1
|
Neubert E, Rassler B, Hoschke A, Raffort C, Salameh A. Effects of Normobaric Hypoxia and Adrenergic Blockade over 72 h on Cardiac Function in Rats. Int J Mol Sci 2023; 24:11417. [PMID: 37511176 PMCID: PMC10379660 DOI: 10.3390/ijms241411417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
In rats, acute normobaric hypoxia depressed left ventricular (LV) inotropic function. After 24 h of hypoxic exposure, a slight recovery of LV function occurred. We speculated that prolonged hypoxia (72 h) would induce acclimatization and, hence, recovery of LV function. Moreover, we investigated biomarkers of nitrosative stress and apoptosis as possible causes of hypoxic LV depression. To elucidate the role of hypoxic sympathetic activation, we studied whether adrenergic blockade would further deteriorate the general state of the animals and their cardiac function. Ninety-four rats were exposed over 72 h either to normal room air (N) or to normobaric hypoxia (H). The rodents received infusion (0.1 mL/h) with 0.9% NaCl or with different adrenergic blockers. Despite clear signs of acclimatization to hypoxia, the LV depression continued persistently after 72 h of hypoxia. Immunohistochemical analyses revealed significant increases in markers of nitrosative stress, adenosine triphosphate deficiency and apoptosis in the myocardium, which could provide a possible explanation for the absence of LV function recovery. Adrenergic blockade had a slightly deteriorative effect on the hypoxic LV function compared to the hypoxic group with maintained sympathetic efficacy. These findings show that hypoxic sympathetic activation compensates, at least partially, for the compromised function in hypoxic conditions, therefore emphasizing its importance for hypoxia adaptation.
Collapse
Affiliation(s)
- Elias Neubert
- Carl-Ludwig-Institute of Physiology, University of Leipzig, 04103 Leipzig, Germany
| | - Beate Rassler
- Carl-Ludwig-Institute of Physiology, University of Leipzig, 04103 Leipzig, Germany
| | - Annekathrin Hoschke
- Carl-Ludwig-Institute of Physiology, University of Leipzig, 04103 Leipzig, Germany
| | - Coralie Raffort
- Department of Pediatric Cardiology, Heart Centre, University of Leipzig, 04289 Leipzig, Germany
| | - Aida Salameh
- Department of Pediatric Cardiology, Heart Centre, University of Leipzig, 04289 Leipzig, Germany
| |
Collapse
|
2
|
Kovanda J, Ložek M, Ono S, Kubuš P, Tomek V, Janoušek J. Left ventricular apical pacing in children: feasibility and long-term effect on ventricular function. Europace 2020; 22:306-313. [PMID: 31808515 DOI: 10.1093/europace/euz325] [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: 07/23/2019] [Accepted: 11/05/2019] [Indexed: 11/12/2022] Open
Abstract
AIMS Left ventricular apical pacing (LVAP) has been reported to preserve left ventricular (LV) function in chronically paced children with complete atrioventricular block (CAVB). We sought to evaluate long-term feasibility of LVAP and the effect on LV mechanics and exercise capacity as compared to normal controls. METHODS AND RESULTS Thirty-six consecutive paediatric patients with CAVB and LVAP in the absence (N = 22) or presence of repaired structural heart disease (N = 14, systemic LV in all) and 25 age-matched normal controls were cross-sectionally studied after a median of 3.9 (interquartile range 2.1-6.8) years of pacing using echocardiography and exercise stress testing. Pacemaker implantation was uneventful and there was no death. Probability of the absence of pacemaker-related surgical revision (elective generator replacement excluded) was 89.0% at 5 years after implantation. Left ventricular apical pacing patients had lower maximum oxygen uptake (P = 0.009), no septal to lateral but significant apical to basal LV mechanical delay (P < 0.001) which correlated with decreased LV contraction efficiency (P = 0.001). Left ventricular ejection fraction and global longitudinal LV strain were, however, not different from controls. Results were similar in both the presence and absence of structural heart disease. CONCLUSION Left ventricular apical pacing is technically feasible with a low reintervention rate. Mechanical synchrony between LV septum and free wall is maintained at the price of an apical to basal mechanical delay associated with LV contraction inefficiency as compared to healthy controls. Global LV systolic function is, however, not negatively affected by LVAP.
