Mechanism of Shengmaisan Regulating Cardiac Remodeling of Arrhythmias with Deficiency of Qi and Yin / 中国实验方剂学杂志

Arrhythmia is an important disease among cardiovascular diseases. Malignant arrhythmias often occur clinically and are induced by abnormal ion channels， electrical activity disorders， myocardial fibrosis， inflammation， dysfunctional mitochondrial biogenesis， mitochondrial calcium overload， out-of-balance energy metabolism， oxidative stress， sympathetic hyperactivity， and other pathological cardiac remodeling， and they are the main causes of sudden cardiac death. In traditional Chinese medicine， arrhythmias are considered to be palpitations， which are commonly caused by deficiency of Qi and Yin. It is often manifested as a deficiency of the spleen and stomach， resulting in malfunction of the Qi mechanism， followed by a particularly severe decline in cardiac function. Shengmaisan is a representative formula for nourishing Qi and Yin， consisting of Ginseng Radix et Rhizoma， Ophiopogonis Radix， and Schisandrae Chinensis Fructus. In recent years， clinical studies have shown that Shengmaisan and its additions and subtractions are commonly used in the treatment of arrhythmias. In this article， the mechanisms of the active ingredients of Shengmaisan in the electrophysiology， biochemistry， structure， autonomic nervous system， and subcellular fraction of the heart are reviewed， and the multi-target， multi-system， and integrality of Shengmaisan in the treatment of arrhythmias of Qi and Yin deficiency are described. In addition， energy metabolism disorder is tightly juxtaposed with Qi and Yin deficiency syndrome. Mitochondria， as the center of myocardial energy metabolism， play a paramount role in cardiac remodeling， indicating that Shengmaisan will be a salient part of future research to ameliorate cardiac pathologic remodeling through energy metabolism of mitochondria， so as to provide a theoretical basis for the clinical treatment of these arrhythmias.

Como eu faço no Coração de Atleta: avaliação dos diferentes tipos de adaptação ao exercício / My approach to "Athlete'S Heart": evaluation of the different types of adaptation to exercise

A prática regular de esportes pode induzir adaptações no coração, sendo essa condição comumente chamada de "coração de atleta". As alterações observadas incluem dilatação das câmaras cardíacas, aumento da espessura miocárdica, melhora do enchimento ventricular, aumento da trabeculação do ventrículo esquerdo (VE), dilatação da veia cava inferior, entre outras. Essas alterações também podem ser observadas em algumas doenças cardíacas, como cardiomiopatia (CMP) dilatada, hipertrófica e outras. Dessa forma, os exames de imagem cardíaca são fundamentais na identificação dessas alterações e na diferenciação entre o "coração de atleta" e uma possível cardiopatia.(AU)

Exercise-induced adaptation may occur in amateur and professional athletes. This condition is commonly named "athlete's heart". The alterations observed include dilation of the heart chambers, increased myocardial thickness, improved ventricular filling, increased left ventricular trabeculation, dilation of the inferior vena cava, among others. These changes can also be observed in some heart diseases, such as dilated, hypertrophic and other cardiomyopathies (CMP). Thus, cardiac imaging tests are fundamental in identifying these alterations and in differentiating between "athlete's heart" and possible heart disease. (AU)

Effect of candesartan treatment on echocardiographic indices of cardiac remodeling in post-myocardial infarction patients

SUMMARY Objective: Myocardial infarction has unfavorable effect on structural and functional properties of the myocardium, referred to as cardiac remodeling. Left ventricular mass, left ventricular mass index, and relative wall thickness are important predictors of cardiac remodeling. In this study, we investigated the effect of candesartan treatment in comparison with zofenopril treatment on echocardiographic indices of cardiac remodeling in post myocardial infarction patients. Material and Methods: In this prospective study, patients who underwent successful percutaneous coronary intervention were randomly assigned to a candesartan or zofenopril treatment. After randomization, echocardiographic indices of cardiac remodeling including left ventricular mass, left ventricular mass index, and relative wall thickness were evaluated before the start of treatment along with 1- and 6-month follow-ups. Results: According to our study, candesartan group showed significant reduction of estimated left ventricular mass and left ventricular mass index at 6-month follow-up visit compared to baseline values (199.53±38.51 g vs. 212.69±40.82 g; 99.05 g/m2 (90.00-116.5) vs. 106.0 g/m2 (96.0∼123.00), p<0.05, respectively). This trend was also observed in zofenopril group during the 6-month period (201.22±40.07 g vs. 207.52±41.61 g; 101.0 g/m2 (92.25-111.75.0) vs. 104.50 g/m2 (95.0∼116.75), p<0.05, respectively). Although both classes of drugs had favorable effects on post-myocardial infarction cardiac remodeling, the absolute benefit was more prominent in candesartan group as compared to zofenopril group (p<0.05). Conclusion: Our results suggest that candesartan treatment following myocardial infarction may potentially be useful in terms of improving post-myocardial infarction cardiac remodeling.

