A juvenile murine heart failure model of pressure overload.

Persistent pressure overload can cause cardiac hypertrophy and progressive heart failure (HF). The authors developed a pressure-overload HF model of juvenile mice to study the cardiac response to pressure overload that may be applicable to clinical processes in children. Severe thoracic aortic banding (sTAB) was performed using a 28-gauge needle for 40 juvenile (age, 3 weeks) and 47 adult (age, 6 weeks) C57BL/6 male mice. To monitor the structural and functional changes, M-mode echocardiography was performed for conscious mice that had undergone sTAB and sham operation. Cardiac hypertrophy, dilation, and HF occurred in both juvenile and adult mice after sTAB. Compared with adults, juvenile HF is characterized by greater impairment of ventricular contractility and less hypertrophy. In addition, juvenile mice had significantly higher rates of survival than adult mice during the early postoperative weeks. Consistent with clinical HF seen in children, juvenile banded mice demonstrated a lower growth rate than either adult banded mice or juvenile control mice that had sham operations. The authors first developed a juvenile murine model of pressure-overload HF. Learning the unique characteristics of pressure-overload HF in juveniles should aid in understanding age-specific pathologic changes for HF development in children.

Force frequency relationship of the human ventricle increases during early postnatal development.

Understanding developmental changes in contractility is critical to improving therapies for young cardiac patients. Isometric developed force was measured in human ventricular muscle strips from two age groups: newborns (<2 wk) and infants (3-14 mo) undergoing repair for congenital heart defects. Muscle strips were paced at several cycle lengths (CLs) to determine the force frequency response (FFR). Changes in Na/Ca exchanger (NCX), sarcoplasmic reticulum Ca-ATPase (SERCA), and phospholamban (PLB) were characterized. At CL 2000 ms, developed force was similar in the two groups. Decreasing CL increased developed force in the infant group to 131 +/- 8% (CL 1000 ms) and 157 +/- 18% (CL 500 ms) demonstrating a positive FFR. The FFR in the newborn group was flat. NCX mRNA and protein levels were significantly larger in the newborn than infant group whereas SERCA levels were unchanged. PLB mRNA levels and PLB/SERCA ratio increased with age. Immunostaining for NCX in isolated newborn cells showed peripheral staining. In infant cells, NCX was also found in T-tubules. SERCA staining was regular and striated in both groups. This study shows for the first time that the newborn human ventricle has a flat FFR, which increases with age and may be caused by developmental changes in calcium handling.

Remodeling of early-phase repolarization: a mechanism of abnormal impulse conduction in heart failure.

BACKGROUND: The early phase of action potential (AP) repolarization is critical to impulse conduction in the heart because it provides current for charging electrically coupled cells. In the present study we tested the impact of heart failure-associated electrical remodeling on AP propagation. METHODS AND RESULTS: Subepicardial, midmyocardial, and subendocardial myocytes were enzymatically dissociated from control and pressure-overload failing left ventricle (LV), and APs were recorded. A unique coupling-clamp technique was used to electrically couple 2 isolated myocytes with a controlled value of coupling conductance (Gc). In sham-operated mice, AP duration manifested a clear transmural gradient, with faster repolarization in subepicardial myocytes than in subendocardial myocytes. AP propagation from subendocardial to subepicardial myocytes required less Gc compared with conduction in the opposite direction. In failing heart, AP morphology was dramatically altered, with a significantly elevated plateau potential and prolonged AP duration. Spatially nonuniform alteration of AP duration in failing heart blunted the transmural gradient of repolarization. Furthermore, increased pacing rate prolonged AP duration exclusively in myocytes from failing heart, and the critical conductance required for successful AP propagation decreased significantly at high frequencies. Finally, in failing heart, asymmetry of transmural electrical propagation was abolished. CONCLUSIONS: In failing heart, preferential conduction from subendocardial to subepicardial myocytes is lost, and failing myocytes manifest facilitated AP propagation at fast rates. Together, these electrical remodeling responses may promote conduction of premature impulses and heighten the risk of malignant arrhythmia, a prominent feature of heart failure.