Collapse
Affiliation(s)
- Jan Kovanda
- Children's Heart Centre, 2nd Faculty of Medicine, Charles University in Prague, Motol University Hospital, V Úvalu 84, 150 06 Prague 5, Czech Republic
| | - Miroslav Ložek
- Children's Heart Centre, 2nd Faculty of Medicine, Charles University in Prague, Motol University Hospital, V Úvalu 84, 150 06 Prague 5, Czech Republic.,Department of Biomedical Informatics, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Shin Ono
- Department of Pediatric Cardiology, Kanagawa Children's Medical Center, Kanagawa, Japan
| | - Peter Kubuš
- Children's Heart Centre, 2nd Faculty of Medicine, Charles University in Prague, Motol University Hospital, V Úvalu 84, 150 06 Prague 5, Czech Republic
| | - Viktor Tomek
- Children's Heart Centre, 2nd Faculty of Medicine, Charles University in Prague, Motol University Hospital, V Úvalu 84, 150 06 Prague 5, Czech Republic
| | - Jan Janoušek
- Children's Heart Centre, 2nd Faculty of Medicine, Charles University in Prague, Motol University Hospital, V Úvalu 84, 150 06 Prague 5, Czech Republic
| |
Collapse
|
3
|
Salameh A, Dhein S, Mewes M, Sigusch S, Kiefer P, Vollroth M, Seeger J, Dähnert I. Anti-oxidative or anti-inflammatory additives reduce ischemia/reperfusions injury in an animal model of cardiopulmonary bypass. Saudi J Biol Sci 2019; 27:18-29. [PMID: 31889812 PMCID: PMC6933174 DOI: 10.1016/j.sjbs.2019.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/01/2019] [Accepted: 04/03/2019] [Indexed: 01/02/2023] Open
Abstract
Severe inborn cardiac malformations are typically corrected in cardioplegia, with a cardio-pulmonary bypass (CPB) taking over body circulation. During the operation the arrested hearts are subjected to a global ischemia/reperfusion injury. Although the applied cardioplegic solutions have a certain protective effect, application of additional substances to reduce cardiac damage are of interest. 18 domestic piglets (10–15 kg) were subjected to a 90 min CPB and a 120 min reperfusion phase without or with the application of epigallocatechin-3-gallate (10 mg/kg body weight) or minocycline (4 mg/kg body weight), with both drugs given before and after CPB. 18 additional sham-operated piglets without or with epigallocatechin-3-gallate or minocycline served as controls. In total 36 piglets were analyzed (3 CPB-groups and 3 control groups without or with epigallocatechin-3-gallate or minocycline respectively; 6 piglets per group). Hemodynamic and blood parameters and ATP-measurements were assessed. Moreover, a histological evaluation of the heart muscle was performed. Results Piglets of the CPB-group needed more catecholamine support to achieve sufficient blood pressure. Ejection fraction and cardiac output were not different between the 6 groups. However, cardiac ATP-levels and blood lactate were significantly lower and creatine kinase was significantly higher in the three CPB-groups. Markers of apoptosis, hypoxia, nitrosative and oxidative stress were significantly elevated in hearts of the CPB-group. Nevertheless, addition of epigallocatechin-3-gallate or minocycline significantly reduced markers of myocardial damage. Noteworthy, EGCG was more effective in reducing markers of hypoxia, whereas minocycline more efficiently decreased inflammation. Conclusions While epigallocatechin-3-gallate or minocycline did not improve cardiac hemodynamics, markers of myocardial damage were significantly lower in the CPB-groups with epigallocatechin-3-gallate or minocycline supplementation.
Collapse
Key Words
- ACT, activated clotting time
- AEC, 3-amino-9-ethylcarbazole
- AIF, apoptosis-inducing factor
- CO, cardiac output
- CPB, cardio-pulmonary bypass
- Cardio-pulmonary bypass
- DNA, deoxyribonucleic acid
- EF, ejection fraction
- EGCG, epigallo-3-catechin-gallate
- EGCG, ischemia/reperfusion injury
- HIF1α, hypoxia-inducible factor α
- HPLC, high pressure liquid chromatography
- Heart
- MPTP, mitochondrial permeability transition pore
- Minocycline
- NT, nitrotyrosine
- PAR, poly-ADP-ribose
- PARP, poly-ADP-ribose polymerase
- ROS, reactive oxygen species
- TNFα, tumor necrosis factor α
- cC3, cleaved caspase-3
Collapse
Affiliation(s)
- Aida Salameh
- University of Leipzig, Heart Centre Clinic for Paediatric Cardiology, Germany
- Corresponding author at: University of Leipzig, Heart Centre Clinic for Paediatric Cardiology, Struempellstrasse 39, 04289 Leipzig, Germany.
