Mechano-electrical interactions and heterogeneities in wild-type and drug-induced long QT syndrome rabbits

BACKGROUND

Electromechanical reciprocity - comprising electro-mechanical (EMC) and mechano-electric coupling (MEC) - provides cardiac adaptation to changing physiological demands. Understanding electromechanical reciprocity and its impact on function and heterogeneity in pathological conditions - such as (drug-induced) acquired long QT syndrome (aLQTS) - might lead to novel insights in arrhythmogenesis. Our aim is to investigate how electrical changes impact on mechanical function (EMC) and vice versa (MEC) under physiological conditions and in aLQTS.

METHODS

To measure regional differences in EMC and MEC in vivo, we used tissue phase mapping cardiac MRI and 24-lead ECG vest in healthy (control) and I_Kr -blocker E-4031-induced aLQTS rabbit hearts. MEC was studied in vivo by acutely increasing cardiac preload, and ex vivo by using voltage optical mapping in beating hearts at different preloads.

RESULTS

In aLQTS, electrical repolarization (heart rate corrected RT-interval, RTn370) was prolonged compared to control (p<0.0001) with increased spatial and temporal RT heterogeneity (p<0.01). Changing electrical function (in aLQTS) resulted in significantly reduced diastolic mechanical function and prolonged contraction duration (EMC), causing increased apico-basal mechanical heterogeneity. Increased preload acutely prolonged RTn370 in both control and aLQTS hearts (MEC). This effect was more pronounced in aLQTS (p<0.0001). Additionally, regional RT-dispersion increased in aLQTS. Motion-correction allowed to determine APD-prolongation in beating aLQTS hearts, but limited motion correction accuracy upon preload-changes prevented a clear analysis of MEC ex vivo.

CONCLUSION

Mechano-induced RT-prolongation and increased heterogeneity were more pronounced in aLQTS than in healthy hearts. Acute MEC effects may play an additional role in LQT-related arrhythmogenesis, warranting further mechanistic investigations.

KEY POINT SUMMARY

Electromechanical reciprocity - comprising excitation-contraction coupling (EMC) and mechano-electric feedback loops (MEC) - is essential for physiological cardiac function. Alterations in electrical and/or mechanical heterogeneity are known to have potentially pro-arrhythmic effects. In this study, we aimed to investigate how electrical changes impact on the mechanical function (EMC) and vice versa (MEC) - both under physiological conditions (control) and in acquired long QT syndrome (aLQTS). We show that changing the electrical function (in aLQTS) results in significantly altered mechanical heterogeneity via EMC and - vice versa - that increasing the preload acutely prolongs repolarization duration and increases electrical heterogeneity, particularly in aLQTS as compared to control. Our results substantiate the hypothesis that LQTS is an 'electro-mechanical' - rather than a 'purely electrical' - disease and suggest that acute MEC effects may play an additional role in LQT-related arrhythmogenesis. Abstract figure legend Electromechanical reciprocity in healthy (control) and acquired long QT syndrome (aLQTS) rabbit hearts. A.-B. Electrical alteration in aLQTS. A. Exemplary ECG traces demonstrating I_Kr -blocker E-4031-induced RT prolongation in aLQTS. B. Visualization of heart rate corrected RTn370 (each color-coded scale includes 20ms) on rabbits' torso in aLQTS compared to control (n = 6 each). C. Electro-mechanical coupling (EMC). Exemplary myocardial longitudinal velocity curve in base (cm/s) during cardiac cycle in control (blue) and aLQTS (red). Indicated are peak amplitudes (AMPsys, AMPdia) and time-to-diastolic peak (TTPdia). D. Mechano-electrical coupling (MEC). Box plots of preload induced changes in repolarization. Comparison between the timepoints baseline (15 sec before increase in preload) and time of the maximal RTn370 increase peak-preload (around 20 sec after NaCl bolus injection). Heart rate corrected RTn370 demonstrates more pronounced RT-changes in aLQTS compared to control (n = 13 each). This article is protected by copyright. All rights reserved.

Differences in extent of mechano-induced QT-changes in SQTS, WT and LQTS rabbit models

Background

Electro-mechanical (EMC) and mechano-electrical coupling (MEC) are essential for normal cardiac function. Alterations in these can result in increased arrhythmia formation. In “electrical” cardiac diseases, long-QT and short-QT syndrome, regional mechanical function is altered via EMC.

Purpose

In this study, we aimed to investigate how acute changes in mechanics may impact on electrical function (MEC) in these diseases.

