Enhancement of the force-frequency effect on myocardial contractility by adrenergic stimulation in conscious dogs

Changes in cardiac contractility during graded exercise are greater in subjects with smaller body mass index, and greater in men than women: analyses using wave intensity and force-frequency relations

INTRODUCTION AND PURPOSE

Estimation of the contractility of the left ventricle during exercise is an important part of the rehabilitation protocol. It is known that cardiac contractility increases with an increase in heart rate. This phenomenon is called the force-frequency relation (FFR). Using wave intensity, we aimed to evaluate FFR noninvasively during graded exercise.

METHODS

We enrolled 83 healthy subjects. Using ultrasonic diagnostic equipment, we measured wave intensity (WD), which was defined in terms of blood velocity and arterial diameter, in the carotid artery and heart rate (HR) before and during bicycle ergometer exercise. FFRs were constructed by plotting the maximum value of WD (WD₁) against HR. We analyzed the variation among FFR responses of individual subjects.

RESULTS

WD₁ increased linearly with an increase in HR during exercise. The average slope of the FFR was 1.0 ± 0.5 m/s³ bpm. The slope of FFR decreased with an increase in body mass index (BMI). The slopes of FFRs were steeper in men than women, although there were no differences in BMI between men and women.

CONCLUSIONS

The FFR was obtained noninvasively by carotid arterial wave intensity (WD₁) and graded exercise. The slope of the FFR decreased with an increase in BMI, and was steeper in men than women.

Nuclear calcium in cardiac myocytes

Calcium (Ca) is a universal second messenger involved in the regulation of various cellular processes, including electrical signaling, contraction, secretion, memory, gene transcription, and cell death. In heart, Ca governs cardiomyocyte contraction, is central in electrophysiological properties, and controls major signaling pathway implicated in gene transcription. How cardiomyocytes decode Ca signal to regulate gene expression without interfering with, or being controlled by, "contractile" Ca that floods the entire cytosol during each heartbeat is still elusive. In this review, we summarize recent findings on nuclear Ca regulation and its downstream signaling in cardiomyocytes. We will address difficulties in reliable quantification of nuclear Ca fluxes and discuss its role in the development and progression of cardiac hypertrophy and heart failure. We also point out key open questions to stimulate future work.

Noninvasive evaluation of left ventricular force-frequency relationships by measuring carotid arterial wave intensity during exercise stress

Background and purpose

Estimation of the contractility of the left ventricle during exercise is important in drawing up a protocol of cardiac rehabilitation. It has been demonstrated that color Doppler- and echo tracking-derived carotid arterial wave intensity is a sensitive index of global left ventricular (LV) contractility. We assessed the feasibility of measuring carotid arterial wave intensity and determining force−frequency (contractility−heart rate) relations (FFRs) during exercise totally noninvasively.

Methods

We measured carotid arterial wave intensity with a combined color Doppler and echo tracking system in 25 healthy young male volunteers (age 20.8 ± 1.2 years) at rest and during exercise. FFRs were constructed by plotting the maximum value of wave intensity (WD₁) against heart rate (HR).

Results

We first confirmed that HR increased linearly with an increase in work load in each subject (r² = 0.95 ± 0.04). WD₁ increased linearly with an increase in HR. The goodness-of-fit of the regression line of WD₁ on HR in each subject was very high (r² = 0.48−0.94, p < 0.0001, respectively). The slope of the WD₁-HR relation ranged 0.30−2.20 [m/s³ (beat/min)].

Conclusions

Global LV FFRs can be generated in healthy young volunteers with an entirely noninvasive combination of exercise and wave intensity. These data should show the potential usefulness of the FFR in the context of cardiac rehabilitation.

The force-frequency relationship: insights from mathematical modeling

The force-frequency relationship has intrigued researchers since its discovery by Bowditch in 1871. Many attempts have been made to construct mathematical descriptions of this phenomenon, beginning with the simple formulation of Koch-Wesser and Blinks in 1963 to the most sophisticated ones of today. This property of cardiac muscle is amplified by β-adrenergic stimulation, and, in a coordinated way, the neurohumoral state alters both frequency (acting on the sinoatrial node) as well as force generation (modifying ventricular myocytes). This synchronized tuning is needed to meet new metabolic demands. Cardiac modelers have already linked mechanical and electrical activity in their formulations and showed how those activities feedback on each other. However, now it is necessary to include neurological control to have a complete description of heart performance, especially when changes in frequency are involved. Study of arrhythmias (or antiarrhythmic drugs) based on mathematical models should incorporate this effect to make useful predictions or point out potential pharmaceutical targets.

Central vagal activation by alpha(2) -adrenergic stimulation is impaired in spontaneously hypertensive rats

AIM

To elucidate the abnormality of vagal control in spontaneously hypertensive rats (SHR) by measuring left ventricular myocardial interstitial acetylcholine (ACh) release in response to α(2) -adrenergic stimulation as an index of in vivo vagal nerve activity.

METHODS

A cardiac microdialysis technique was applied to the rat left ventricle in vivo, and the effect of α(2) -adrenergic stimulation by medetomidine or electrical vagal nerve stimulation on myocardial interstitial ACh levels was examined in normotensive Wistar-Kyoto rats (WKY) and SHR under anaesthetized conditions.