| | - Stefan Dhein
- University of Leipzig, Rudolf-Boehm-Institute for Pharmacology and Toxicology, Germany
| | - Marie Mewes
- University of Leipzig, Heart Centre Clinic for Paediatric Cardiology, Germany
| | - Sophie Sigusch
- University of Leipzig, Heart Centre Clinic for Paediatric Cardiology, Germany
| | - Philipp Kiefer
- University of Leipzig, Heart Center, Department of Cardiac Surgery, Leipzig, Germany
| | - Marcel Vollroth
- University of Leipzig, Heart Center, Department of Cardiac Surgery, Leipzig, Germany
| | - Johannes Seeger
- University of Leipzig, Institute of Vetinary Anatomy, Histology and Embryology, Germany
| | - Ingo Dähnert
- University of Leipzig, Heart Centre Clinic for Paediatric Cardiology, Germany
| |
Collapse
|
4
|
Mizuno M, Ito Y, Sugidachi A. A novel porcine model of thrombotic myocardial infarction with cardiac dysfunction sensitive to dual antiplatelet therapy. Eur J Pharmacol 2018; 834:103-108. [PMID: 30016661 DOI: 10.1016/j.ejphar.2018.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 07/03/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
Abstract
Few effective porcine models of myocardial infarction (MI) related to platelet thrombus formation are available. In this study, we established a novel porcine MI model and examined the effect of dual antiplatelet therapy (DAPT) with aspirin and prasugrel, a P2Y12 antagonist, using this MI model. Thrombotic MI was photochemically induced using rose bengal. Male miniature pigs were divided into 3 treatment groups: Sham, MI, and DAPT. In the DAPT group, aspirin (10 mg/kg, p.o.) and prasugrel (1 mg/kg, p.o.) were administered 4 h before photo-irradiation. Platelet aggregation, MI volume, and cardiac function were evaluated 24 h after photo-irradiation. Inhibition of ADP-induced platelet aggregation in the DAPT group was about 45%, similar to the effects of DAPT in a clinical setting. No MI was observed in the Sham group, and MI volume was 12.9 ± 2.9% in the left ventricle (P = 0.0016) in the MI group. Additionally, an increase in end-systolic volume (P = 0.0006), and a decrease in stroke volume (P = 0.0001) and ejection fraction (P < 0.0001) were observed in the MI group compared to the Sham group without any changes in end-diastolic volume. DAPT significantly decreased MI volume (P = 0.0006) and ameliorated cardiac dysfunction compared to the MI group. In conclusion, a novel porcine model of thrombotic MI with cardiac dysfunction was established. In this model, DAPT decreased MI volume and ameliorated of cardiac dysfunction, suggesting that this porcine MI model could be useful for future research on MI and antithrombotic agents.
Collapse
Affiliation(s)
- Makoto Mizuno
- Rare Disease and LCM Laboratories, Daiichi Sankyo Co., Ltd., Tokyo, Japan
| | - Yusuke Ito
- Rare Disease and LCM Laboratories, Daiichi Sankyo Co., Ltd., Tokyo, Japan
| | - Atsuhiro Sugidachi
- Rare Disease and LCM Laboratories, Daiichi Sankyo Co., Ltd., Tokyo, Japan.