Propagation of pacemaker activity.

Spontaneous activity of specific regions (e.g., the Sinoatrial node, SAN) is essential for the normal activation sequence of the heart and also serve as a primary means of modulating cardiac rate by sympathetic tone and circulating catecholamines. The mechanisms of how a small SAN region can electrically drive a much larger atrium, or how a small ectopic focus can drive surrounding ventricular or atrial tissue are complex, and involve the membrane properties and electrical coupling within the SAN or focus region as well as the membrane properties, coupling conductance magnitudes and also regional distribution within the surrounding tissue. We review here studies over the past few decades in which mathematical models and experimental studies have been used to determine some of the design principles of successful propagation from a pacemaking focus. These principles can be briefly summarized as (1) central relative uncoupling to protect the spontaneously firing cells from too much electrotonic inhibition, (2) a transitional region in which the cell type and electrical coupling change from the central SAN region to the peripheral atrial region, and (3) a distributed anisotropy to facilitate focal activity.

Stretch-activated channel activation promotes early afterdepolarizations in rat ventricular myocytes under oxidative stress.

Mechanical stretch and oxidative stress have been shown to prolong action potential duration (APD) and produce early afterdepolarizations (EADs). Here, we developed a simulation model to study the role of stretch-activated channel (SAC) currents in triggering EADs in ventricular myocytes under oxidative stress. We adapted our coupling clamp circuit so that a model ionic current representing the actual SAC current was injected into ventricular myocytes and added as a real-time current. This current was calculated as I(SAC) = G(SAC) * (V(m) - E(SAC)), where G(SAC) is the stretch-activated conductance, V(m) is the membrane potential, and E(SAC) is the reversal potential. In rat ventricular myocytes, application of G(SAC) did not produce sustained automaticity or EADs, although turn-on of G(SAC) did produce some transient automaticity at high levels of G(SAC). Exposure of myocytes to 100 microM H(2)O(2) induced significant APD prolongation and increase in intracellular Ca(2+) load and transient, but no EAD or sustained automaticity was generated in the absence of G(SAC). However, the combination of G(SAC) and H(2)O(2) consistently produced EADs at lower levels of G(SAC) (2.6 +/- 0.4 nS, n = 14, P < 0.05). Pacing myocytes at a faster rate further prolonged APD and promoted the development of EADs. SAC activation plays an important role in facilitating the development of EADs in ventricular myocytes under acute oxidative stress. This mechanism may contribute to the increased propensity to lethal ventricular arrhythmias seen in cardiomyopathies, where the myocardium stretch and oxidative stress generally coexist.

The endothelin-1 G5665T polymorphism impacts transplant-free survival for single ventricle patients.

BACKGROUND: Early survival for children with single-ventricle congenital heart disease has improved, but late attrition remains a serious problem. The endothelin-1 G5665T single nucleotide polymorphism has been linked to increased vascular reactivity and hypertension. The goal of this study was to determine whether this single nucleotide polymorphism alters transplant-free survival for children with single-ventricle congenital heart disease. METHODS: DNA was isolated from 165 children with single-ventricle congenital heart disease born between January 1980 and December 2006. The endothelin-1 G5665T single nucleotide polymorphism genotype was determined by using real-time polymerase chain reaction. Kaplan-Meier survival curves were generated with a combined end point of death or transplantation. The Cox proportional hazard method was used to evaluate potential covariates. RESULTS: The endothelin-1 G5665T genotype was significantly associated with transplant-free survival for the group as a whole (P = .002), with the greatest effect in children with hypoplastic left heart syndrome (n = 64, P = .0002) as opposed to patients with other types of single-ventricle anatomy (n = 101, P = .1). Cox proportional hazard modeling revealed 3 independent predictors of poor outcome: endothelin G5665T genotype (T/T genotype, P = .001), prematurity (gestational age <37 weeks, P = .02), and era of surgical intervention (1990s vs other decades, P = .02). CONCLUSIONS: Long-term survival of single-ventricle patients is dependent on many factors. These data suggest that genetic variability involving vascular resistance modifiers, such as endothelin-1, might play an important role, particularly in patients with hypoplastic left heart syndrome. Future studies should include evaluation of the relationship between endothelin genotype and plasma endothelin levels and possibly therapeutic trials of endothelin blockers in high-risk patients.

