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Gaddam RR, Amalkar VS, Sali VK, Nakuluri K, Jacobs JS, Kim YR, Li Q, Bahal R, Irani K, Vikram A. Role of miR-204 in segmental cardiac effects of phenylephrine and pressure overload. Biochem Biophys Res Commun 2023; 675:85-91. [PMID: 37454401 DOI: 10.1016/j.bbrc.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
Cardiotoxicity caused by adrenergic receptor agonists overdosing or stress-induced catecholamine release promotes cardiomyopathy, resembling Takotsubo cardiomyopathy (TC). TC is characterized by transient regional systolic dysfunction of the left ventricle. The animal models of TC and modalities for assessing regional wall motion abnormalities in animal models are lacking. We previously reported the protective role of a small noncoding microRNA-204-5p (miR-204) in cardiomyopathies, but its role in TC remains unknown. Here we compared the impact of miR-204 absence on phenylephrine (PE)-induced and transaortic constriction (TAC)-induced changes in cardiac muscle motion in the posterior and anterior apical, mid, and basal segments of the left ventricle using 2-dimensional speckle-tracking echocardiography (2-STE). Wildtype and miR-204-/- mice were subjected to cardiac stress in the form of PE for four weeks or TAC-induced pressure overload for five weeks. PE treatment increased longitudinal and radial motion in the apex of the left ventricle and shortened the peak motion time of all left ventricle segments. The TAC led to decreased longitudinal and radial motion in the left ventricle segments, and there was no difference in the peak motion time. Compared to wildtype mice, PE-induced peak cardiac muscle motion time in the anterior base of the left ventricle was significantly earlier in the miR-204-/- mice. There was no difference in TAC-induced peak cardiac muscle motion time between wildtype and miR-204-/- mice. Our findings demonstrate that PE and TAC induce regional wall motion abnormalities that 2-STE can detect. It also highlights the role of miR-204 in regulating cardiac muscle motion during catecholamine-induced cardiotoxicity.
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Affiliation(s)
- Ravinder Reddy Gaddam
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, IA, USA; Abboud Cardiovascular Research Center, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Veda Sudhir Amalkar
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, IA, USA
| | - Veeresh Kumar Sali
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, IA, USA
| | - Krishnamurthy Nakuluri
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, IA, USA
| | - Julie S Jacobs
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, IA, USA
| | - Young-Rae Kim
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, IA, USA
| | - Quixia Li
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, IA, USA
| | - Raman Bahal
- Department of Pharmaceutical Sciences, University of Connecticut, Storrs, CT-06269, USA
| | - Kaikobad Irani
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, IA, USA; Abboud Cardiovascular Research Center, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Fraternal Order of Eagles Diabetes Research Center (FOEDRC), University of Iowa Carver College of Medicine, Iowa City, IA, USA; Veterans Affairs Medical Center, Iowa City, IA, USA, Department of Medicine, University of Iowa, Iowa City, IA, 52242, USA.
| | - Ajit Vikram
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, IA, USA; Abboud Cardiovascular Research Center, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Fraternal Order of Eagles Diabetes Research Center (FOEDRC), University of Iowa Carver College of Medicine, Iowa City, IA, USA.
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2
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van Weperen VYH, Ripplinger CM, Vaseghi M. Autonomic control of ventricular function in health and disease: current state of the art. Clin Auton Res 2023; 33:491-517. [PMID: 37166736 PMCID: PMC10173946 DOI: 10.1007/s10286-023-00948-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/20/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE Cardiac autonomic dysfunction is one of the main pillars of cardiovascular pathophysiology. The purpose of this review is to provide an overview of the current state of the art on the pathological remodeling that occurs within the autonomic nervous system with cardiac injury and available neuromodulatory therapies for autonomic dysfunction in heart failure. METHODS Data from peer-reviewed publications on autonomic function in health and after cardiac injury are reviewed. The role of and evidence behind various neuromodulatory therapies both in preclinical investigation and in-use in clinical practice are summarized. RESULTS A harmonic interplay between the heart and the autonomic nervous system exists at multiple levels of the neuraxis. This interplay becomes disrupted in the setting of cardiovascular disease, resulting in pathological changes at multiple levels, from subcellular cardiac signaling of neurotransmitters to extra-cardiac, extra-thoracic remodeling. The subsequent detrimental cycle of sympathovagal imbalance, characterized by sympathoexcitation and parasympathetic withdrawal, predisposes to ventricular arrhythmias, progression of heart failure, and cardiac mortality. Knowledge on the etiology and pathophysiology of this condition has increased exponentially over the past few decades, resulting in a number of different neuromodulatory approaches. However, significant knowledge gaps in both sympathetic and parasympathetic interactions and causal factors that mediate progressive sympathoexcitation and parasympathetic dysfunction remain. CONCLUSIONS Although our understanding of autonomic imbalance in cardiovascular diseases has significantly increased, specific, pivotal mediators of this imbalance and the recognition and implementation of available autonomic parameters and neuromodulatory therapies are still lagging.
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Affiliation(s)
- Valerie Y H van Weperen
- Division of Cardiology, Department of Medicine, UCLA Cardiac Arrythmia Center, University of California, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA
| | | | - Marmar Vaseghi
- Division of Cardiology, Department of Medicine, UCLA Cardiac Arrythmia Center, University of California, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA.