| |
Collapse
|
5
|
Nguyên UC, Verzaal NJ, van Nieuwenhoven FA, Vernooy K, Prinzen FW. Pathobiology of cardiac dyssynchrony and resynchronization therapy. Europace 2018; 20:1898-1909. [DOI: 10.1093/europace/euy035] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 02/16/2018] [Indexed: 02/04/2023] Open
Affiliation(s)
- Uyên Châu Nguyên
- Department of Physiology, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, ER Maastricht, The Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, ER Maastricht, The Netherlands
| | - Nienke J Verzaal
- Department of Physiology, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, ER Maastricht, The Netherlands
| | - Frans A van Nieuwenhoven
- Department of Physiology, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, ER Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, ER Maastricht, The Netherlands
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, ER Maastricht, The Netherlands
| |
Collapse
|
6
|
Duchenne J, Claus P, Pagourelias ED, Mada RO, Van Puyvelde J, Vunckx K, Verbeken E, Gheysens O, Rega F, Voigt JU. Sheep can be used as animal model of regional myocardial remodeling and controllable work. Cardiol J 2018; 26:375-384. [PMID: 29570208 DOI: 10.5603/cj.a2018.0007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 12/31/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Pacing the right heart has been shown to induce reversible conduction delay and subse-quent asymmetric remodeling of the left ventricle (LV) in dogs and pigs. Both species have disadvantages in animal experiments. Therefore the aim of this study was to develop a more feasible and easy-to-use animal model in sheep. METHODS Dual-chamber (DDD) pacemakers with epicardial leads on the right atrium and right ven-tricular free wall were implanted in 13 sheep. All animals underwent 8 weeks of chronic rapid pacing at 180 bpm. Reported observations were made at 110 bpm. RESULTS DDD pacing acutely induced a left bundle branch block (LBBB) - like pattern with almost doubling in QRS width and the appearance of a septal flash, indicating mechanical dyssynchrony. Atrial pacing (AAI) resulted in normal ventricular conduction and function. During 8 weeks of rapid DDD pacing, animals developed LV remodeling (confirmed with histology) with septal wall thinning (-30%, p < 0.05), lateral wall thickening (+22%, p < 0.05), LV volume increase (+32%, p < 0.05), decrease of LV ejection fraction (-31%, p < 0.05), and functional mitral regurgitation. After 8 weeks, segmental pressure-strain-loops, representing regional myocardial work, were recorded. Switching from AAI to DDD pacing decreased immediately work in the septum and increased it in the lateral wall (-69 and +41%, respectively, p < 0.05). Global LV stroke work and dP/dtmax decreased (-27% and -25%, respectively, p < 0.05). CONCLUSIONS This study presents the development a new sheep model with an asymmetrically remod-eled LV. Simple pacemaker programing allows direct modulation of regional myocardial function and work. This animal model provides a new and valuable alternative for canine or porcine models and has the potential to become instrumental for investigating regional function and loading conditions on regional LV remodeling.
Collapse
Affiliation(s)
- Jürgen Duchenne
- Department of Cardiovascular Sciences and Department of Cardiovascular Diseases, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium.
| | - Piet Claus
- Department of Cardiovascular Sciences and Department of Cardiovascular Diseases, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Efstathios D Pagourelias
- Department of Cardiovascular Sciences and Department of Cardiovascular Diseases, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Razvan O Mada
- Department of Cardiovascular Sciences and Department of Cardiovascular Diseases, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Joeri Van Puyvelde
- Department of Cardiovascular Sciences and Department of Cardiothoracic Surgery, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Kathleen Vunckx
- Department of Imaging and Pathology and Department of Nuclear Medicine, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Eric Verbeken
- Department of Imaging and Pathology and Department of Pathology, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Olivier Gheysens
- Department of Imaging and Pathology and Department of Nuclear Medicine, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiovascular Sciences and Department of Cardiothoracic Surgery, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences and Department of Cardiovascular Diseases, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
7
|
Salameh A, Greimann W, Vondrys D, Kostelka M. Calcification or Not. This Is the Question. A 1-Year Study of Bovine Pericardial Vascular Patches (CardioCel) in Minipigs. Semin Thorac Cardiovasc Surg 2017; 30:54-59. [PMID: 29024719 DOI: 10.1053/j.semtcvs.2017.09.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2017] [Indexed: 11/11/2022]
Abstract
A main problem with bioprosthesis used for surgical correction of congenital cardiac malformation is its tendency to shrink and to calcify. Recently, a new material, that is, decellularized bovine pericardium (CardioCel), was introduced in clinics. It was proposed that this new patch material should not calcify and should be particularly suitable for the correction of vascular defects in inborn cardiac diseases. The aim of our chronic minipig study was to evaluate the performance of CardioCel patches implanted in aortic and pulmonary artery position, respectively. Ten minipigs aged 3 months were operated on. A CardioCel patch was implanted in the aorta ascendens and arteria pulmonalis, respectively. Seven minipigs completed the 12 months' follow-up. Angiography of both vessels, measurement of pressure gradients, and histologic evaluation of the implanted patches were carried out. Angiography of both great vessels revealed a good clinical outcome without stenosis. However, histologic examination of the patches showed calcification and neo-formation of hyaline cartilage in both vessel types. Staining of collagen and elastic fibers as well as α-smooth muscle actin demonstrated that the patches did not remodel into an anatomic vascular structure during the 1 year of implantation. In our chronic piglet model, CardioCel patches, when implanted in the ascending aorta and the pulmonary artery, led to calcification and neo-formation of hyaline cartilage in both vessel types 1 year after implantation. The present study indicates that the ideal patch biomaterial for repair of inborn cardiac diseases is still a goal not achieved yet.
