pressure due to reflected waves, was significantly correlated with the magnitude of dI_ (r = 0.63, P < 0.001). Wave intensity is a quantity that indicates the rate of energy flux due to wave travel and since its value is positive for forward-traveling waves and negative for backward-traveling waves, its calculation allows the timing of reflected waves to be accurately predicted. Furthermore, the magnitude of wave intensity in backward-traveling waves (dI_) is related to the augmentation index and may provide a measure of the amplitude of the reflected wave. This analysis of the arterial system is done in the time domain and therefore can be easily applied to assess temporal changes in arterial characteristics.

Mechanically induced calcium waves in articular chondrocytes are inhibited by gadolinium and amiloride

Chondrocytes in articular cartilage utilize mechanical signals from their environment to regulate their metabolic activity. However, the sequence of events involved in the transduction of mechanical signals to a biochemical signal is not fully understood. It has been proposed that an increase in the concentration of intracellular calcium ion ([Ca2+]i) is one of the earliest events in the process of cellular mechanical signal transduction. With use of fluorescent confocal microscopy, [Ca2+]i was monitored in isolated articular chondrocytes subjected to controlled deformation with the edge of a glass micropipette. Mechanical stimulation resulted in an immediate and transient increase in [Ca2+]i. The initiation of Ca2+ waves was abolished by removing Ca2+ from the extracellular media and was significantly inhibited by the presence of gadolinium ion (10 microM) or amiloride (1 mM), which have previously been reported to block mechanosensitive ion channels. Inhibitors of intracellular Ca2+ release (dantrolene and 8-diethylaminooctyl 3,4,5-trimethoxybenzoate hydrochloride) or cytoskeletal disrupting agents (cytochalasin D and colchicine) had no significant effect on the characteristics of the Ca2+ waves. These findings suggest that a possible mechanism of Ca2+ mobilization in this case is a self-reinforcing influx of Ca2+ from the extracellular media, initiated by a Ca2+-permeable mechanosensitive ion channel. Our results indicate that a transient increase in intracellular Ca2+ concentration may be one of the earliest events involved in the response of chondrocytes to mechanical stress and support the hypothesis that deformation-induced Ca2+ waves are initiated through mechanosensitive ion channels.