Developmental changes in time course of recovery from inactivation in L-type calcium currents of rabbit ventricular myocytes.

The mechanisms of recovery from inactivation of the L-type calcium current (I(Ca)) are not well established, and recovery is affected by many experimental conditions. Little is known about developmental changes of recovery from inactivation of I(Ca). We studied developmental changes of recovery from inactivation in I(Ca) using isolated adult and newborn (1-4 days) rabbit ventricular myocytes. We used broken-patch and perforated-patch techniques with physiological extracellular ionic concentrations of calcium and sodium and interpulse conditioning potentials of -80 or -50 mV. We also maximized I(Ca) with forskolin. We found that recovery from inactivation did not differ between adult and newborn cells when either EGTA or BAPTA was used to buffer intracellular calcium. Maximizing I(Ca) with forskolin slowed recovery from inactivation in newborn but not in adult cells. In contrast, when the intracellular buffering of the cell was left nearly intact (perforated patch), recovery from inactivation (half-time of recovery) in the newborn cells was significantly slower than for the adult cells when either a conditioning potential of -80 mV (140 +/- 9 vs. 58 +/- 4 ms, newborn vs. adult; P < 0.05) or -50 mV (641 +/- 106 vs. 168 +/- 15 ms, newborn vs. adult; P < 0.05) was used. Forskolin significantly increased half-time of recovery for both adult and newborn cells. Dialysis with no calcium buffer showed a slower recovery from inactivation in newborn cells. Intracellular dialysis with a calcium buffer masked differences in recovery from inactivation of I(Ca) between newborn and adult rabbit ventricular cells.

Effects of single-site versus biventricular epicardial pacing on myocardial performance in an immature animal model of atrioventricular block.

INTRODUCTION: Single-site ventricular pacing results in dyssynchronous ventricular activation and may contribute to ventricular dysfunction. We evaluated epicardial biventricular (BiV) pacing as a means of maintaining synchronous ventricular activation in an acute piglet model of AV block with normal ventricular anatomy and function. METHODS AND RESULTS: We used left ventricular (LV) impedance catheters and tissue Doppler imaging to assess the cardiodynamics of immature piglets (n = 6, 33-78 days, 9.35 +/- 0.85 kg). Following catheter ablation of the AV node, a pacemaker was programmed 20 beats per minute above the intrinsic atrial rate. The animals were paced at 5-minute intervals via the following AV sequential configurations: Right atrial appendage (RA)-RV apex (RVA), RA-LV apex (LVA), and RA-biventricular (RVA/LVA). RA-RVA was the experimental control. LV systolic mechanics, measured by the slope of the end-systolic pressure-volume relationship (E(es)), increased with BiV pacing (12.8 +/- 3.4 mmHg/mL, P < 0.02) or single-site LVA pacing (10.6 +/- 3.4 mmHg/mL, P < 0.05) compared with single-site RVA pacing (8.3 +/- 1.4 mmHg/mL). QRS duration lengthened compared with sinus rhythm (42 +/- 8 msec) with either RVA (56 +/- 9 msec, P < 0.02) or LVA (54 +/- 7 msec, P < 0.03), but not with BiV (48 +/- 7 msec, P = 0.08) pacing. Tissue Doppler imaging showed LV dyssynchrony with RVA (septal-to-lateral delay 46.0 +/- 51.7 msec), with return toward normal with LVA (-9.6 +/- 33.6 msec, P < 0.04) or BiV (-4.1 +/- 33.8 msec, P < 0.04) pacing. CONCLUSIONS: In this acute immature piglet model of AV block, LV performance improved with single-site pacing from the LVA and BiV pacing (RVA/LVA), as compared with single-site pacing from the RVA. These changes correlated with tissue Doppler indices of mechanical synchrony, though not necessarily with QRS duration.