Inhibitor of growth protein-2 silencing alleviates angiotensin Ⅱ-induced cardiac remodeling in mice by reducing p53 acetylation / 南方医科大学学报

OBJECTIVE@#To investigate the effect of inhibitor of growth protein-2 (Ing2) silencing on angiotensin Ⅱ (AngⅡ)-induced cardiac remodeling in mice and explore the underlying mechanism.@*METHODS@#An adenoviral vector carrying Ing2 shRNA or empty adenoviral vector was injected into the tail vein of mice, followed 48 h later by infusion of 1000 ng · kg-1 · min-1 Ang Ⅱ or saline using a mini-osmotic pump for 42 consecutive days. Transthoracic echocardiography was used to assess cardiac geometry and function and the level of cardiac hypertrophy in the mice. Masson and WGA staining were used to detect myocardial fibrosis and cross-sectional area of cardiomyocytes, and myocardial cell apoptosis was detected with TUNEL assay. Western blotting was performed to detect myocardial expressions of cleaved caspase 3, ING2, collagen Ⅰ, Ac-p53(Lys382) and p-p53 (Ser15); Ing2 mRNA expression was detected using real-time PCR. Mitochondrial biogenesis, as measured by mitochondrial ROS content, ATP content, citrate synthase activity and calcium storage, was determined using commercial assay kits.@*RESULTS@#The expression levels of Ing2 mRNA and protein were significantly higher in the mice with chronic Ang Ⅱ infusion than in saline-infused mice. Chronic infusion of AngⅡ significantly increased the left ventricular end-systolic diameter (LVESD) and left ventricular end-diastolic diameter (LVEDD) and reduced left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) in the mice. Ing2 silencing obviously alleviated AngⅡ-induced cardiac function decline, as shown by decreased LVEDD and LVESD and increased LVEF and LVFS, improved myocardial mitochondrial damage and myocardial hypertrophy and fibrosis, and inhibited cardiomyocyte apoptosis. Chronic AngⅡ infusion significantly increased myocardial expression levels of Ac-p53(Lys382) and p-p53(Ser15) in the mice, and Ing2 silencing prior to AngⅡ infusion lessened AngⅡ- induced increase of Ac-p53(Lys382) without affecting p53 (ser15) expression.@*CONCLUSION@#Ing2 silencing can inhibit AngⅡ-induced cardiac remodeling and dysfunction in mice by reducing p53 acetylation.

The traditional Chinese medicines treat chronic heart failure and their main bioactive constituents and mechanisms

Chronic heart failure (CHF) is a severe public health problem with increasing morbidity and mortality, any treatment targeting a single session is insufficient to tackle this. CHF is characterized by reduced cardiac output resulting from neurohumoral dysregulation and cardiac remodeling, which might be related to oxidative stress, inflammation, endoplasmic reticulum stress, apoptosis, autophagy, mitochondrial function, and angiogenesis. These molecular mechanisms interact with each other through crosstalk. Historically, Chinese medicinal herbs have been widely applied in the treatment of CHF, and therapeutic effects of Chinese medicinal herbs and their ingredients have been scientifically confirmed over the past decades. Traditional Chinese medicine (TCM) with multiple components can confront the different pathogenesis of CHF through multiple targets. This review analyzes commonly used TCM patent drugs and TCM decoctions that are applicable to different stages of CHF based on clinical trials. Diverse bioactive ingredients in Chinese medicinal herbs have been found to treat CHF via multiple molecular mechanisms. This review comprehensively covers the key works on the effects and underlying mechanisms of TCM, herbal ingredients and synergistic effects of constituent compatibility in treating CHF, providing additional ideas to address this threat.