RESULTS

Intravenous medetomidine (0.1 mg kg(-1) ) significantly increased the ACh levels in WKY (from 2.4 ± 0.6 to 4.2 ± 1.3 nmol L(-1) , P < 0.05, n = 7) but not in SHR (from 2.5 ± 0.7 to 2.7 ± 0.7 nmol L(-1) , n = 7). In contrast, electrical vagal nerve stimulation increased the ACh levels in both WKY (from 1.0 ± 0.4 to 2.9 ± 0.9 nmol L(-1) , P < 0.001, n = 6) and SHR (from 0.9 ± 0.2 to 2.2 ± 0.4 nmol L(-1) , P < 0.001, n = 6). Intravenous administration of medetomidine (0.1 mg kg(-1) ) did not affect the vagal nerve stimulation-induced ACh release in either WKY or SHR.

CONCLUSION

Medetomidine-induced central vagal activation was impaired in SHR, whereas peripheral vagal control of ACh release was preserved. In addition to abnormal sympathetic control, vagal control by the central nervous system may be impaired in SHR.

Adrenergic effects on force-frequency relationship: a pivotal role for the cardiac intrinsic systems

AIM

The force-frequency relationship (F-FR) is an important intrinsic regulatory mechanism of cardiac contractility. The involvement of autonomic nervous system in this physiological aspect of cardiac control remains unclear. The aim of the study was to evaluate the role of extrinsic and intrinsic cardiac adrenergic innervations on the heart rate (HR)-related positive inotropic response.

METHODS

Twenty-four dogs were anesthetized and acutely instrumented to monitor and record ECG, systemic and left ventricular pressures and derivatives, and to pace the heart at 130, 150, 170, 190 and 210 bpm, in order to construct the F-FR curve. Animals were randomly assigned to four groups (n = 6 each): vehicle (V), ganglion-blocked (G-B), β-blocked (β-B) and ganglion-blocked plus β-blocked (G-B + β-B).

RESULTS

Vehicle treated animals presented the classical F-FR. In the β-B group F-FR was blunted, but never fully suppressed. The G-B treated animals showed a bell-shape response curve of the induced inotropic effect with the zenith at 170 bpm: the first part of the curve resembling the control one, followed by a rapid decline toward baseline value. The co-administration of G-B and β-B agents reversed the contractile response to HR rise with a curve resembling the negative F-FR curve observed in the failing heart.

CONCLUSION

The F-FR appeared to be constituted by two consecutive mechanisms: first depolarization-rate dependent, and a second catecholamine-dependent. The natural consequence of these observations is that the full expression of F-FR needs an intact adrenergic system.

Dynamic control of maximal ventricular elastance in conscious dogs before and after pacing-induced heart failure

We identified the transfer functions relating beat-to-beat fluctuations in arterial blood pressure to maximal ventricular elastance (ABP-->E(max)) and beat-to-beat fluctuations in heart rate to E(max) (HR-->E(max)) to characterize the dynamic properties of the arterial ventricular contractility baroreflex and force-frequency relation, respectively, in three conscious dogs before and after pacing-induced heart failure. During the control condition, the average gain value, dominant time constant, and time delay were respectively -0.0374 ml(-1), 12.8 sec, and 2 sec for the ABP-->E(max) transfer function and 0.0137 mmHg/ml-bpm, 1.77 sec, and 0 sec for the HR-->E(max) transfer function. During the heart failure condition, both transfer functions were markedly depressed. These results are consistent with known physiology and previous studies and provide perhaps the first quantitative information on the dynamic control of E(max) during normal closed-loop operation.

Control of cardiac contractility in the rat working heart-brainstem preparation

A great deal of knowledge exists regarding neural control of myocardial function in the rat. Most of the studies addressing this issue were conducted either under general anaesthesia or in isolated hearts in vitro. Our principal aim was to provide a detailed quantitative description of mechanisms controlling cardiac contractility in the rat, in an anaesthetic-free preparation with a preserved functional brainstem. Furthermore, while vagally mediated negative inotropy is a well-known phenomenon, at present there is no direct evidence for its presence in the rat; we searched for such evidence. To this end, in the arterially perfused working heart-brainstem preparation of the rat, we measured left ventricular pressure (LVP) and computed its first derivative (LVdP/dt). We made the following new observations. (i) Zatebradine (cardiac sodium pacemaker current blocker) caused a bradycardia associated with increases in LVP and LVdP/dt; the latter effect was via a frequency-dependent mechanism. (ii) We confirmed that in the rat, the force-frequency relationship (dependence of contractility on heart rate) is positive over a low range of heart rates, and negative and linear at physiological levels of heart rate, and provided its quantitative description. (iii) The increase in systemic pressure caused a rise in contractility, and vagal blockade or destruction of the central nervous system did not alter this inotropic effect, suggesting that it was mediated by intrinsic cardiac mechanisms. (iv) Vagal stimulation caused complex polyphasic changes in LVdP/dt and LVP in unpaced preparations; during pacing, it caused slowly developing falls in LVdP/dt that could be prevented by atropine. We conclude that control of ventricular contractility in the rat heart differs from that in other mammals not only by its negative frequency dependence, but also in the potent influence of aortic pressure on LVdP/dt. At the level of autonomic neural control, our newly found, vagally mediated negative inotropic effect adds to the accumulating body of data regarding both the presence and the functional importance of parasympathetic innervation of the ventricular myocardium.