Methods

To determine how acute changes in preload impact on QT duration, adult rabbits of both sexes were given a 6ml/kg BW bolus of 0.9% NaCl IV and 12-lead-ECGs were assessed first in wildtype (WT) and acquired drug-induced (E4031 to block IKr) LQT2 (“aLQT2”) rabbits, and in a second step in transgenic short-QT type 1 (“SQT1”, KCNH2-N588K) and WT littermate control rabbits (“WT-LMC”).

Results

At baseline, aLQT2 rabbits demonstrated a markedly prolonged heart-rate corrected QTc duration compared to WT (p&lt;0.0001; n=13), with increased QT-dispersion (QTMax-Min [ms], WT 21.4±5.7 vs. aLQT2 25.8±5.8; p=0.003; n=13) and increased short-term variability of QT (STVQT [ms], WT 3.5±1.0 vs. aLQT2 5.3±1.7; p=0.02; n=13), markers for regional and temporal heterogeneity of repolarization, respectively. SQT1 rabbits (n=8) demonstrated a shorter QTc duration compared to WT-LMC (n=10; p=0.04), with no differences in QT-dispersion and STVQT between the two groups.

Increased preload acutely prolonged QT and heart-rate corrected QTc in all groups (despite a slight increase in heart-rate by an average of 25 beats/min): in WT [ms] 171.6±11.6 to 213.3±20.3 (p&lt;0.0001) vs. aLQT2 208.9±19.6 to 271.0±37.5 (p&lt;0.0001; n=13 each), and in WT-LMC 171.3±4.8 to 199.2±5.4 (p&lt;0.0001; n=10) vs. SQT1 156.0±4.7 to 177.3±3.5 (p=0.0004; n=8). Importantly, the extent of mechano-induced electrical changes differed among genotypes, with less pronounced QTc prolongation in SQT1 compared to WT-LMC (delta QTc [ms], SQT1 21.2±3.4 (n=8) vs. WT-LMC 27.9±2.8 (n=10; p=0.15)), and a more pronounced QTc prolongation in aLQT2 compared to WT (delta QTc [ms], WT 41.6±14.9 vs. aLQT2 62.1±32.1; p=0.006; n=13 each). Moreover, QT-dispersion was increased significantly upon global mechanical change only in aLQTS (QTMax-Min [ms], 25.8±5.5 to 32.7±12.3; p=0.03; n=13).

Conclusion

Acute changes in mechanical function result in electrical changes via MEC in SQT1, WT and aLQT2 rabbits. The extent of these changes, however, depends on the underlying QTc duration, with the least pronounced QTc prolongation in SQT1 rabbits, with the shortest QTc, and the most pronounced QTc prolongation in aLQT2 rabbits, with the longest QTc. The most pronounced MEC effects on global QT duration as well as on regional QT dispersion in aLQT2 indicate that acute MEC effects may play an additional role in LQTS-related arrhythmogenesis.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): German Research Foundation (DFG) andSwiss National Science Foundation (SNF)

Electro-mechanical and mechano-electrical interactions in healthy and drug-induced LQTS rabbit hearts

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): German Research Foundation

Background

Electrical and mechanical heterogeneities and their interactions (electro-mechanical and mechano-electrical coupling; EMC / MEC) are essential for normal cardiac function. Alterations in these can result in increased arrhythmia formation.

Purpose

With this study, we aim to investigate EMC and MEC under physiological and pathological conditions to better understand their roles in arrhythmia development.

Methods

Multi-channel ECG and TPM-MRI were used to measure regional differences in EMC in healthy ("control") and IKr-blocker E-4031 induced acute LQTS ("E-4031") rabbit hearts in vivo. MEC was studied in both groups by acutely changing mechanical function (increased preload by 6 ml/kg BW bolus of NaCl).

Results

In acute LQTS hearts (E-4031 10µg/kg bolus + 1µg/(kg*min) iv), cardiac repolarization was markedly prolonged compared to healthy controls, (p &lt; 0.0001; n = 13), with increased QT-dispersion (Max-Min), a marker for regional heterogeneity of repolarization (p &lt; 0.01; n = 13).

Changing electrical function by E-4031 resulted in changes of mechanical features (EMC): in acute LQTS hearts, diastolic longitudinal velocity (Vz) was reduced in all basal (p = 0.003; n = 19) and 4/6 mid segments (p = 0.006; n = 19). Longitudinal diastolic TTP was prolonged significantly in 5/6 basal and 4/6 mid segments by E-4031. These alterations led to an increased apicobasal heterogeneity of longitudinal contraction duration (basal-apical Vz_dia_TTP [ms] 2.9 ± 10.6 vs. 21.1 ± 21.3; p = 0.01; n = 9).