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3
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Couch LS, Channon K, Thum T. Molecular Mechanisms of Takotsubo Syndrome. Int J Mol Sci 2022; 23:12262. [PMID: 36293121 PMCID: PMC9603071 DOI: 10.3390/ijms232012262] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 12/04/2022] Open
Abstract
Takotsubo syndrome (TTS) is a severe but reversible acute heart failure syndrome that occurs following high catecholaminergic stress. TTS patients are similar to those with acute coronary syndrome, with chest pain, dyspnoea and ST segment changes on electrocardiogram, but are characterised by apical akinesia of the left ventricle, with basal hyperkinesia in the absence of culprit coronary artery stenosis. The pathophysiology of TTS is not completely understood and there is a paucity of evidence to guide treatment. The mechanisms of TTS are thought to involve catecholaminergic myocardial stunning, microvascular dysfunction, increased inflammation and changes in cardiomyocyte metabolism. Here, we summarise the available literature to focus on the molecular basis for the pathophysiology of TTS to advance the understanding of the condition.
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Affiliation(s)
- Liam S. Couch
- Department of Cardiovascular Medicine, University of Oxford, Oxford OX1 2JD, UK
| | - Keith Channon
- Department of Cardiovascular Medicine, University of Oxford, Oxford OX1 2JD, UK
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies, Hannover Medical School, 30625 Hannover, Germany
- Fraunhofer Institute of Toxicology and Experimental Medicine, 30625 Hannover, Germany
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4
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Tranter MH, Redfors B, Wright PT, Couch LS, Lyon AR, Omerovic E, Harding SE. Hyperthermia as a trigger for Takotsubo syndrome in a rat model. Front Cardiovasc Med 2022; 9:869585. [PMID: 35958426 PMCID: PMC9360576 DOI: 10.3389/fcvm.2022.869585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/04/2022] [Indexed: 12/23/2022] Open
Abstract
Takotsubo syndrome is a well-characterized cause of acute yet reversible heart failure associated with periods of intense emotional stress, often mimicking on presentation an acute coronary syndrome. Animal models of Takotsubo syndrome have been developed, either through the application of a stressor, or administration of exogenous catecholamine. We found that in a model of isoproterenol-induced Takotsubo syndrome in anesthetized rats hyperthermia (40–41°C) would occur after the administration of isoproterenol. Maintenance of this hyperthermia would result in an apical hypocontractility typical of the syndrome, whereas prevention of hyperthermia with active cooling to maintain a euthermic core body temperature prevented (but did not subsequently reverse) apical hypocontractility. In vitro experimentation with isolated cardiomyocytes showed no effect of hyperthermia on either baseline contractility or contractility change after beta-adrenoceptor stimulation. We suggest that the rise in body temperature that is characteristic of catecholamine storm may be a component in the development of Takotsubo syndrome.
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Affiliation(s)
- Matthew H. Tranter
- Faculty of Medicine, Imperial College London, Hammersmith Campus, National Heart and Lung Institute (NHLI), London, United Kingdom
- Oriel College, University of Oxford, Oxford, United Kingdom
- *Correspondence: Matthew H. Tranter
| | - Bjorn Redfors
- Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter T. Wright
- Faculty of Medicine, Imperial College London, Hammersmith Campus, National Heart and Lung Institute (NHLI), London, United Kingdom
- School of Life and Health Sciences, University of Roehampton, London, United Kingdom
| | - Liam S. Couch
- Faculty of Medicine, Imperial College London, Hammersmith Campus, National Heart and Lung Institute (NHLI), London, United Kingdom
| | - Alexander R. Lyon
- Faculty of Medicine, Imperial College London, Hammersmith Campus, National Heart and Lung Institute (NHLI), London, United Kingdom
| | - Elmir Omerovic
- Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sian E. Harding
- Faculty of Medicine, Imperial College London, Hammersmith Campus, National Heart and Lung Institute (NHLI), London, United Kingdom
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Fan X, Yang G, Kowitz J, Akin I, Zhou X, El-Battrawy I. Takotsubo Syndrome: Translational Implications and Pathomechanisms. Int J Mol Sci 2022; 23:ijms23041951. [PMID: 35216067 PMCID: PMC8875072 DOI: 10.3390/ijms23041951] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/04/2022] [Accepted: 02/05/2022] [Indexed: 02/07/2023] Open
Abstract
Takotsubo syndrome (TTS) is identified as an acute severe ventricular systolic dysfunction, which is usually characterized by reversible and transient akinesia of walls of the ventricle in the absence of a significant obstructive coronary artery disease (CAD). Patients present with chest pain, ST-segment elevation or ischemia signs on ECG and increased troponin, similar to myocardial infarction. Currently, the known mechanisms associated with the development of TTS include elevated levels of circulating plasma catecholamines and their metabolites, coronary microvascular dysfunction, sympathetic hyperexcitability, inflammation, estrogen deficiency, spasm of the epicardial coronary vessels, genetic predisposition and thyroidal dysfunction. However, the real etiologic link remains unclear and seems to be multifactorial. Currently, the elusive pathogenesis of TTS and the lack of optimal treatment leads to the necessity of the application of experimental models or platforms for studying TTS. Excessive catecholamines can cause weakened ventricular wall motion at the apex and increased basal motion due to the apicobasal adrenoceptor gradient. The use of beta-blockers does not seem to impact the outcome of TTS patients, suggesting that signaling other than the beta-adrenoceptor-associated pathway is also involved and that the pathogenesis may be more complex than it was expected. Herein, we review the pathophysiological mechanisms related to TTS; preclinical TTS models and platforms such as animal models, human-induced pluripotent stem cell-derived cardiomyocyte (hiPSC-CM) models and their usefulness for TTS studies, including exploring and improving the understanding of the pathomechanism of the disease. This might be helpful to provide novel insights on the exact pathophysiological mechanisms and may offer more information for experimental and clinical research on TTS.
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Affiliation(s)
- Xuehui Fan
- First Department of Medicine, Medical Faculty Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, 68167 Mannheim, Germany; (X.F.); (J.K.); (I.A.)