Control of cardiac rate, contractility, and atrioventricular conduction by medullary raphe neurons in anesthetized rats

The sympathetic actions of medullary raphé neurons on heart rate (HR), atrioventricular conduction, ventricular contractility, and rate of relaxation were examined in nine urethane-anesthetized (1-1.5 g/kg iv), artificially ventilated rats that had been adrenalectomized and given atropine methylnitrate (1 mg/kg iv). Mean arterial pressure (MAP), ECG, and left ventricular pressure were recorded. The peak rates of rise and fall in the first derivative of left ventricular (LV) pressure (dP/dtmax and dP/dtmin, respectively) and the stimulus-R ($-R) interval were measured during brief periods of atrial pacing at 8.5 Hz before and after ventral medullary raphé neurons were activated by dl-homocysteic acid (DLH, 0.1 M) or inhibited by GABA (0.3 M) in local microinjections (90 nl). LV dP/dtmax values were corrected for the confounding effect of MAP, determined at the end of the experiments after giving propranolol (1 mg/kg iv) to block sympathetic actions on the heart. DLH microinjections into the ventral medullary raphé region increased HR by 44 +/- 2 beats/min, LV dP/dtmax by 1,055 +/- 156 mmHg/s, and the negative value of LV dP/dtmin by 729 +/- 204 mmHg/s (all, P < 0.001) while shortening the $-R interval by 2.8 +/- 0.8 ms (P < 0.01). GABA microinjections caused no significant change in HR, LV dP/dtmax, or $-R interval but reduced LV dP/dtmin from -5,974 +/- 93 to -5,548 +/- 171 mmHg/s and MAP from 115 +/- 4 to 105 +/- 5 mmHg (both, P < 0.01). Rises in tail skin temperature confirmed that GABA injections effectively inhibited raphé neurons. When activated, the neurons in the ventral medullary raphé region thus enhance atrioventricular conduction, ventricular contractility, and relaxation in parallel with HR, but they provide little or no tonic sympathetic drive to the heart.

Disruption of the ventricular myocardial force-frequency relationship after cardiac surgery in children: noninvasive assessment by means of tissue Doppler imaging

OBJECTIVE

Impaired ventricular function after cardiopulmonary bypass and surgical repair remains a commonly encountered clinical problem. We hypothesized that the well-described impairment of calcium cycling after cardiac surgery would significantly affect the ventricular myocardial force-frequency relationship, which can be measured noninvasively by using the tissue Doppler echocardiography-derived index of contractility isovolumic acceleration.

METHODS

Children undergoing repair of congenital heart defects were studied. Rate-related changes in contractility were measured by means of simultaneous atrial pacing and tissue Doppler echocardiography preoperatively and postoperatively.

RESULTS

Although closure of atrial septal defect did not affect ventricular myocardial systolic performance, closure of ventricular septal defect lead to a marked postoperative decrease of basal contractile force (2.0 +/- 0.7 m/s2 preoperatively vs 1.0 +/- 0.7 m/s2 postoperatively, P < .02). Furthermore, the force-frequency relationship curves were significantly different (P < .001), with a reduced force-rate trajectory, and also peak force was attained. Neonates undergoing the arterial switch procedure showed the most marked postoperative decrease of isovolumic acceleration at basal heart rates and force-frequency relationship with reduced trajectory and peak force development (P < .0001).

CONCLUSIONS

This is the first clinical study describing the noninvasive acquisition of ventricular force-frequency relationships in children undergoing operations for congenital heart disease. There is a marked variability in response, ranging from no effect in patients undergoing atrial septal defect closure to a profound reduction in myocardial contractile responses after neonatal arterial switch. This simple noninvasive method allows measurement of a hitherto rarely examined property of the myocardium, an understanding of which might allow refinement of myocardial protection and postoperative myocardial support.

Functional properties of human embryonic stem cell-derived cardiomyocytes: intracellular Ca2+ handling and the role of sarcoplasmic reticulum in the contraction

Since cardiac transplantation is limited by the small availability of donor organs, regeneration of the diseased myocardium by cell transplantation is an attractive therapeutic modality. To determine the compatibility of human embryonic stem cell-derived cardiomyocytes (hESC-CMs) (7 to 55 days old) with the myocardium, we investigated their functional properties regarding intracellular Ca2+ handling and the role of the sarcoplasmic reticulum in the contraction. The functional properties of hESC-CMs were investigated by recording simultaneously [Ca2+]i transients and contractions. Additionally, we performed Western blot analysis of the Ca2+-handling proteins SERCA2, calsequestrin, phospholamban, and Na+/Ca2+ exchanger (NCX). Our major findings are, first, that hESC-CMs displayed temporally related [Ca2+]i transients and contractions, negative force-frequency relations, and lack of post-rest potentiation. Second, ryanodine, thapsigargin, and caffeine did not affect the [Ca2+]i transient and contraction, indicating that at this developmental stage, contraction depends on transsarcolemmal Ca2+ influx rather than on sarcoplasmic reticulum Ca2+ release. Third, in agreement with the notion that a voltage-dependent Ca2+ current is present in hESC-CMs and contributes to the mechanical function, verapamil completely blocked contraction. Fourth, whereas hESC-CMs expressed SERCA2 and NCX at levels comparable to those of the adult porcine myocardium, calsequestrin and phospholamban were not expressed. Our study shows for the first time that functional properties related to intracellular Ca2+ handling of hESC-CMs differ markedly from the adult myocardium, probably due to immature sarcoplasmic reticulum capacity.