Increased preload acutely prolonged QTc in both "control" and "E-4031" hearts (‘control’ 156.6 ± 11.6 to 198.3 ± 20.3; p &lt; 0.0001 vs. ‘E-4031’ 193.9 ± 19.6 to 256.0 ± 37.5; p &lt; 0.0001; n = 13) (MEC). This effect was more pronounced in "E-4031" acute LQTS hearts than in healthy hearts (Figure 1; delta QTc [ms] ‘control’ 41.6 ± 14.9 vs. ‘E4031’ 62.1 ± 32.1; p &lt; 0.006, n = 13). QT-dispersion (Max-Min) was increased significantly upon mechanical change only in "E-4031" (‘E-4031’ 25.8 ± 5.5 to 32.7 ± 12.3; p &lt; 0.03, n = 13).

Conclusion

E-4031-induced changes in electrical function resulted in marked alterations in mechanical features via EMC. Similarly, acute changes in mechanical function (increased preload) resulted in electrical changes via MEC. Importantly, QT-prolonging effects of acutely increased preload, as well as its effects on regional heterogeneity of repolarization, were more pronounced in E-4031-induced acute LQTS hearts, indicating that cardiac repolarization in LQTS may be more susceptible to acute MEC effects than in healthy hearts. Acute MEC effects may thus play an additional role in LQT-related arrhythmogenesis. Abstract Figure.

Nano-scale morphology of cardiomyocyte t-tubule/sarcoplasmic reticulum junctions revealed by ultra-rapid high-pressure freezing and electron tomography

Detailed knowledge of the ultrastructure of intracellular compartments is a prerequisite for our understanding of how cells function. In cardiac muscle cells, close apposition of transverse (t)-tubule (TT) and sarcoplasmic reticulum (SR) membranes supports stable high-gain excitation-contraction coupling. Here, the fine structure of this key intracellular element is examined in rabbit and mouse ventricular cardiomyocytes, using ultra-rapid high-pressure freezing (HPF, omitting aldehyde fixation) and electron microscopy. 3D electron tomograms were used to quantify the dimensions of TT, terminal cisternae of the SR, and the space between SR and TT membranes (dyadic cleft). In comparison to conventional aldehyde-based chemical sample fixation, HPF-preserved samples of both species show considerably more voluminous SR terminal cisternae, both in absolute dimensions and in terms of junctional SR to TT volume ratio. In rabbit cardiomyocytes, the average dyadic cleft surface area of HPF and chemically fixed myocytes did not differ, but cleft volume was significantly smaller in HPF samples than in conventionally fixed tissue; in murine cardiomyocytes, the dyadic cleft surface area was higher in HPF samples with no difference in cleft volume. In both species, the apposition of the TT and SR membranes in the dyad was more likely to be closer than 10 nm in HPF samples compared to CFD, presumably resulting from avoidance of sample shrinkage associated with conventional fixation techniques. Overall, we provide a note of caution regarding quantitative interpretation of chemically-fixed ultrastructures, and offer novel insight into cardiac TT and SR ultrastructure with relevance for our understanding of cardiac physiology.

Field study on bovine paratuberculosis using real-time PCR and liquid culture for testing environmental and individual fecal samples implemented in dairy cow management

Bovine paratuberculosis (Johne's disease) is a bacterial, chronic, and wasting intestinal disease caused by Mycobacterium avium ssp. paratuberculosis (MAP). Johne's disease causes severe losses in dairy farm productivity and is also suspected to be a potential trigger for Crohn's disease in humans. The fecal-oral infection of MAP to neonates is recognized as an important within-herd transmission route. Our objective was to recommend diagnostic methods for herds with suspected paratuberculosis requiring fast results, as well as for herds with breeding programs or others that aim at being nonsuspected of paratuberculosis infection. We determined a period of 8 wk from sampling to diagnostic findings suitable for testing of cows during the dry period. We therefore tested environmental and individual fecal samples with one rapid and one highly sensitive diagnostic method. Environmental samples (boot swabs) were taken as a first step in 3 herds and tested using a DNA extraction protocol for feces and subsequent real-time PCR (referred to as fecal PCR). Additionally, cultivation in liquid medium for 6 wk was performed and verified with real-time PCR (referred to as liquid culture). Automation of DNA extraction based on magnetic beads and the PCR setup was performed with pipetting robots. As a result, we successfully detected MAP in boot swabs of all herds by both methods. In a second step, 245 individual fecal samples from the 3 herds were examined using also fecal PCR and liquid culture. The results obtained by fecal PCR were compared with detection of MAP using cultivation in liquid medium for 6 wk. Testing individual cows, we identified MAP-specific DNA in 53 fecal samples using the liquid culture. Using fecal PCR, we revealed 43 positive samples of which 39 also tested positive in the liquid culture, revealing MAP-positive cows in all 3 herds. The fecal PCR procedure allows rapid detection of MAP-specific DNA with 74% of the sensitivity of liquid culture. For the purpose of testing with maximal sensitivity, cultivation in liquid medium is recommended. Cultivation of MAP in liquid medium M7H9C means a significant time gain in comparison to cultivation on solid media, which requires twice as much time. Thus, this testing fits within the 6- to 8-wk dry period of gravid cows and provides test results before calving, a prerequisite to prevent fecal-oral transmission to newborn calves.