Calcium transients in infant human atrial myocytes.

Isolated infant human atrial cells have a slower early repolarization than adult human atrial cells. In addition, from room temperature voltage-clamp studies, infant cells have lower basal L-type calcium currents than adult cells. We hypothesized that the slower repolarization increases the calcium transient of infant human atrial cells. Atrial myocytes were enzymatically dissociated from biopsies of human right atrial appendages of infant (3-8 mo) patients who were undergoing open-heart surgery. Intracellular calcium transients were measured with fluorescence microscopy with application of either square waves or action potential waveforms at physiologic temperature. After repetitive application (1 Hz) of 100-ms duration conditioning depolarizations to 10 mV (from -80 mV), a test pulse of varying duration (DeltaT; 2-100 ms) produced smaller transients (expressed as percentage of the last conditioning pulse) at shorter durations (33 +/- 7% for DeltaT = 2 ms, 80 +/- 4% for DeltaT = 25 ms). With repetitive application of either adult or infant prerecorded action potentials to infant cells, the cells had a decreased calcium transient with the adult action potential (F/F(0) 2.2 +/- 0.4 for infant action potential versus 1.6 +/- 0.2 for adult action potential; n = 7; p < 0.05). The delayed early repolarization of infant cells alters the Ca(2+) transient, which may compensate for the lower availability of basal calcium current in infant cells. The steep relationship that we have demonstrated between test-pulse duration and the calcium transient suggests that modulation of the early repolarization phase of the action potential may be of great significance in modulating excitation-contraction coupling.

Expression of protein phosphatases during postnatal development of rabbit heart.

Protein phosphatases play a major role in the regulation of L-type calcium current (I(Ca)) in heart cells. We previously showed developmental differences in the effects of inhibitors of protein phosphatases (PP's) on the modulation of I(Ca), with greater stimulatory effects on I(Ca) observed in newborn than in adult ventricular cells. We hypothesized that this developmental difference might be due to greater expression and levels of PP 1 and PP 2A in newborn than in adult ventricular cells. We thus determined the mRNA expression of alpha and beta subunits of PP 1 and the a subunit of PP 2A in adult and newborn rabbit ventricles and levels of PP 1 and PP 2A in total homogenates, particulate membranes, and in soluble fraction prepared from isolated ventricular myocytes from adult and newborn rabbits. RT-PCR analysis demonstrated the presence of mRNA of these subunits of PP's in both newborn and adult ventricles. Northern blot analysis using 32P labeled cDNA probes specific for PP 1alpha, PP 1beta and PP 2Aalpha showed that the expression of steady state mRNA levels for PP 1alpha, PP 1beta and PP 2Aalpha were much higher in newborn compared to adult rabbit ventricles. mRNA for glyceraldehyde-3-phosphate dehydrogenase (GAPDH) and for sarcoplasmic reticulum Ca(2+)-ATPase (SERCA) in rabbit ventricles were measured as controls. GAPDH did not show significant developmental changes while mRNA for SERCA was higher in adult compared to newborns. Western blot analysis showed that PP 1 and PP 2A protein levels were also much higher in newborn compared to adult rabbit ventricular cells. Immunoblot analysis in particulate membranes and soluble fraction showed that PP1 was mainly membrane bound while PP 2 was present only in soluble fraction. These findings suggest that the two major protein phosphatases (PP 1 and PP 2A) in heart are expressed at much higher levels in newborn and decline to lower levels in adult ventricular myocytes. The presence of high levels of PP's and particularly PP 1 in newborn cells may be responsible for the greater dependence of newborn cells on the inhibition of PP as a mechanism of action of beta-agonist isoproterenol on I(Ca).

Induced automaticity in isolated rat atrial cells by incorporation of a stretch-activated conductance.