Regional differences in the force-frequency relation of human left ventricular myocardium in mitral regurgitation: implications for ventricular shape

Sphericalization of the left ventricular (LV) chamber shape in patients with mitral regurgitation (MR) contributes to increased LV wall stress and energy consumption. On the basis of previous observations, we hypothesized the existence of regional differences in the force-frequency relation (FFR) within the LV that may contribute to its shape. Accordingly, in the present study, we assessed regional variation in the FFR in patients undergoing surgery for chronic, nonischemic MR with class II–III heart failure symptoms and related our findings to the in vivo LV shape. FFRs (steady-state isometric twitches, 0.2–3.4 Hz, 37°C) were evaluated in MR myocardium from the LV subepicardial free wall (MR-FW) and papillary muscle (MR-PM) and from the subepicardial free wall in coronary artery bypass graft patients with normal LV contraction patterns [nonfailing (NF)]. Ascending slope, optimal stimulation frequency, and maximal twitch tension of the FFR were depressed in MR-FW and MR-PM compared with NF ( P < 0.05). FFR depression was greater in MR-PM than in MR-FW. Between 107 and 134 beats/min, twitch tension became weaker in MR-PM, whereas it increased in MR-FW. Elevation of intracellular cAMP with forskolin eliminated FFR depression in MR-FW but not in MR-PM. MR-PM also had a 35% lower myosin heavy chain content and slowed twitch kinetics. In MR patients, the echocardiographic end-diastolic LV shape (end-diastolic eccentricity index = long axis/short axis) correlated with the ratio of ascending FFR slopes such that the end-diastolic eccentricity index increased 10% per 15% increase in slope ratio ( r = 0.88, P = 0.01). These regional differences in the frequency dependence of contractility between the free wall and papillary myocardium may contribute to changes in LV shape in MR as well as during exercise.

[From ischaemia to heart failure: heart rate--actor or stamper?]

The heart rate in sinus rhythm depends on If current-induced automaticity of sinus node cells. Such a current is activated by hyperpolarisation and is modulated by influences from sympathetic and para-sympathetic tones. There are established prognostic values for the baseline heart rate and its variability in coronary heart disease and heart failure. However, heart rate per se directly modulates myocardial oxygen consumption and cardiac contractility by interfering with the excitation-contraction coupling. The therapeutic implications of pharmacological modulation of the heart rate are important mainly for slowing the heart rate, as illustrated by the use of calcium antagonists in coronary heart disease and beta-blockers in both coronary heart disease and heart failure. The possibility of a direct action on sinusal automaticity by drugs such as ivabradine, an If channel blocker, reveals new therapeutic perspectives. Indeed, a benefit of combination therapy with these drugs and beta-blockers should be lower heart rate values than can be attained with maximally tolerated doses of beta-blockers.

Systolic and diastolic properties of univentricular hearts in children: insights from physiologic indices that reflect calcium cycling

Physiologic indices that reflect intracellular Ca2+ cycling were chosen to evaluate contraction and relaxation properties of the univentricular heart. We hypothesized that these indices would be impaired in univentricular hearts. With advances in surgical palliation, an increasing number of children are surviving with univentricular hearts supporting the systemic circulation. Similar to the adult failing heart, single ventricles may also manifest impaired Ca2+ cycling, which may have important therapeutic implications. In our study, we did not actually measure Ca2+ uptake or transients in the cardiac myocyte. Rather, we used previously validated physiologic indices that are known to reflect Ca2+ cycling. Sixteen children were studied, eight with single ventricles (SV) and eight as matched control subjects. Systolic properties were studied using maximal derivative of ventricular pressure (dP/dtmax), force-frequency relationship, and mechanical restitution. Diastolic properties were assessed using time constant of relaxation (tau) and the relaxation-frequency relationship. The critical HR (HRcrit) was assessed from the force-frequency relationship and relaxation-frequency relationship. DP/dtmax and tau were calculated from micromanometric tracings at increasing HRs, generated by right atrial pacing. In SV patients, dP/dtmax was lower than in the control group at each matched HR, and the force-frequency relationship was shifted downward. Restitution of contractility was slower in patients with SV. Tau was similar in both groups at lower HRs but significantly prolonged in the SV group at faster HRs. In the SV, HRcrit was significantly shifted to the left. These findings indicate impaired systolic and diastolic properties of univentricular heart, especially at increased HRs. Because these physiologic indices reflect Ca2+ cycling, it is speculated that the phenomenon of Ca2+ cycling may be impaired in the myocytes of univentricular hearts.

Effects of changing heart rate on electrophysiological and hemodynamic function in the dog

Cardiovascular parameters were measured in dogs after RR interval was changed from 0.25 s to 1.2 s with atropine and graded doses of zatebradine, an I(f)-channel blocker. Left ventricular (LV) pre-ejection period (PEP), systemic vascular resistance, tau (an estimate of myocardial stiffness), PQ, QTc, dLVP/dt(max) and dLVP/dt(min), aortic pressure, and right atrial pressure did not change when each parameter was plotted against RR interval (r(2)'s < or = 0.5). LV end-diastolic pressure, stroke volume index, LV ejection time (ET), and QT all increased either linearly or curvilinearly as RR interval prolonged. Cardiac output index and PEP/ET decreased curvilinearly. When heart rate (HR) was fixed by pacing, and graded doses of zatebradine were given, changes in cardiovascular function were minimal. Thus zatebradine affects cardiovascular function principally by changing HR and not by affecting function directly. This study provides data on the effects of changing HR, alone, on cardiovascular parameters measured frequently during pharmacological and toxicological studies. It should prove useful when physiological variables, including HR, change, and there is need to know what change in HR, alone, contributes.