Collapse
Affiliation(s)
- Aida Salameh
- Clinic for Pediatric Cardiology, University of Leipzig, Heart Centre, Leipzig, Germany.
| | - Wiebke Greimann
- Clinic for Pediatric Cardiology, University of Leipzig, Heart Centre, Leipzig, Germany
| | | | - Martin Kostelka
- Clinic for Cardiac Surgery, University of Leipzig, Heart Centre, Leipzig, Germany
| |
Collapse
|
8
|
Marshall AM. A Review of Surgical Atrioventricular Block with Emphasis in Patients with Single Ventricle Physiology. CONGENIT HEART DIS 2016; 11:462-467. [PMID: 27139742 DOI: 10.1111/chd.12372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2016] [Indexed: 11/30/2022]
Abstract
We perceived an increased incidence of surgical atrioventricular (AV) block in patients with single ventricle physiology undergoing two ventricle rehabilitation for hypoplastic left heart syndrome compared to the overall incidence of surgical AV block for our institution. Retrospective investigation of our center's data revealed a statistically significant increase in the incidence of surgical AV block in the single ventricle population and two ventricle rehabilitation population compared to the two ventricle population. Here we review the literature with respect to historic definitions, incidence, risk factors, pre- and post-op management, current indications for pacemaker placement and added cost and comorbidity associated with surgical AV block. We then offer possible strategies for decreasing the incidence of surgical AV block within both the single and two ventricle populations.
Collapse
Affiliation(s)
- Amanda M Marshall
- Pediatric Cardiology, Children's Hospital & Medical Center, University of Nebraska Medical Center/Children's Hospital & Medical Center, Omaha, Neb, USA.
| |
Collapse
|
9
|
Janoušek J. Device therapy in children with and without congenital heart disease. Herzschrittmacherther Elektrophysiol 2014; 25:183-187. [PMID: 25070934 DOI: 10.1007/s00399-014-0335-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 06/12/2014] [Indexed: 06/03/2023]
Abstract
Device therapy in children has undergone several changes over the last few years due to developments in technology as well new approaches to preservation of ventricular function in paediatric pacing, novel data on pacing lead survival, inclusion of cardiac resynchronisation therapy and accumulating experience with the implantable cardioverter-defibrillator. Despite these developments device therapy in children is still associated with significant complications mainly due to patient size, growth and underlying structural heart disease. The amount of available data on therapy outcomes is much smaller than in their adult counterparts and prospective randomized studies are completely missing. Thus device therapy has to be cautiously tailored to individual patient needs having in mind the specific situation of expected decades of treatment. Avoidance of complications and potential harm precluding successful therapy continuation in the future should be one of the main principles.