- Key Laboratory of Medical Electrophysiology, Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Collaborative Innovation Center for Prevention of Cardiovascular Diseases, Institute of Cardiovascular Research, Southwest Medical University, Luzhou 646000, China
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, 68167 Mannheim, Germany
| | - Guoqiang Yang
- Department of Acupuncture and Rehabilitation, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou 646000, China;
- Research Unit of Molecular Imaging Probes, Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Jacqueline Kowitz
- First Department of Medicine, Medical Faculty Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, 68167 Mannheim, Germany; (X.F.); (J.K.); (I.A.)
| | - Ibrahim Akin
- First Department of Medicine, Medical Faculty Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, 68167 Mannheim, Germany; (X.F.); (J.K.); (I.A.)
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, 68167 Mannheim, Germany
| | - Xiaobo Zhou
- First Department of Medicine, Medical Faculty Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, 68167 Mannheim, Germany; (X.F.); (J.K.); (I.A.)
- Key Laboratory of Medical Electrophysiology, Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Collaborative Innovation Center for Prevention of Cardiovascular Diseases, Institute of Cardiovascular Research, Southwest Medical University, Luzhou 646000, China
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, 68167 Mannheim, Germany
- Correspondence: (X.Z.); (I.E.-B.)
| | - Ibrahim El-Battrawy
- First Department of Medicine, Medical Faculty Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, 68167 Mannheim, Germany; (X.F.); (J.K.); (I.A.)
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, 68167 Mannheim, Germany
- Correspondence: (X.Z.); (I.E.-B.)
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6
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Omerovic E, Citro R, Bossone E, Redfors B, Backs J, Bruns B, Ciccarelli M, Couch LS, Dawson D, Grassi G, Iacoviello M, Parodi G, Schneider B, Templin C, Ghadri JR, Thum T, Chioncel O, Tocchetti CG, Van Der Velden J, Heymans S, Lyon AR. Pathophysiology of Takotsubo Syndrome - a joint scientific statement from the Heart Failure Association Takotsubo Syndrome Study Group and Myocardial Function Working Group of the European Society of Cardiology - Part 1: Overview and the central role for catecholamines and sympathetic nervous system. Eur J Heart Fail 2021; 24:257-273. [PMID: 34907620 DOI: 10.1002/ejhf.2400] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/04/2021] [Accepted: 12/07/2021] [Indexed: 11/11/2022] Open
Abstract
This is the first part of a scientific statement from the Heart Failure Association of the European Society of Cardiology focused upon the pathophysiology of Takotsubo syndrome and is complimentary to the previous HFA Position Statement on Takotsubo syndrome which focused upon clinical management. In part 1 we provide an overview of the pathophysiology of Takotsubo syndrome and fundamental questions to consider. We then review and discuss the central role of catecholamines and the sympathetic nervous system in the pathophysiology, and the direct effects of high surges in catecholamines upon myocardial biology including β-adrenergic receptor signaling, G protein coupled receptor kinases, cardiomyocyte calcium physiology, myofilament physiology, cardiomyocyte gene expression, myocardial electrophysiology and arrhythmogenicity, myocardial inflammation, metabolism and energetics. The integrated effects upon ventricular haemodynamics are discussed and integrated into the pathophysiological model. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Rodolfo Citro
- Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Eduardo Bossone
- Division of Cardiology, A. Cardarelli Hospital, Naples, Italy
| | - Bjorn Redfors
- Department of Cardiology, Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Johannes Backs
- Institute of Experimental Cardiology, Heidelberg University, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Germany
| | - Bastian Bruns
- Institute of Experimental Cardiology, Heidelberg University, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Germany.,Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Michele Ciccarelli
- Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy
| | - Liam S Couch
- National Heart and Lung Institute, Imperial College, London, UK
| | - Dana Dawson
- Aberdeen Cardiovascular and Diabetes Centre, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, Scotland, UK
| | - Guido Grassi
- Clinica Medica, University of Milano Bicocca, Milan, Italy
| | - Massimo Iacoviello
- University Cardiology Unit, Cardiothoracic Department, University Hospital, Bari, Italy
| | - Guido Parodi
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
| | | | - Christian Templin
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Jelena R Ghadri
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Thum
- Hannover Medical School, Institute of Molecular and Translational Therapeutic Strategies, Hannover, Germany
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania and University of Medicine Carol Davila, Bucharest, Romania
| | - C Gabriele Tocchetti
- Department of Translational Medical Sciences and Interdepartmental Center for Clinical and Translational Research (CIRCET), Federico II University, Naples, Italy
| | | | - Stephane Heymans
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, The Netherlands and Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology and Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Alexander R Lyon
- National Heart and Lung Institute, Imperial College, London, UK.,Department of Cardiology, Royal Brompton Hospital, London, United Kingdom
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7
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Budnik M, Piątkowski R, Ochijewicz D, Zaleska M, Grabowski M, Opolski G. Pathophysiology of Takotsubo Syndrome as A Bridge to Personalized Treatment. J Pers Med 2021; 11:jpm11090879. [PMID: 34575656 PMCID: PMC8466771 DOI: 10.3390/jpm11090879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 08/29/2021] [Accepted: 08/30/2021] [Indexed: 01/17/2023] Open
Abstract
Takotsubo syndrome (TTS) consists of transient dysfunction of the left and/or right ventricle in the absence of ruptured plaque; thrombus or vessel dissection. TTS may be divided into two categories. Primary TTS occurs when the cause of hospitalization is the symptoms resulting from damage to the myocardium usually preceded by emotional stress. Secondary TTS occurs in patients hospitalized for other medical; surgical; anesthetic; obstetric or psychiatric conditions who have activation of their sympathetic nervous system and catecholamines release- they develop TTS as a complication of their primary condition or its treatment. There are several hypotheses concerning the cause of the disease. They include a decrease in estrogen levels; microcirculation dysfunction; endothelial dysfunction and the hypothesis based on the importance of the brain-heart axis. More and more research concerns the importance of genetic factors in the development of the disease. To date; no effective treatment or prevention of recurrent TTS has been found. Only when the pathophysiology of the disease is fully known; then personalized treatment will be possible.