Stretch of the atrium and sympathetic activity have been implicated as substrates for atrial fibrillation. We investigate how a model of stretch in combination with sympathetic stimulation can induce automaticity in atrial cells. We adapted our coupling clamp circuit so that a model ionic current that represents stretch-activated channels (SACs) was injected into an isolated rat atrial cell in real time. This current was calculated as ISAC= GSAC (Vm-ESAC), where GSAC and ESAC are the conductance and reversal potential of SACs and Vm is the cell's membrane potential. Repetitive automaticity was induced by a sufficiently large GSAC and this critical value of GSAC was decreased by exposure to isoproterenol. The critical value of GSAC decreased from 0.63+/-0.05 nS (mean+/-SE) in control to 0.40+/-0.07 nS in isoproterenol (P<0.05). Additionally, after exposure to isoproterenol, automaticity continued after GSAC was no longer applied and was accompanied by delayed after-depolarizations. In three cells, repetitive automaticity could not be induced at any value of GSAC. Exposure to 10 nM isoproterenol converted these cells to cells with repetitive automaticity in response to GSAC. We conclude that automaticity can be induced in isolated rat atrial cells by application of a model of SACs. Exposure to isoproterenol enhances this effect.

Inhibition of fast sodium current in rabbit ventricular myocytes by protein tyrosine kinase inhibitors.

The present study investigated the effects of protein tyrosine kinase inhibitors on the fast sodium current ( I(Na)) in rabbit ventricular myocytes. Single rabbit ventricular myocytes were isolated enzymatically using Langendorff perfusion. I(Na) was recorded using the whole-cell patch-clamp technique at room temperature. The protein tyrosine kinase inhibitors genistein, AG957, ST638, and PP2 reversibly inhibited I(Na) in a concentration-dependent manner. At a test pulse potential of -30 mV, genistein (n=7) inhibited I(Na) by 37.7+/-3.2%, 53.4+/-2.5%, and 71.8+/-2.7% at concentrations of 15, 50, and 100 microM, respectively, without changing the voltage dependence of activation, while 100 microM AG957, 100 microM ST638, and 30 microM PP2 inhibited I(Na) by 38.7+/-2.4, 35.8+/-3.4, and 21.1+/-3.9%, respectively. Genistein (100 microM) and AG957 (100 microM) shifted the voltage for half-maximal inactivation of I(Na) from -76.7+/-2.0 mV (n=10) in control to -88.37+/-2.6 mV (n=6, P<0.05), and -82.9+/-1.7 (n=4, P<0.05), respectively, without changing the slope factor. Genistein and AG957 also significantly prolonged the time course of I(Na) recovery from inactivation. Daidzein and PP3, inactive analogs of genistein and PP2, respectively, did not inhibit I(Na) significantly. We conclude that protein tyrosine kinase signaling pathways may play an important role in regulation of I(Na) in cardiac myocytes.

Developmental differences in L-type calcium current of human atrial myocytes.

We investigated differences in L-type Ca2+ current (ICa) between infant (INF, 1-12 mo old), young adult (YAD, 14-18 yr old), and older adult (AD) myocytes from biopsies of right atrial appendages. Basal ICa was smaller in INF myocytes (1.2 +/- 0.1 pA/pF, n = 29, 6 +/- 1 mo old, 11 patients) than in YAD (2.5 +/- 0.2 pA/pF, n = 20, 16 +/- 1 yr old, 5 patients) or AD (2.6 +/- 0.3 pA/pF, n = 19, 66 +/- 3 yr old, 9 patients) myocytes (P < 0.05). Maximal ICa produced by isoproterenol (Iso) was similar in INF, YAD, and AD cells: 8.4 +/- 1.1, 9.6 +/- 1.0, and 9.2 +/- 1.3 pA/pF, respectively. Efficacy (Emax) was larger in INF (607 +/- 50%) than for YAD (371 +/- 29%) or AD (455 +/- 12%) myocytes. Potency (EC50) was 8- to 10-fold higher in AD (0.82 +/- 0.09 nM) or YAD (0.41 +/- 0.14 nM) than in INF (7.6 +/- 3.5 nM) myocytes. Protein levels were similar for Gialpha2 but much greater for Gialpha3 in INF than in AD or YAD atrial tissue. When Gialpha3 activity was inhibited by inclusion of a Gialpha3 COOH-terminal decapeptide in the pipette, basal ICa and the response to 10 nM Iso were increased in INF, but not in YAD, cells. We propose that basal ICa and the response to low-dose beta-adrenergic stimulation are inhibited in INF (but not YAD or AD) cells as a result of constitutive inhibitory effects of Gialpha3.