Collapse
MESH Headings
- Cardiac Pacing, Artificial/methods
- Child
- Child, Preschool
- Defibrillators, Implantable
- Female
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/therapy
- Humans
- Infant
- Infant, Newborn
- Male
- Tachycardia, Ventricular/diagnosis
- Tachycardia, Ventricular/etiology
- Tachycardia, Ventricular/therapy
Collapse
Affiliation(s)
- Jan Janoušek
- Children's Heart Centre (Dětské kardiocentrum), University Hospital Motol, V Úvalu 84, 150 06, Praha, Czech Republic,
| |
Collapse
|
10
|
Salameh A, Haunschild J, Bräuchle P, Peim O, Seidel T, Reitmann M, Kostelka M, Bakhtiary F, Dhein S, Dähnert I. On the role of the gap junction protein Cx43 (GJA1) in human cardiac malformations with Fallot-pathology. a study on paediatric cardiac specimen. PLoS One 2014; 9:e95344. [PMID: 24751918 PMCID: PMC3994046 DOI: 10.1371/journal.pone.0095344] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 03/25/2014] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Gap junction channels are involved in growth and differentiation. Therefore, we wanted to elucidate if the main cardiac gap junction protein connexin43 (GJA1) is altered in patients with Tetralogy of Fallot or double-outlet right ventricle of Fallot-type (62 patients referred to as Fallot) compared to other cardiac anomalies (21 patients referred to as non-Fallot). Patients were divided into three age groups: 0-2years, 2-12years and >12years. Myocardial tissue samples were collected during corrective surgery and analysis of cell morphology, GJA1- and N-cadherin (CDH2)-distribution, as well as GJA1 protein- and mRNA-expression was carried out. Moreover, GJA1-gene analysis of 16 patients and 20 healthy subjects was performed. RESULTS Myocardial cell length and width were significantly increased in the oldest age group compared to the younger ones. GJA1 distribution changed significantly during maturation with the ratio of polar/lateral GJA1 increasing from 2.93±0.68 to 8.52±1.41. While in 0-2years old patients ∼6% of the lateral GJA1 was co-localised with CDH2 this decreased with age. Furthermore, the changes in cell morphology and GJA1-distribution were not due to the heart defect itself but were significantly dependent on age. Total GJA1 protein expression decreased during growing-up, whereas GJA1-mRNA remained unchanged. Sequencing of the GJA1-gene revealed only few heterozygous single nucleotide polymorphisms within the Fallot and the healthy control group. CONCLUSION During maturation significant changes in gap junction remodelling occur which might be necessary for the growing and developing heart. In our study point mutations within the Cx43-gene could not be identified as a cause of the development of TOF.
Collapse
Affiliation(s)
- Aida Salameh
- Clinic for Paediatric Cardiology, Heart Centre, University of Leipzig, Leipzig, Germany
- * E-mail:
| | - Josphina Haunschild
- Clinic for Cardiac Surgery, Heart Centre, University of Leipzig, Leipzig, Germany
| | - Paul Bräuchle
- Clinic for Paediatric Cardiology, Heart Centre, University of Leipzig, Leipzig, Germany
| | - Oliver Peim
- Clinic for Paediatric Cardiology, Heart Centre, University of Leipzig, Leipzig, Germany
| | - Thomas Seidel
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, United States of America
| | - Marko Reitmann
- Clinic for Paediatric Cardiology, Heart Centre, University of Leipzig, Leipzig, Germany
| | - Martin Kostelka
- Clinic for Cardiac Surgery, Heart Centre, University of Leipzig, Leipzig, Germany
| | - Farhad Bakhtiary
- Clinic for Cardiac Surgery, Heart Centre, University of Leipzig, Leipzig, Germany
| | - Stefan Dhein
- Clinic for Cardiac Surgery, Heart Centre, University of Leipzig, Leipzig, Germany
| | - Ingo Dähnert
- Clinic for Paediatric Cardiology, Heart Centre, University of Leipzig, Leipzig, Germany
| |
Collapse
|
11
|
Abstract
PURPOSE OF REVIEW To review and prioritize data on pediatric cardiac pacing published during the period of the last 18 months. RECENT FINDINGS New approaches to preservation of ventricular function in pediatric pacing are based on recent publications confirming major influence of the ventricular pacing site on left ventricular (LV) function and synchrony. Current studies on epicardial vs. transvenous pacing continue to show survival superiority of endocardial leads. Long-term outcome of epicardial pacing may, however, be positively influenced by technical refinements. Recent amendments of the guidelines for cardiac resynchronization therapy (CRT) in adult idiopathic and ischemic cardiomyopathy are likely to influence CRT indications in children. Novel data give interesting insights into implantable cardioverter-defibrillator (ICD) lead survival as well as the use of ICDs in young patients with hypertrophic cardiomyopathy. SUMMARY Pediatric cardiac pacing and ICD therapy is still a developing field likely to improve with technical refinements, proper lead placement and more specific therapy indications. The current review will give the reader information about recent developments and directions for the future.