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8
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Lyon AR, Citro R, Schneider B, Morel O, Ghadri JR, Templin C, Omerovic E. Pathophysiology of Takotsubo Syndrome: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 77:902-921. [PMID: 33602474 DOI: 10.1016/j.jacc.2020.10.060] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/13/2020] [Accepted: 10/19/2020] [Indexed: 01/09/2023]
Abstract
Takotsubo syndrome (TTS) has been a recognized clinical entity for 31 years, since its first description in 1990. TTS is now routinely diagnosed in patients who present with acute chest pain, electrocardiographic changes, troponin elevation, unobstructed coronary arteries, and a typical pattern of circumferential left ventricular wall motion abnormalities that usually involve the apical and midventricular myocardium. Increasing understanding of this intriguing syndrome stems from wider recognition, possible increasing frequency, and a rising number of publications focused on the pathophysiology in clinical and laboratory studies. A comprehensive understanding of TTS pathophysiology and evidence-based treatments are lacking, and specific and effective treatments are urgently required. This paper reviews the pathophysiology of this fascinating syndrome; what is known from both clinical and preclinical studies, including review of the evidence for microvascular dysfunction, myocardial beta-adrenergic signaling, inflammation, and electrophysiology; and where focused research needs to fill gaps in understanding TTS.
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Affiliation(s)
- Alexander R Lyon
- Department of Cardiology, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, United Kingdom.
| | - Rodolfo Citro
- Cardio-Thoracic and Vascular Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy
| | | | - Olivier Morel
- Department of Cardiology, University of Strasbourg, UMR INSERM 1260 Regenerative Nanomedicine, Strasbourg, France
| | - Jelena R Ghadri
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Elmir Omerovic
- Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. https://twitter.com/ElmirOmerovic2
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Gibson LE, Klinker MR, Wood MJ. Variants of Takotsubo syndrome in the perioperative period: A review of potential mechanisms and anaesthetic implications. Anaesth Crit Care Pain Med 2020; 39:647-654. [PMID: 32920217 DOI: 10.1016/j.accpm.2020.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/29/2020] [Accepted: 01/29/2020] [Indexed: 01/27/2023]
Abstract
Takotsubo syndrome (TS) is a condition of transient cardiac dysfunction that develops in the setting of abrupt sympathetic stimulation. Although classically identified by ballooning of the apical segment, TS can also present in atypical forms with abnormalities of the basal, mid-ventricular, or other focal segments. In the perioperative setting, anaesthetic effects and physiologic perturbations from surgery can further confound the diagnosis. We present a narrative review of the most recent evidence for underlying pathophysiologic mechanisms of the variable ballooning patterns and highlight important anaesthetic considerations in the diagnosis and management of these patients.
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Affiliation(s)
- Lauren E Gibson
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States.
| | - Mark R Klinker
- Concord Hospital Cardiac Associates, Concord, NH, United States
| | - Malissa J Wood
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, United States
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10
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Sigalas C, Cremer M, Winbo A, Bose SJ, Ashton JL, Bub G, Montgomery JM, Burton RAB. Combining tissue engineering and optical imaging approaches to explore interactions along the neuro-cardiac axis. ROYAL SOCIETY OPEN SCIENCE 2020; 7:200265. [PMID: 32742694 PMCID: PMC7353978 DOI: 10.1098/rsos.200265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/27/2020] [Indexed: 05/05/2023]
Abstract
Interactions along the neuro-cardiac axis are being explored with regard to their involvement in cardiac diseases, including catecholaminergic polymorphic ventricular tachycardia, hypertension, atrial fibrillation, long QT syndrome and sudden death in epilepsy. Interrogation of the pathophysiology and pathogenesis of neuro-cardiac diseases in animal models present challenges resulting from species differences, phenotypic variation, developmental effects and limited availability of data relevant at both the tissue and cellular level. By contrast, tissue-engineered models containing cardiomyocytes and peripheral sympathetic and parasympathetic neurons afford characterization of cellular- and tissue-level behaviours while maintaining precise control over developmental conditions, cellular genotype and phenotype. Such approaches are uniquely suited to long-term, high-throughput characterization using optical recording techniques with the potential for increased translational benefit compared to more established techniques. Furthermore, tissue-engineered constructs provide an intermediary between whole animal/tissue experiments and in silico models. This paper reviews the advantages of tissue engineering methods of multiple cell types and optical imaging techniques for the characterization of neuro-cardiac diseases.