Regulation of transient outward current in human atrial myocytes by protein tyrosine kinase pathway.

INTRODUCTION: Regulation of transient outward current (I(to)) in human myocytes is unclear. The present study investigated the effect of protein tyrosine kinase (PTK) inhibitors on I(to) in human atrial myocytes. METHODS AND RESULTS: Atrial myocytes were isolated enzymatically from biopsies of human right atrial appendage obtained from patients undergoing coronary artery bypass surgery. I(to) was recorded by the whole-cell patch-clamp technique in voltage-clamp configuration. Two groups of PTK inhibitors, the ATP binding site PTK inhibitors genistein and AG957 and the protein substrate PTK inhibitors ST638 and PP2, significantly inhibited I(to) in a concentration-dependent manner, with a potency order of genistein>AG957>ST638>PP2. At test pulse potential of +60 mV, I(to) was inhibited by 28% +/- 3%, 59% +/- 3%, and 89% +/- 3% by 15, 50, and 100 microM genistein, respectively. Daidzein and PP3, inactive analogues of genistein and PP2, respectively, did not produce any inhibitory effects on I(to). In addition to the inhibition of I(to) amplitude, the protein substrate PTK inhibitors ST638 and PP2 significantly accelerated I(to) inactivation (current decay) and delayed recovery from inactivation. Inhibition of protein tyrosine phosphatase partially reversed the effect of genistein. Stimulation or inhibition of serine/ threonine kinases (PKA, PKC, and PKG) did not change I(to) or alter the inhibitory response of PTK inhibitors on I(to). CONCLUSION: In human atrial cells, the PTK pathway plays an important role in the regulation of basal I(to), independent of serine/threonine kinases.

Differences in transient outward current properties between neonatal and adult human atrial myocytes.

UNLABELLED: Knowledge of postnatal modulation of I(to) in human atrial myocytes is quite limited. The present study investigated the differences in I(to) properties between neonatal and adult human atrial myocytes. METHODS: Atrial myocytes were dissociated enzymatically from biopsies of human right atrial appendage. I(to) and action potentials were recorded by whole-cell patch-clamp technique. The expressed protein levels of Kv4.3 and KChIP2 in atrial tissue were detected by western blot technique. RESULTS: I(to) was present in all atrial cells (n = 37) from 10 neonatal patients (2.5-7 months). The mean value of I(to) density in neonatal atrial cells was significantly larger than in adult atrial cells. The time constants for I(to) current decay were significantly faster for neonatal cells, compared to adult cells. I(to) recovery from inactivation at holding potential of - 80 mV was significantly slower for neonatal atrial cells than for adult atrial cells. There was no difference in the voltage dependence of I(to) activation between neonatal and adult cells. The voltage-dependent inactivation slope factor was smaller for neonatal compared to adult atrial cells. A more significant frequency-dependent suppression of I(to) peak current and a more significant lengthening of APD(30) were observed in neonatal atrial cells compared to adult atrial cells. Western blots showed both Kv4.3 and KChIP2 are expressed in neonatal atria, but with significantly higher level of Kv4.3 and lower level of KChIP2 protein compared to adult. CONCLUSION: There are significant differences in the properties of I(to) between neonatal and adult human atrial cells, including a larger current density, faster inactivation and slower recovery from inactivation in the neonatal atrial cells. The physiological differences of I(to) are consistent with the different expression protein levels of Kv4.3 and KChIP2.