Differential effects of heart rate reduction and beta-blockade on left ventricular relaxation during exercise

Left ventricular (LV) relaxation is crucial for LV function, especially during exercise. We compared the effects of increasing doses of ivabradine, a selective inward hyperpolarization-activated current inhibitor, and atenolol on the rate and extent of LV relaxation (best fit method: time constant tau(BF), pressure asymptote P(BF)) at rest and during exercise. Eight dogs were chronically instrumented to measure LV pressure and LV wall stresses. During exercise under saline, heart rate increased from 108 +/- 5 to 220 +/- 6 beats/min and tau(BF) was significantly reduced from 22 +/- 1 to 14 +/- 2 ms. At rest, atenolol but not ivabradine increased tau(BF). For similar heart rate reductions during exercise, atenolol impeded the shortening of tau(BF) (23 +/- 2 ms) whereas ivabradine had no effect (15 +/- 2 ms). The extent of the relaxation process (P(BF)) at peak exercise was increased by ivabradine, and to a greater extent by atenolol, compared with saline. Thus, for a similar reduction in heart rate at rest and during exercise, ivabradine, in contrast with atenolol, does not exert any negative lusitropic effect.

The positive inotropic effects of milrinone but not of digoxin are attenuated at short cycle lengths

The effects of inotropically active agents on the left ventricular force-interval relation are a potential determinant of their clinical utility and safety. However, little information is available concerning the effects of noncatecholamine positive inotropic agents on this relation. Therefore this study compared the short-term effects of digoxin and milrinone on resting hemodynamics, frequency potentiation (FP), and mechanical restitution (MR) in patients undergoing nonemergency cardiac catheterization. Both digoxin and milrinone produced similar increases in LV + dP/dt at rest (12.2 +/- 1.3%, p < 0.000001 and 11.4 +/- 3.2%, p < 0.01, respectively). The positive inotropic effects of digoxin were marginally attenuated during FP (by 8.5 +/- 4.2% and 4.6 +/- 2.9% at 10 and 60 s, respectively, both p = NS compared with baseline). Similarly, on MRC analysis, the parameter c (a measure of sensitivity of contractile performance to reductions in cycle length) increased by 3.6 +/- 3.7% (p = NS). Whereas the positive inotropic effects of milrinone were not significantly attenuated during FP, they were abolished and possibly reversed at short cycle lengths on MR curve construction (6.8 +/- 5.9% negative inotropic effect at 60% of resting cycle length; p = NS; p < 0.05 vs. resting cycle length). In conclusion, in patients with well-preserved left ventricular systolic function, the positive inotropic effects of milrinone but not of digoxin are markedly dependent on heart rate. These properties may influence both relative safety and efficacy of both agents.

Modulation of force-frequency relation by phospholamban in genetically engineered mice

Phospholamban levels regulate cardiac sarcoplasmic reticulum Ca2+ pump activity and myocardial contractility. To determine whether and to what extent phospholamban modulates the force-frequency relation and ventricular relaxation in vivo, we studied transgenic mice overexpressing phospholamban (PLBOE), gene-targeted mice without phospholamban (PLBKO), and isogenic wild-type controls. Contractility was assessed by the peak rate of left ventricular (LV) isovolumic contraction (+dP/dtmax), and diastolic function was assessed by both the peak rate (-dP/dtmax) and the time constant (tau) of isovolumic LV relaxation, using a high-fidelity LV catheter. Incremental atrial pacing was used to generate heart rate vs. -dP/dtmax (force-frequency) relations. Biphasic force-frequency relations were produced in all animals, and the critical heart rate (HRcrit) was taken as the heart rate at which dP/dtmax was maximal. The average LV +dP/dtmax increased in both PLBKO and PLBOE compared with their isogenic controls (both P < 0.05). The HRcrit for LV +dP/dtmax was significantly higher in PLBKO (427 +/- 20 beats/min) compared with controls (360 +/- 18 beats/min), whereas the HRcrit in PLBOE (340 +/- 30 beats/min) was significantly lower compared with that in isogenic controls (440 +/- 25 beats/min). The intrinsic heart rates were significantly lower, and the HRcrit and the +/-dP/dtmax at HRcrit were significantly greater in FVB/N than in SvJ control mice. We conclude that 1) the level of phospholamban is a critical negative determinant of the force-frequency relation and myocardial contractility in vivo, and 2) contractile parameters may differ significantly between strains of normal mice.

Electrical and hemodynamic correlates of the maximal rate of pressure increase in the human left ventricle

BACKGROUND

The rate of left ventricular (LV) pressure increase (LV + dP/dt) may be related to QRS duration, as well as to a number of hemodynamic parameters.

METHODS AND RESULTS

We studied the relation between basal LV + dP/dt and QRS duration in 43 patients with normal LV function and 81 patients with heart failure undergoing diagnostic catheterization. We also examined the relationship between LV + dP/dt and heart rate, as well as measures of both LV preload and afterload. In patients with normal LV function, there was a strong relationship between basal LV + dP/dt and resting heart rate, whereas the relationship with QRS duration was of borderline significance. In patients with heart failure, the relationship with heart rate was lost; however, LV systolic pressure, QRS duration, and LV end-diastolic pressure all made significant contributions to a model predicting LV + dP/dt.

CONCLUSIONS

These data show a strong relationship between resting heart rate and LV + dP/dt in the healthy human LV. In patients with heart failure, the relationship with heart rate is not maintained; however, there is a systematic relationship between LV + dP/dt and both the time-course of the electrical activation and measures of LV loading conditions.