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Affiliation(s)
| | - Maegan Cremer
- Department of Pharmacology, University of Oxford, Oxford, UK
| | - Annika Winbo
- Department of Physiology, University of Auckland, Auckland, New Zealand
- Department of Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand
| | - Samuel J. Bose
- Department of Pharmacology, University of Oxford, Oxford, UK
| | - Jesse L. Ashton
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Gil Bub
- Department of Physiology, McGill University, Montreal, Canada
| | | | - Rebecca A. B. Burton
- Department of Pharmacology, University of Oxford, Oxford, UK
- Author for correspondence: Rebecca A. B. Burton e-mail:
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Zaghlol R, Kashyap K, Al-Shbool G, Basyal B, Desale S, Campia U, Barac A. Usefulness of Malignancy as a Predictor of WorseIn-Hospital Outcomes in Patients With Takotsubo Cardiomyopathy. Am J Cardiol 2019; 123:995-1001. [PMID: 30595393 DOI: 10.1016/j.amjcard.2018.11.054] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/26/2018] [Accepted: 11/30/2018] [Indexed: 01/18/2023]
Abstract
Takotsubo cardiomyopathy (TC) is a form of dilated cardiomyopathy often associated with physical or emotional stress. Association with cancer has been reported, however, in-hospital outcomes in TC patients with history of malignancy have not been fully characterized. We conducted a retrospective chart review of hospitalized patients with diagnosis of TC between January 2006 and January 2017. Patients were divided into 2 groups based on the previous history of malignancy. Presenting symptoms, cardiac imaging and short-term events including in-hospital complications and mortality, were compared. Of 318 patients with TC, 81 (25.4%) had a previous diagnosis of cancer. Mean age was 67.5 (SD 12.6), 151 (47.5%) were African American, 122 (38.4%) Caucasian, and 10 (3.1%) of other ethnicities. Patients with history of malignancy were older (70.0 [SD 10.6] vs 66.6 [SD 13.1] years, p = 0.03), had higher heart rate on presentation (93 [SD 19] vs 87 [SD 25] beats/minute, p = 0.03), higher prevalence of severely decreased cardiac function (left ventricular ejection fraction <25%) (29.6% vs 16%, p = 0.01), longer hospitalization (7 (4-13) vs 4 (3-8) days, p = 0.001) and experienced more in-hospital cardiac arrests (6 [7.4%] vs 5 [2.1%], p = 0.035) compared with patients without malignancy history. Higher percentage of longer hospitalization and left ventricular ejection fraction <25% in the cancer group persisted after controlling for sepsis, chemotherapy exposure, and metastatic disease. In conclusion, in a racially diverse hospitalized population of TC, prevalence of cancer history is high, and diagnosis of previous malignancy is associated with adverse in-hospital outcomes.
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Niederer SA, Campbell KS, Campbell SG. A short history of the development of mathematical models of cardiac mechanics. J Mol Cell Cardiol 2018; 127:11-19. [PMID: 30503754 PMCID: PMC6525149 DOI: 10.1016/j.yjmcc.2018.11.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/02/2018] [Accepted: 11/21/2018] [Indexed: 11/15/2022]
Abstract
Cardiac mechanics plays a crucial role in atrial and ventricular function, in the regulation of growth and remodelling, in the progression of disease, and the response to treatment. The spatial scale of the critical mechanisms ranges from nm (molecules) to cm (hearts) with the fastest events occurring in milliseconds (molecular events) and the slowest requiring months (growth and remodelling). Due to its complexity and importance, cardiac mechanics has been studied extensively both experimentally and through mathematical models and simulation. Models of cardiac mechanics evolved from seminal studies in skeletal muscle, and developed into cardiac specific, species specific, human specific and finally patient specific calculations. These models provide a formal framework to link multiple experimental assays recorded over nearly 100 years into a single unified representation of cardiac function. This review first provides a summary of the proteins, physiology and anatomy involved in the generation of cardiac pump function. We then describe the evolution of models of cardiac mechanics starting with the early theoretical frameworks describing the link between sarcomeres and muscle contraction, transitioning through myosin-level models to calcium-driven systems, and ending with whole heart patient-specific models.
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Affiliation(s)
| | - Kenneth S Campbell
- Department of Physiology and Division of Cardiovascular Medicine, University of Kentucky, Lexington, USA
| | - Stuart G Campbell
- Departments of Biomedical Engineering and Cellular and Molecular Physiology, Yale University, New Haven, USA
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13
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Hydrogen sulfide attenuates cardiac injury in takotsubo cardiomyopathy by alleviating oxidative stress. Nitric Oxide 2017; 67:10-25. [PMID: 28450188 DOI: 10.1016/j.niox.2017.04.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 03/23/2017] [Accepted: 04/21/2017] [Indexed: 12/16/2022]
Abstract
Takotsubo cardiomyopathy (TCM) is characterized by transient left ventricular apical ballooning with the absence of coronary occlusion, which is an acute cardiac syndrome with substantial morbidity and mortality. It was reported that reduced endogenous hydrogen sulfide (H2S) levels may be related to various heart diseases. The present study investigated the mechanism by which H2S administration modulates and protects cardiac function in TCM rats. In order to establish a TCM model, Sprague Dawley (SD) rats were injected with a single dose of β-adrenergic agonist isoprenaline (ISO). We found that ISO induced cardiac dysfunction, which was characterized by a significant decrease in left ventricular systolic pressure (LVSP), maximum contraction velocity (+dp/dtmax), maximum relaxation velocity (-dp/dtmax) and increased left ventricular end-diastolic pressure (LVEDP). Accordingly, we found that plasma and heart tissue H2S levels in TCM rats decreased significantly, and cardiac cystathionine γ-lyase (CSE) and 3-mercaptopyruvate sulfurtransferase (3-MST) expression were lower. Moreover, cardiac dysfunction in TCM was associated with oxidative stress response and reactive oxygen species (ROS) formation. NADPH Oxidase 4 (NOX4) and p67 protein expressions significantly increased in TCM cardiac tissues. In addition, Sodium hydrosulfide (NaHS) ameliorated ISO-induced cardiac dysfunction and reversed ISO-induced oxidative stress. This study revealed that H2S exerted cardioprotective effects by reducing NADPH oxidase, which reduced ROS formation and prevented oxidative stress. Our study provided novel evidence that H2S is protective in myocardial dysfunction in TCM rats and could be a therapeutic target for alleviating β-adrenergic system overstimulation-induced cardiovascular dysfunction.