Influence of electrophysiological heterogeneity on electrical stimulation in healthy and failing human hearts

The application of strong electrical stimuli is a common method used for terminating irregular cardiac behaviour. The study presents the influence of electrophysiological heterogeneity on the response of human hearts to electrical stimulation. The human electrophysiology was simulated using the ten Tusscher-Noble-Noble-Panfilov cell model. The anisotropic propagation of depolarisation in three-dimensional virtual myocardial preparations was calculated using bidomain equations. The research was carried out on different types of virtual cardiac wedge. The selection of the modelling parameters emphasises the influence of cellular electrophysiology on the response of the human myocardium to electrical stimulation. The simulations were initially performed on a virtual cardiac control model characterised by electrophysiological homogeneity. The second preparation incorporated the transmural electrophysiological heterogeneity characteristic of the healthy human heart. In the third model type, the normal electrophysiological heterogeneity was modified by the conditions of heart failure. The main currents responsible for repolarisation (Ito, IKs and IKI) were reduced by 25%. Successively, [Na+]i was increased by the regulation of the Na+-Ca2+ exchange function, and fibrosis was represented by decreasing electrical conductivity. Various electrical stimulation configurations were used to investigate the differences in the responses of the three different models. Monophasic and biphasic electrical stimuli were applied through rectangular paddles and needle electrodes. A whole systolic period was simulated. The distribution of the transmembrane voltage indicated that the modification of electrophysiological heterogeneity induced drastic changes during the repolarisation phase. The results illustrated that each of the heart failure conditions amplifies the modification of the response of the myocardium to electrical stimulation. Therefore a theoretical model of the failing human heart must incorporate all the characteristic features.

Hyperelastic description of elastomechanic properties of the heart: a new material law and its application

Knowledge concerning passive mechanic cardiac properties is necessary to model behavior of whole hearts. Commonly, a continuum mechanics based description is chosen in conjunction with the finite element method. The aim of this work is to summarize, derive and evaluate hyperelastic material laws for inhomogeneous, anisotropic myocardium. Hence, different material laws were set up and their parameters were determined taking measurement data in literature into account. The material laws were compared from a theoretical and numerical point of view. Furthermore, the application of continuum mechanics based methods is evaluated concerning aspects of numerical solution and spatial discretisation. In further work the laws will be implemented and integrated in an existing software environment, which allows the calculation of deformations in complex geometries.

Modeling force development in the sarcomere in consideration of electromechanical coupling

Models of the cellular force development simulate the contractive behavior of the sarcomere. In conjunction with electrophysiological models they can contribute to a better comprehension of physiology and pathologies. Aim of this study is to examine the coupling of cellular electrophysiological processes and force development. For that a graphical user interface was developed to simplify the parameterization and calculation of the models as well as to present the results graphically. A feedback mechanism is introduced to pay attention to close connections between force development and intracellular processes. On basis of various tests with different boundary conditions, new force models are developed, parameterized, validated and compared with models in literature. In future studies the results will be tested in multiple cell organization.

Excitation propagation and force development in the left ventricle of the visible female data set

Simulations of the electro-mechanical behavior of the heart improve the comprehension of the mechanisms of the cardiovascular system. In this study a left ventricular model including electrical excitation and force development is presented. The electrical model consists of a complex electrophysiological cell model and a monodomain excitation diffusion model. The force development bases on the intracellular calcium concentration and is calculated with a force model. It consists--like the electrophysiological model--of non-linear coupled differential equations. Simulations are obtained in a realistic and anisotropic model of the left ventricle of the Visible Female data set provided by the National Library of Medicine, USA. Effects to the mechanical behavior will be examined in future.