Abnormal global left ventricular relaxation occurs early during the development of pharmacologically induced ischemia

In animal and human models, left ventricular (LV) diastolic function has been observed to be highly sensitive to myocardial ischemia. The response of LV diastolic parameters to pharmacologically induced ischemia, however, has not been characterized and might be important in the interpretation of dobutamine stress echocardiography. Eight mongrel dogs, in which were inserted a high-fidelity micromanometer LV catheter, coronary sinus sampling catheter, and ultrasonic coronary artery flow probe, underwent intravenous dobutamine infusion at escalating doses both before (control protocol) and after (ischemia protocol) creation of left anterior descending coronary artery stenosis with a hydraulic cuff occluder adjusted to maintain resting coronary artery flow but attenuate reactive hyperemia. At each dobutamine dose, epicardial short-axis 2-dimensional echocardiographic images and hemodynamic measurements were obtained. LV diastolic function was examined by calculation of peak (-)dP/dt and the time constant of isovolumic relaxation (tau). The dobutamine infusion protocol was terminated on the earliest recognition of an anterior wall motion abnormality. Peak (+)dP/dt normalized for developed isovolumetric pressure was calculated as a relatively load-independent index of global LV contractile function. Dobutamine infusion with and without ischemia resulted in comparable changes in heart rate and (+)dP/dt/IP, with no change in LV end-diastolic or -systolic pressure. The magnitude of peak (-)dP/dt increased less during the ischemia (1231 +/- 109 to 1791 +/- 200 mm Hg/sec) versus the control (1390 +/- 154 to 2432 +/- 320 mm Hg/sec) protocol (P <.05). Similarly, the observed decrease in tau was less during the ischemia (53 +/- 3 to 38 +/- 4 msec) than the control (51 +/- 5 to 23 +/- 3 msec) protocol, corresponding to a slower rate of relaxation (P <.05). In addition, the smaller decrease in tau was observed at the dobutamine dose before the dose at which an echocardiographic wall motion abnormality was first recognized. Dobutamine-induced ischemia is associated with abnormal LV diastolic function. In addition, these abnormalities seem to occur early in the development of ischemia. These observations extend to pharmacologically induced ischemia prior findings from other models of ischemia, suggesting the high sensitivity of LV diastolic function to the development of myocardial ischemia.

Adrenergic-mediated effects of cocaine on the myocardial force-frequency relationship

We studied the role of sarcolemmal alpha- and beta-adrenoceptors activation in the effects of cocaine on the positive force staircase in isolated guinea pig atria. The preparations were superfused with Tyrode's solution at 31 degrees C while attached to a force transducer to measure peak tension developed (PTD), maximum velocity of development of tension (Vmax T) and time to peak tension (TPT). The positive force staircase was not affected by propranolol or phentolamine, but it was abolished by nifedipine. Cocaine 1 mg/l (2.9 microM) enhanced PTD and Vmax T, while TPT remained unchanged. On the other hand, cocaine did not modify the increase in PTD induced by the increase in frequency of stimulation, but significantly reduced the magnitude of the increase in Vmax T. The cocaine-induced attenuation of the increase in Vmax T in response to changes in the frequency of stimulation was abolished by both propranolol and phentolamine. It is concluded that the effect of cocaine on the force-frequency relationship required background activation of alpha- and beta-adrenergic receptors.

Loss of adrenergic control of the force-frequency relation in heart failure secondary to idiopathic or ischemic cardiomyopathy

This study was designed to determine whether the force-frequency effect on myocardial contractility, known to be importantly regulated by the adrenergic nervous system in experimental animals, can be enhanced by beta-adrenergic receptor stimulation in patients with heart failure. Animal experiments have demonstrated that the positive force-frequency relation in most mammals is subject to enhancement by beta-adrenergic receptor stimulation during exercise or infusion of a beta-receptor agonist. In animal models of heart failure, this regulatory mechanism generally is lost. The response to progressive increases in heart rate to 150 to 160 beats/min by right atrial pacing before and during dobutamine infusion was studied in 3 relatively normal subjects and in 5 patients with severe dilated cardiomyopathy. Left ventricular (LV) pressure and its first derivative (LV dP/dt(max)) were measured with a micromanometer, and the time constant of LV relaxation was assessed. The slopes of the relations between heart rate and LV dP/dt(max) in control subjects were positive at baseline and the mean slope increased substantially and significantly during dobutamine infusion. In patients with heart failure, the heart rate versus LV dP/dt(max) relations were depressed and flattened without a descending limb. Dobutamine infusion shifted this relation upward slightly, without increase in mean slope, indicating lack of amplification. The rate of isovolumic relaxation significantly decreased as heart rate increased at baseline and was further shortened by dobutamine. In patients with heart failure, a depressed and flattened relation between heart rate and LV dP/dt(max) (force-frequency effect) did not show the amplification of myocardial contractility by beta-adrenergic stimulation observed in the normal heart. This abnormality in control of the force-frequency relation undoubtedly plays an important role in the impairment of cardiac function during exercise in heart failure.

Force-frequency relations in the failing rabbit heart and responses to adrenergic stimulation

BACKGROUND

Recent experiments have documented the importance of beta-adrenergic regulation of the force-frequency relation (FFR) in the normal and failing heart. As in isolated human cardiac muscle, a descending limb of the FFR occurs at high frequencies in the intact rabbit heart, and therefore a new model of atrial pacing-induced heart failure was developed in the rabbit. Responses of the FFR to beta-adrenergic stimulation were then assessed in the conscious state before and after the induction of heart failure.