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Land S, Park-Holohan SJ, Smith NP, Dos Remedios CG, Kentish JC, Niederer SA. A model of cardiac contraction based on novel measurements of tension development in human cardiomyocytes. J Mol Cell Cardiol 2017; 106:68-83. [PMID: 28392437 DOI: 10.1016/j.yjmcc.2017.03.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 01/12/2017] [Accepted: 03/31/2017] [Indexed: 11/18/2022]
Abstract
Experimental data from human cardiac myocytes at body temperature is crucial for a quantitative understanding of clinically relevant cardiac function and development of whole-organ computational models. However, such experimental data is currently very limited. Specifically, important measurements to characterize changes in tension development in human cardiomyocytes that occur with perturbations in cell length are not available. To address this deficiency, in this study we present an experimental data set collected from skinned human cardiac myocytes, including the passive and viscoelastic properties of isolated myocytes, the steady-state force calcium relationship at different sarcomere lengths, and changes in tension following a rapid increase or decrease in length, and after constant velocity shortening. This data set is, to our knowledge, the first characterization of length and velocity-dependence of tension generation in human skinned cardiac myocytes at body temperature. We use this data to develop a computational model of contraction and passive viscoelasticity in human myocytes. Our model includes troponin C kinetics, tropomyosin kinetics, a three-state crossbridge model that accounts for the distortion of crossbridges, and the cellular viscoelastic response. Each component is parametrized using our experimental data collected in human cardiomyocytes at body temperature. Furthermore we are able to confirm that properties of length-dependent activation at 37°C are similar to other species, with a shift in calcium sensitivity and increase in maximum tension. We revise our model of tension generation in the skinned isolated myocyte to replicate reported tension traces generated in intact muscle during isometric tension, to provide a model of human tension generation for multi-scale simulations. This process requires changes to calcium sensitivity, cooperativity, and crossbridge transition rates. We apply this model within multi-scale simulations of biventricular cardiac function and further refine the parametrization within the whole organ context, based on obtaining a healthy ejection fraction. This process reveals that crossbridge cycling rates differ between skinned myocytes and intact myocytes.
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Affiliation(s)
- Sander Land
- Department of Biomedical Engineering, King's College London, UK.
| | - So-Jin Park-Holohan
- Cardiovascular Division, King's College London British Heart Foundation Centre of Research Excellence, UK
| | - Nicolas P Smith
- Department of Engineering Science, University of Auckland, New Zealand
| | | | - Jonathan C Kentish
- Cardiovascular Division, King's College London British Heart Foundation Centre of Research Excellence, UK
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15
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Takotsubo Cardiomyopathy in a Patient with Undiscovered Sigmoid Colon Cancer. Case Rep Cardiol 2017; 2017:4563203. [PMID: 28377824 PMCID: PMC5362718 DOI: 10.1155/2017/4563203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 11/28/2016] [Accepted: 12/19/2016] [Indexed: 11/18/2022] Open
Abstract
Takotsubo cardiomyopathy (TTC) is a stress-related cardiomyopathy that is characterized by reversible left systolic dysfunction, which appears to be precipitated by sudden emotional or physical stress in the absence of myocardial infarction. Here we present a rare case that clinically presented with intermittent abdominal pain, initially impressed as non-ST elevation myocardial infarction and congestive heart failure but with a normal coronary angiogram. Her symptoms relieved spontaneously without returning. Sigmoid colon cancer was diagnosed via colonoscopy later due to persistent abdominal discomfort. In the absence of detectable emotional or physical stress factors, the newly diagnosed sigmoid colon cancer was the only possible trigger factor of TTC. We offer this case as a reminder that cancer should be considered in the differential diagnosis of patients presenting with the etiology of TTC.
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16
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Sarapultsev PA, Sarapultsev AP. Stress cardiomyopathy: Is it limited to Takotsubo syndrome? Problems of definition. Int J Cardiol 2016; 221:698-718. [PMID: 27424315 DOI: 10.1016/j.ijcard.2016.07.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/04/2016] [Indexed: 02/09/2023]
Abstract
In 2006, Takotsubo syndrome (TTC) was described as a distinct type of stress-induced cardiomyopathy (stress cardiomyopathy). However, when thinking about Takotsubo cardiomyopathy from the viewpoints of the AHA and ESC classifications, 2 possible problems may arise. The first potential problem is that a forecast of disease outcome is lacking in the ESC classification, whereas the AHA only states that 'outcome is favorable with appropriate medical therapy'. However, based on the literature data, one can make a general conclusion that occurrence of myocardial lesions in TTC (i.e., myocardial fibrosis and contraction-band necrosis) causes the same effects as in other diseases with similar levels of myocardial damage and should not be considered to have a lesser impact on mortality. To summarise, TTC can cause not only severe complications such as pulmonary oedema, cardiogenic shock, and dangerous ventricular arrhythmias, but also damage to the myocardium, which can result in the development of potentially fatal conditions even after the disappearance of LV apical ballooning. The second potential problem arises from the definition of TTC as a stress cardiomyopathy in the AHA classification. In fact, the main factors leading to TTC are stress and microvascular anginas, since, as has been already discussed, coronary spasm can cause myocardium stunning, resulting in persistent apical ballooning. Thus, based on this review, 3 distinct types of stress cardiomyopathies exist (variant angina, microvascular angina, and TTC), with poor prognosis. Adding these diseases to the classification of cardiomyopathies will facilitate diagnosis and preventive prolonged treatment, which should include intensive anti-stress therapy.
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Affiliation(s)
- Petr A Sarapultsev
- Federal State Autonomous Educational Institution of Higher Professional Education, Ural Federal University named after the first President of Russia B. N. Yeltsin, Russia; Institute of Immunology and Physiology of the Ural Branch of the RAS, Russia
| | - Alexey P Sarapultsev
- Federal State Autonomous Educational Institution of Higher Professional Education, Ural Federal University named after the first President of Russia B. N. Yeltsin, Russia; Institute of Immunology and Physiology of the Ural Branch of the RAS, Russia.