Collapse
|
12
|
Abstract
Patients with heart failure and decreased function frequently develop discoordinate contraction because of electric activation delay. Often termed dyssynchrony, this further decreases systolic function and chamber efficiency and worsens morbidity and mortality. In the mid- 1990s, a pacemaker-based treatment termed cardiac resynchronization therapy (CRT) was developed to restore mechanical synchrony by electrically activating both right and left sides of the heart. It is a major therapeutic advance for the new millennium. Acute chamber effects of CRT include increased cardiac output and mechanical efficiency and reduced mitral regurgitation, whereas reduction in chamber volumes ensues more chronically. Patient candidates for CRT have a prolonged QRS duration and discoordinate wall motion, although other factors may also be important because ≈30% of such selected subjects do not respond to the treatment. In contrast to existing pharmacological inotropes, CRT both acutely and chronically increases cardiac systolic function and work, yet it also reduces long-term mortality. Recent studies reveal unique molecular and cellular changes from CRT that may also contribute to this success. Heart failure with dyssynchrony displays decreased myocyte and myofilament function, calcium handling, β-adrenergic responsiveness, mitochondrial ATP synthase activity, cell survival signaling, and other changes. CRT reverses many of these abnormalities often by triggering entirely new pathways. In this review, we discuss chamber, circulatory, and basic myocardial effects of dyssynchrony and CRT in the failing heart, and we highlight new research aiming to better target and implement CRT, as well as leverage its molecular effects.
Collapse
Affiliation(s)
- Jonathan A Kirk
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | |
Collapse
|
13
|
|
14
|
Janoušek J, van Geldorp IE, Krupičková S, Rosenthal E, Nugent K, Tomaske M, Früh A, Elders J, Hiippala A, Kerst G, Gebauer RA, Kubuš P, Frias P, Gabbarini F, Clur SA, Nagel B, Ganame J, Papagiannis J, Marek J, Tisma-Dupanovic S, Tsao S, Nürnberg JH, Wren C, Friedberg M, de Guillebon M, Volaufova J, Prinzen FW, Delhaas T. Permanent cardiac pacing in children: choosing the optimal pacing site: a multicenter study. Circulation 2012; 127:613-23. [PMID: 23275383 DOI: 10.1161/circulationaha.112.115428] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND We evaluated the effects of the site of ventricular pacing on left ventricular (LV) synchrony and function in children requiring permanent pacing. METHODS AND RESULTS One hundred seventy-eight children (aged <18 years) from 21 centers with atrioventricular block and a structurally normal heart undergoing permanent pacing were studied cross-sectionally. Median age at evaluation was 11.2 (interquartile range, 6.3-15.0) years. Median pacing duration was 5.4 (interquartile range, 3.1-8.8) years. Pacing sites were the free wall of the right ventricular (RV) outflow tract (n=8), lateral RV (n=44), RV apex (n=61), RV septum (n=29), LV apex (n=12), LV midlateral wall (n=17), and LV base (n=7). LV synchrony, pump function, and contraction efficiency were significantly affected by pacing site and were superior in children paced at the LV apex/LV midlateral wall. LV dyssynchrony correlated inversely with LV ejection fraction (R=0.80, P=0.031). Pacing from the RV outflow tract/lateral RV predicted significantly decreased LV function (LV ejection fraction <45%; odds ratio, 10.72; confidence interval, 2.07-55.60; P=0.005), whereas LV apex/LV midlateral wall pacing was associated with preserved LV function (LV ejection fraction ≥55%; odds ratio, 8.26; confidence interval, 1.46-47.62; P=0.018). Presence of maternal autoantibodies, gender, age at implantation, duration of pacing, DDD mode, and QRS duration had no significant impact on LV ejection fraction. CONCLUSIONS The site of ventricular pacing has a major impact on LV mechanical synchrony, efficiency, and pump function in children who require lifelong pacing. Of the sites studied, LV apex/LV midlateral wall pacing has the greatest potential to prevent pacing-induced reduction of cardiac pump function.
Collapse
Affiliation(s)
- Jan Janoušek
- Children's Heart Center, University Hospital Motol, V Úvalu 84, 150 06 Prague 5, Czech Republic.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|