METHODS AND RESULTS

Rapid atrial pacing for an average of 19.5 days in instrumented rabbits produced severe left ventricular dilation with reduced cardiac output (echocardiography) and depressed myocardial contractility and relaxation rate (left ventricular dP/dt, catheter-tip micromanometer), associated with reductions in beta-adrenergic receptor density and adenylyl cyclase activity. Before heart failure, heart rate was slowed in the conscious animal from 280 +/- 30 (SD) to about 225 beats/min using a sinus node inhibitor (zatebradine), and heart rate was then increased in steps by atrial pacing from 250 to 450 beats/min; the heart rate-versus-left ventricular dP/dtmax (FFR) response showed an ascending response (increasing contractility), with a descending limb at rates greater than 375 beats/min, and dobutamine infusion amplified the ascending limb of the FFR (increased slope) and attenuated the descending limb. In heart failure the basal FFR was severely depressed with a descending limb over 350 beats/min; dobutamine shifted the FFR upward somewhat without change in the slope of the ascending limb, whereas dobutamine prevented the descending limb of the FFR. Similar responses were observed in the relations between heart rate and cardiac output.

CONCLUSIONS

A new model of heart failure in the conscious rabbit was developed using rapid atrial pacing and applied to study force-frequency effects. In heart failure, normal beta-adrenergic amplification of the ascending limb of the FFR by dobutamine was absent, but a marked descending limb of the FFR at higher heart rates was prevented by dobutamine. Observed reductions in components of the beta-adrenergic receptor system likely were responsible for impaired beta-adrenergic FFR amplification, but the mechanism(s) for the descending limb and its correction by dobutamine are not yet established. These responses of the FFR may influence importantly the ability of the failing heart to respond to exercise and stress.

Effects of a sinus node inhibitor on the normal and failing rabbit heart

The effects on cardiac function of slowed frequency produced by a sinus node inhibitor (zatebradine, or UL-FS 49) were studied in the conscious rabbit under control conditions (n = 16) and after heart failure was produced by rapid atrial pacing for an average of 18.5 days (n = 8). Echocardiography was used to verify severe left ventricular (LV) dysfunction, and high-fidelity micromanometry and cardiac output measurements (Doppler echo) were performed. Echocardiographic fractional shortening was 40.3 +/- 4.1 % (SD) in controls; in heart failure it was 18.0 +/- 1.6 %, and the LV was enlarged. In controls, as heart rate (HR) was decreased from 279 beats per minute (bpm) by incremental doses of zatebradine (up to 0.75 mg/kg), maximal changes occurred when the heart reached 218 bpm with a maximum decrease of the first derivative of LV pressure (LV dP/dtmax) of 15.9 %; LV enddiastolic pressure (EDP) increased from 4.3 to 8.4 mmHg along with a significant decrease in cardiac index (CI) of 15.2 %, while LV systolic pressure (SP) was stable. In heart failure, LV dP/dtmax and CI were markedly reduced compared to controls and with reduction of HR from 257 to 221 bpm LV dP/dtmax was unchanged, LVEDP increased slightly (NS), LVSP was unchanged and CI fell by 13.5 % at the highest dose. In subgroups (control n = 9, failure n = 6), in order to eliminate the hemodynamic effects of cardiac slowing by zatebradine the sinus rate present before zatebradine was matched by atrial pacing; this procedure eliminated all hemodynamic abnormalities accompanying cardiac slowing in both groups. In conclusion, slowed HR due to a sinus node inhibitor was well tolerated in severe heart failure, and all negative hemodynamic responses in both controls and in heart failure were due entirely to a negative forcefrequency effect, without a direct depressant action of zatebradine on the myocardium.

Altered inotropic and lusitropic responses to heart rate in conscious dogs with tachycardia-induced heart failure

OBJECTIVES

The effects of increasing heart rate on left ventricular contraction and relaxation were examined in conscious dogs with tachycardia-induced heart failure under autonomically blocked conditions.

BACKGROUND

Previous studies using isolated myocardium have shown attenuated positive inotropic responses to stimulation frequency in heart failure. However, these responses have not been well examined in intact preparations in the presence of heart failure with autonomic system blockade, where the intrinsic ventricular responses to increasing heart rate could be revealed.

METHODS

Seven dogs were instrumented with a micromanometer and a conductance volume catheter. After autonomic blockade to eliminate neural reflexes, left ventricular contractile properties were quantified by the slope of the end-systolic pressure-volume relation (ventricular elastance), and left ventricular relaxation was assessed by the time constant of isovolumetric ventricular pressure decay.

RESULTS

Increasing the heart rate by 60 beats/min enhanced ventricular elastance by 71 +/- 18% (mean +/- SD) and decreased end-systolic volume by 6 +/- 5% in normal hearts. In failing hearts, ventricular elastance increased by only 21 +/- 20%, and end-systolic volume did not change appreciably. Although the reduction in left ventricular end-diastolic and minimal pressures by tachycardia was smaller in the failing heart, ventricular relaxation rate remained unaltered both in the normal heart and in the failing heart.

CONCLUSIONS

Under conscious but autonomically blocked conditions, effects of increasing heart rate on the failing left ventricle are characterized by a predominant attenuation of the inotropic response rather than of the lusitropic response.