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17
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Girardey M, Jesel L, Campia U, Messas N, Hess S, Imperiale A, Blondet C, Trinh A, Ohlmann P, Morel O. Impact of Malignancies in the Early and Late Time Course of Takotsubo Cardiomyopathy. Circ J 2016; 80:2192-8. [DOI: 10.1253/circj.cj-16-0388] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Mélanie Girardey
- Cardiology Department, Nouvel Hôpital Civil, University Hospital, University of Strasbourg
| | - Laurence Jesel
- Cardiology Department, Nouvel Hôpital Civil, University Hospital, University of Strasbourg
| | - Umberto Campia
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center
| | - Nathan Messas
- Cardiology Department, Nouvel Hôpital Civil, University Hospital, University of Strasbourg
| | - Sébastien Hess
- Cardiology Department, Nouvel Hôpital Civil, University Hospital, University of Strasbourg
| | - Alessio Imperiale
- Radiology Department, Nouvel Hôpital Civil, University Hospital, University of Strasbourg
| | - Cyrille Blondet
- Radiology Department, Nouvel Hôpital Civil, University Hospital, University of Strasbourg
| | - Annie Trinh
- Cardiology Department, Nouvel Hôpital Civil, University Hospital, University of Strasbourg
| | - Patrick Ohlmann
- Cardiology Department, Nouvel Hôpital Civil, University Hospital, University of Strasbourg
| | - Olivier Morel
- Cardiology Department, Nouvel Hôpital Civil, University Hospital, University of Strasbourg
- UMR CNRS 7213, Pharmacy Department, University of Strasbourg
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18
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Land S, Gurev V, Arens S, Augustin CM, Baron L, Blake R, Bradley C, Castro S, Crozier A, Favino M, Fastl TE, Fritz T, Gao H, Gizzi A, Griffith BE, Hurtado DE, Krause R, Luo X, Nash MP, Pezzuto S, Plank G, Rossi S, Ruprecht D, Seemann G, Smith NP, Sundnes J, Rice JJ, Trayanova N, Wang D, Jenny Wang Z, Niederer SA. Verification of cardiac mechanics software: benchmark problems and solutions for testing active and passive material behaviour. Proc Math Phys Eng Sci 2015; 471:20150641. [PMID: 26807042 PMCID: PMC4707707 DOI: 10.1098/rspa.2015.0641] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Models of cardiac mechanics are increasingly used to investigate cardiac physiology. These models are characterized by a high level of complexity, including the particular anisotropic material properties of biological tissue and the actively contracting material. A large number of independent simulation codes have been developed, but a consistent way of verifying the accuracy and replicability of simulations is lacking. To aid in the verification of current and future cardiac mechanics solvers, this study provides three benchmark problems for cardiac mechanics. These benchmark problems test the ability to accurately simulate pressure-type forces that depend on the deformed objects geometry, anisotropic and spatially varying material properties similar to those seen in the left ventricle and active contractile forces. The benchmark was solved by 11 different groups to generate consensus solutions, with typical differences in higher-resolution solutions at approximately 0.5%, and consistent results between linear, quadratic and cubic finite elements as well as different approaches to simulating incompressible materials. Online tools and solutions are made available to allow these tests to be effectively used in verification of future cardiac mechanics software.
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Affiliation(s)
- Sander Land
- Department of Biomedical Engineering, King's College London , London, UK
| | - Viatcheslav Gurev
- Thomas J. Watson Research Center, IBM Research, Yorktown Heights , NY 10598, USA
| | - Sander Arens
- Department of Physics and Astronomy , Ghent University , Ghent, Belgium
| | | | - Lukas Baron
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology , Karlsruhe, Germany
| | - Robert Blake
- Department of Biomedical Engineering and Institute for Computational Medicine , Johns Hopkins University , Baltimore, MD 21218, USA
| | - Chris Bradley
- Auckland Bioengineering Institute, University of Auckland , Auckland, New Zealand
| | - Sebastian Castro
- Department of Structural and Geotechnical Engineering , Pontifica Universidad Católica de Chile , Chile
| | - Andrew Crozier
- Institute of Biophysics, Medical University of Graz , Graz, Austria
| | - Marco Favino
- Center for Computational Medicine in Cardiology , Institute of Computational Science, Università della Svizzera italiana , Lugano, Switzerland
| | - Thomas E Fastl
- Department of Biomedical Engineering, King's College London , London, UK
| | - Thomas Fritz
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology , Karlsruhe, Germany
| | - Hao Gao
- School of Mathematics and Statistics, University of Glasgow , Glasgow, UK
| | - Alessio Gizzi
- Department of Engineering, Nonlinear Physics and Mathematical Modeling Lab , University Campus Bio-Medico of Rome , Rome, Italy
| | - Boyce E Griffith
- Interdisciplinary Applied Mathematics Center , University of North Carolina at Chapel Hill , Chapel Hill, NC, USA
| | - Daniel E Hurtado
- Department of Structural and Geotechnical Engineering , Pontifica Universidad Católica de Chile , Chile
| | - Rolf Krause
- Center for Computational Medicine in Cardiology , Institute of Computational Science, Università della Svizzera italiana , Lugano, Switzerland
| | - Xiaoyu Luo
- School of Mathematics and Statistics, University of Glasgow , Glasgow, UK
| | - Martyn P Nash
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand; Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | - Simone Pezzuto
- Center for Computational Medicine in Cardiology, Institute of Computational Science, Università della Svizzera italiana, Lugano, Switzerland; Simula Research Laboratory, Fornebu, Norway
| | - Gernot Plank
- Institute of Biophysics, Medical University of Graz , Graz, Austria
| | - Simone Rossi
- Civil and Environmental Engineering Department , Duke University , Durham, NC 27708-0287, USA
| | - Daniel Ruprecht
- Center for Computational Medicine in Cardiology , Institute of Computational Science, Università della Svizzera italiana , Lugano, Switzerland
| | - Gunnar Seemann
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology , Karlsruhe, Germany
| | - Nicolas P Smith