Comparison of macroscopic models of excitation and force propagation in the heart

Computer aided simulations of the heart provide knowledge of phenomena, which are commonly neither visible nor measurable with current techniques. This knowledge can be applied e.g. in cardiologic diagnosis and therapy. A variety of models was created to reconstruct cardiac processes, e.g. electrical propagation and force development. In this work different macroscopic models were compared, i.e. models based on excitation-diffusion equations and cellular automata. The comparison was carried out concerning reconstruct-ability of cardiac phenomena, mathematical and biophysical foundation as well as computational expense. Particularly, the reconstruct-ability of electromechanic feedback mechanisms was examined. Perspectives for further developments and improvements of models were given.

[Computer models of the electrophysiological properties of the heart]

Computer models of the heart can improve the understanding of the electrophysiological processes in healthy and diseased heart. They become more and more important for detailed diagnosis of arrhythmias and for optimization of therapy. Models of myocardium cells known today are described--they are based on the properties of all relevant ion channels in the cell membrane. Then it is demonstrated, how many cells can be joined to form a cell patch and how finally the complete heart can be modelled. A simpler approach is using a so called cellular automation that allows for a significant reduction of calculation time while sacrificing some accordance to reality. Adaptive cellular automations allow for a fast simulation with acceptable accuracy. Using them some results were gained for the simulation of typical arrhythmias, in the field of validation using an animal model and for therapy planning with RF-ablation.

[Coxiella burnetii infections and infections with bacteria of the genus Chlamydia in dairy cattle]

Comparative studies on the prevalence of infections caused by Coxiella burnetii (C. burnetii) and Chlamydia were carried out with 592 cattle older than 2 years and 234 cattle younger than 2 years. Of these 477 originated from 24 dairy herds with considerable fertility problems (positive herds) and 349 from 14 dairy herds without major fertility problems (control herds). For the direct detection of these pathogens in the genitals capture ELISAs were employed, for the demonstration of antibodies the complement fixation test (CFT). Direct detection of C. burnetii and Chlamydia single as well as mixed infection revealed significant higher values for cattle from positive herds compared with those from the control herds. Animals revealing insemination ratios of > or = 2 showed significantly more frequent excretion of Chlamydia via the genitals and antibodies against C. burnetii than cattle with an insemination ratio of < 2. Investigations of cows which had had an abortion showed no indications of significantly more frequent C. burnetii or chlamydial infections. Inseminated but non-pregnant cows excreted significantly more C. burnetii and Chlamydia than pregnant cows. Clinical signs of endometritis were associated with an enhanced excretion of Chlamydia. Animals younger than 2 years excreted significantly more frequently C. burnetii but not Chlamydia via the genitals than animals older than 2 years. Indirect test showed results vice versa.

[Effect of ad lib and restricted milk feeding on the course of illness and body weight in young calves with diarrhea]

Two different feeding regimens for calves (age up to 21 days) suffering from acute diarrhea were evaluated with respect to course of illness and change in body weight. The patients of the experimental group were given whole milk ad libitum three times a day. The patients of the control group were offered whole milk at a rate of 13% their body mass per day divided into three meals. In addition, both groups were offered an oral rehydration solution at a rate 9.5% of body mass per day, also divided into three portions. Data from 60 calves (30 in both groups) were available for statistical analysis. The duration of illness in the experimental group was 10.9 +/- 6.0 days vs. 10.0 +/- 5.2 days in the control group. The daily increase of body mass in the experimental group averaged 0.607 +/- 0.452 kg, the one in the control group 0.230 +/- 0.231 kg (p = 0.0002). The calves of the experimental group required 13.16 +/- 11.18 I milk per kg weight gain, the calves of the control group 21.39 +/- 12.80 I. Six calves of the experimental group and two calves of the control group subsequently had a relapse. On the basis of the results obtained, a feeding regimen for calves suffering from acute diarrhea is suggested.

[Systemic effects of ruminal acidosis following ruminal drinking in dairy calves. A retrospective analysis of 293 cases]

In a retrospective study the data of 293 young calves (age upon admission less than four weeks) with evidence of ruminal drinking (rumen pH < 6.0) were analyzed for possible associations between ruminal acidosis and various parameters of systemic acid-base metabolism (blood pH, blood levels of HCO3- and L-lactate, as well as anion gap). On the basis of the degree of ruminal acidosis (pH < 5.0/ > or = 5.0) and evidence of diarrhea, the animals were assigned to one of four groups. The results indicate that severe ruminal acidosis leads to disturbances of systemic acid-base metabolism in young calves, too. With additional diarrhea, those disturbances can be complex.