Differential effects of tert-butyl-benzohydroquinone, a putative SR Ca2+ pump inhibitor, on isometric relaxation during the staircase in the rabbit and rat ventricle

1. The effects of 2,5 di-(tert-butyl)-1,4-benzohydroquinone (TBQ), a putative inhibitor of the sarcoplasmic reticulum Ca2+ pump, on mechanical relaxation and contraction-relaxation coupling have been studied at different frequencies (0.5-3 Hz) in isometrically contracting isolated right ventricular preparations of rabbit and rat at 37 degrees C. Two types of mechanical responses have been studied: the twitch tension and the force transient (rewarming spike, RSp) following a rapid cooling contracture (RCC, an index of sarcoplasmic reticulum Ca2+ content) on return to 37 degrees C. 2. The coupling between contraction and relaxation was assessed by two methods: (a) by evaluation of the variation of the slope relating the maximal rate of tension fall to twitch peak tension; (b) by modelling the twitch according to the following equation: TwT (t) = C x (t/A)B x exp(1-(t/AB) where TwT(t) is the time course of isometric tension, t is time, C and A are an inotropic and a chronotropic index respectively and B, a contraction-relaxation coupling index (Nwasokwa, 1993). 3. In the rabbit ventricle, 30 microM TBQ did not prevent the frequency-induced shortening of the twitch time to half-relaxation (t1/2) and of the time constant (tau) describing the final part of the RSp relaxation (tau decreased from 140 ms (0.5 Hz) to 133 ms (3 Hz) in control and from 253 ms (0.5 Hz) to 197 ms (3 Hz) after exposure to TBQ). By contrast, at a given frequency, the prolongation of relaxation induced by TBQ was proportional to its inotropic effect (unchanged slopes and B values) but TBQ did not prevent the acceleration of relaxation observed at high frequencies: B increased from 2.02 (0.5 Hz) to a peak value of 2.18 (1 Hz) in control and from 1.88 (0.5 Hz) to a maximum of 2.48 (2 Hz) after TBQ exposure. TBQ significantly attenuated the decay of RCCs elicited after increasingly longer periods of muscle quiescence as normally observed in control conditions. 4. In the rat ventricle, TBQ depressed relaxation more than expected on the basis of its negative inotropic effects (B decreased from 2.16 to 1.84 at 0.5 Hz and from 2.15 to 1.66 at 3 Hz). TBQ also slowed the rate of RSp relaxation (tau increased from 95 ms to 168 ms at 0.5 Hz, and from 109 ms to 149 ms at 3 Hz) and increased twitch t1/2. By contrast with the results obtained in the rabbit ventricle, B, tau and t1/2 were frequency-insensitive whether or not TBQ was present. 5. TBQ exerts negative inotropic effects consistent with inhibition of the SR Ca2+ pump. In the rabbit ventricle, the TBQ-induced potentiation of relaxation acceleration at high pacing frequencies suggests the involvement of counteracting Ca(2+)-mediated mechanisms probably via Ca(2+)-calmodulin-activated kinases. In the rat ventricle, TBQ did not have any differential effect on relaxation depending on the frequency, probably because the extent of the negative staircase was small in the present experimental conditions.

The role of heart rate in myocardial ischemia and infarction: implications of myocardial perfusion-contraction matching

The pathophysiology of myocardial ischemia traditionally has been attributed to disturbances of oxygen demand, as observed in classic effort-induced angina pectoris, or to a primary disruption of coronary blood supply, as in unstable angina or acute myocardial infarction. Laboratory research eliciting various types of perfusion-contraction matching has challenged such a historical distinction between supply and demand-induced determinants of myocardial ischemia. A growing number of clinical studies analyzing the role of heart rate in the course of coronary heart disease suggest the possibility that a common perfusion-contraction scheme may underlie these diverse clinical manifestations. During experimental myocardial ischemia, produced by a low coronary blood flow, regional perfusion-contraction matching exists in which the energy demands and regional contraction are reduced to match the diminished myocardial substrate supply. Heart rate is a major factor influencing transmural blood flow distribution and regional function, because when coronary vasodilation is maximal there is an inverse relation between the level of heart rate and subendocardial perfusion. Thus, in experimental regional ischemia, increasing heart rate reduces subendocardial flow and contraction, whereas slowing of heart rate causes improvement of contraction associated with increased subendocardial blood flow, accompanied by a decrease in outer wall blood flow. Also, "interventricular steal" of blood from the left ventricle by the right ventricle during ischemia can be reversed by slowing the heart rate in the presence of regional ischemia. Improvement of contraction by heart rate slowing is more than would be expected on the basis of the increase in subendocardial perfusion alone, reflecting a combination of decreased oxygen demand and increased oxygen supply, and separate curves relating blood flow per minute to contractile function are observed at different heart rates. However, when perfusion is normalized for heart rate by expressing subendocardial blood flow in units per beat, a single relation is observed at different heart rates. This observation supports the concept of a close coupling between subendocardial blood flow per beat and regional performance, or perfusion-contraction matching, during various levels of ischemia. Based on these principles, it can be predicted that exercise-induced regional ischemia in the presence of coronary stenosis will be attenuated by several mechanisms when heart rate is slowed using either a beta-blocking agent, or a specific bradycardic drug.(ABSTRACT TRUNCATED AT 400 WORDS)

Diastolic failure: pathophysiology and therapeutic implications

Primary diastolic dysfunction or failure is a distinct pathophysiologic entity. It results from increased resistance to ventricular filling, which leads to an inappropriate upward shift of the diastolic pressure-volume relation, particularly during exercise (exercise intolerance). The causes of diastolic failure are inappropriate tachycardia, decreased diastolic compliance and impaired systolic relaxation. Impaired (incomplete or slowed) systolic relaxation must be conceptually distinguished from compensatory prolonged systolic contraction (delayed or retarded relaxation). Optimal therapy will depend on the type of disease, the phase during the course of a given disease and the coexistence and relative contribution of various (de)compensatory processes. Treatment may consist of bradycardic, remodeling and lusitropic drugs.