- Department of Biomedical Engineering, King's College London, London, UK; Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | | | - J Jeremy Rice
- Thomas J. Watson Research Center, IBM Research, Yorktown Heights , NY 10598, USA
| | - Natalia Trayanova
- Department of Biomedical Engineering and Institute for Computational Medicine , Johns Hopkins University , Baltimore, MD 21218, USA
| | - Dafang Wang
- Department of Biomedical Engineering and Institute for Computational Medicine , Johns Hopkins University , Baltimore, MD 21218, USA
| | - Zhinuo Jenny Wang
- Auckland Bioengineering Institute, University of Auckland , Auckland, New Zealand
| | - Steven A Niederer
- Department of Biomedical Engineering, King's College London , London, UK
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19
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Land S, Niederer SA. A Spatially Detailed Model of Isometric Contraction Based on Competitive Binding of Troponin I Explains Cooperative Interactions between Tropomyosin and Crossbridges. PLoS Comput Biol 2015; 11:e1004376. [PMID: 26262582 PMCID: PMC4532474 DOI: 10.1371/journal.pcbi.1004376] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 06/03/2015] [Indexed: 01/20/2023] Open
Abstract
Biophysical models of cardiac tension development provide a succinct representation of our understanding of force generation in the heart. The link between protein kinetics and interactions that gives rise to high cooperativity is not yet fully explained from experiments or previous biophysical models. We propose a biophysical ODE-based representation of cross-bridge (XB), tropomyosin and troponin within a contractile regulatory unit (RU) to investigate the mechanisms behind cooperative activation, as well as the role of cooperativity in dynamic tension generation across different species. The model includes cooperative interactions between regulatory units (RU-RU), between crossbridges (XB-XB), as well more complex interactions between crossbridges and regulatory units (XB-RU interactions). For the steady-state force-calcium relationship, our framework predicts that: (1) XB-RU effects are key in shifting the half-activation value of the force-calcium relationship towards lower [Ca2+], but have only small effects on cooperativity. (2) XB-XB effects approximately double the duty ratio of myosin, but do not significantly affect cooperativity. (3) RU-RU effects derived from the long-range action of tropomyosin are a major factor in cooperative activation, with each additional unblocked RU increasing the rate of additional RU’s unblocking. (4) Myosin affinity for short (1–4 RU) unblocked stretches of actin of is very low, and the resulting suppression of force at low [Ca2+] is a major contributor in the biphasic force-calcium relationship. We also reproduce isometric tension development across mouse, rat and human at physiological temperature and pacing rate, and conclude that species differences require only changes in myosin affinity and troponin I/troponin C affinity. Furthermore, we show that the calcium dependence of the rate of tension redevelopment ktr is explained by transient blocking of RU’s by a temporary decrease in XB-RU effects. Force generation in cardiac muscle cells is driven by changes in calcium concentration. Relatively small changes in the calcium concentration over the course of a heart beat lead to the large changes in force required to fully contract and relax the heart. This is known as ‘cooperative activation’, and involves a complex interaction of several proteins involved in contraction. Current computer models which reproduce force generation often do not represent these processes explicitly, and stochastic approaches that do tend to require large amounts of computational power to solve, which limit the range of investigations in which they can be used. We have created an new computational model that captures the underlying physiological processes in more detail, and is more efficient than stochastic approaches, while still being able to run a large range of simulations. The model is able to explain the biological processes leading to the cooperative activation of muscle. In addition, the model reproduces how this cooperative activation translates to normal muscle function to generate force from changes in calcium across three different species.
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Affiliation(s)
- Sander Land
- Department of Biomedical Engineering, King’s College London, United Kingdom
- * E-mail:
| | - Steven A. Niederer
- Department of Biomedical Engineering, King’s College London, United Kingdom
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20
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Abstract
Takotsubo syndrome is an acute cardiac syndrome first described in 1990 and characterized by transient left ventricular dysfunction affecting more than one coronary artery territory, often in a circumferential apical, mid-ventricular, or basal distribution. Several pathophysiological explanations have been proposed for this syndrome and its intriguing appearance, and awareness is growing that these explanations might not be mutually exclusive. The reversible apical myocardial dysfunction observed might result from more than one pathophysiological phenomenon. The pathophysiology of Takotsubo syndrome is complex and integrates neuroendocrine physiology, potentially involving the cognitive centres of the brain, and including the hypothalamic-pituitary-adrenal axis. Cardiovascular responses are caused by the sudden sympathetic activation and surge in concentrations of circulating catecholamines. The multiple morphological changes seen in the myocardium match those seen after catecholamine-induced cardiotoxicity. The acute prognosis and recurrence rate are now known to be worse than initially thought, and much still needs to be learned about the epidemiology and the underlying pathophysiology of this fascinating condition in order to improve diagnostic and treatment pathways.
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Affiliation(s)
- Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, 2-16-1 Sugao Miyamae-ku, Kawasaki City, Kanagawa 216-8511, Japan
| | - Holger M Nef
- Medizinische Klinik I, Kardiologie und Angiologie, Universitätsklinikum Gießen, Rudolf-Buchheim-Straße 8, Gießen 35392, Germany
| | - Alexander R Lyon
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College, Sydney Street, London SW3 6NP, UK
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