Angiotensin receptor-neprilysin inhibitors and cardiac remodeling

The aim of this study was to determine how sacubitril/valsartan compared with valsartan in an outpatient setting affects left ventricular remodeling in heart failure with reduced ejection fraction and functional (or secondary) mitral regurgitation (SMR) due to the effect of dual inhibition of the renin-angiotensin system and neprilysin. The outpatient study included 90 patients with chronic SMR who were followed up for 12 months. They received sacubitril/valsartan or valsartan instead of the more commonly used angiotensin-converting enzyme inhibitor enalapril for heart failure, in addition to standard medical therapy for heart failure. The difference in NT-proBNP change between groups was the primary endpoint. Changes in effective regurgitation orifice area, left ventricular ejection fraction, left ventricular end-systolic and end-diastolic volume indices, left atrial volume index, E/e' index, and exercise tolerance on the 6-minute walk test were secondary endpoints. In the treatment efficacy analysis, NT-proBNP levels decreased significantly by 37% in the sacubitril/valsartan group and by 11% in the valsartan group (P<0.001). Ejection fraction and exercise tolerance (increase in walking distance in the 6-min test) increased in the sacubitril/valsartan group (P<0.05). Also, in this group, the effective area of the regurgitation orifice, the left atrial volume index, the E/e' index, and the indices of the end-systolic and end-diastolic volume of the left ventricle (P<0.05) decreased more pronouncedly. Compared with valsartan, treatment with sacubitril/valsartan led to a significant improvement in cardiac remodeling in patients with SMR and heart failure with reduced ejection fraction.

Effects of stem cells therapy combined with aerobic exercise on ventricular remodeling in rats with acute myocardial infarction / 中华物理医学与康复杂志

Objective:To explore the effect of supplementing stem cell therapy with aerobic exercise in left ventricle remodeling after myocardial infarction.Methods:Sixty 6-week-old male Wistar rats had acute myocardial infarction induced by ligation of the anterior descending coronary artery. They were then randomly divided into a model group, a stem cell group, an exercise group and an observation group. Another ten healthy Wistar rats formed a sham operation group. The rats in the stem cell and observation groups were infused with a suspension of bone marrow mesenchymal stem cells through the tail vein. Beginning four weeks later, the exercise and observation groups underwent 60 minutes of aerobic treadmill exercise 5 days per week for 8 weeks. At the beginning and end of the eight weeks the rats′ exercise performance was evaluated using a graded treadmill exercise test. And after the last training session cardiac structure and function were detected using ultrasound imaging. Tissue was then collected from the left ventricles and the collagen volume fractions were calculated. The expression of myocardial brain natriuretic peptide (BNP), heavy chain β-myosin (β-MHC) and α-MHC mRNA was detected using real-time fluorescence quantitative PCRs.Results:Compared with the sham operation group, the time and distance to exhaustion shortened significantly in the model group, with a significant decrease in the average maximum running speed, left ventricle ejection fraction (LVEF), left ventricle shortening fraction (LVFS), expression of α-MHC and the α-MHC/β-MHC ratio. There was a significant increase in the average resting heart rate, collagen volume fraction, expression of BNP and β-MHC in the model group. Compared with the model group, there was a significant increase in the average LVEF and LVFS of the stem cell group as well as in the time and distance to exhaustion, maximum running speed, expression of α-MHC and in the α-MHC/β-MHC ratio of the observation group, but a significant decrease in the average collagen volume fraction of the stem cell group compared with the observation group, together with the resting heart rate, collagen volume fraction, the expression of BNP and of β-MHC. Compared with the stem cell group, the observation group showed a significant increase in the average time and distance to exhaustion, maximum running speed, expression of α-MHC and the α-MHC/β-MHC ratio, with a significant decrease in the average resting heart rate, collagen volume fraction, expression of BNP and β-MHC.Conclusion:Aerobic exercise or stem cell therapy alone can inhibit left ventricular remodeling and improve cardiac function after myocardial infarction, at least in rats. The combination of the two treatments has a synergistic effect and can further enhance the effect of stem cell therapy.

Effects of activated CD4 + T cell-derived exosomes on cardiac remodeling after myocardial infarction / 中华危重病急救医学

Objective:To explore the role of activated CD4 + T cells in cardiac remodeling after myocardial infarction (MI). Methods:① Experiment in vitro: naive CD4 + T cells were isolated in mouse spleen, and then stimulated with plate-bound anti-CD3 and anti-CD28 for 48 hours. Exosomes isolated from the supernatant of activated CD4 + T cells were incubated with cardiac fibroblasts (CFs) for 48 hours, and then the ability of CFs proliferation, migration and differentiation were detected by cell counting kit-8 (CCK-8) assay, Transwell assay, and immunofluorescence assay. ② Experiment in vivo: 40 male C57 mice were divided into 4 groups according to random number table method, including control group (Ctrl group), sham operation group (Sham group), MI group, and exosome treatment group (MI+Exo group), with 10 in each group. The mice model of MI was established by ligating the left anterior descending coronary artery. In MI+Exo group, 40 μg/d exosomes were injected intravenously into the tail after modeling. Cardiac function and cardiac fibrosis post-MI were assessed by echocardiography and quantitative polymerase chain reaction (qPCR) at 4th week. Results:① In vitro: exosomes derived from activated CD4 + T cells significantly promote CFs proliferation, migration and differentiation [proliferation ability ( A value): 0.31±0.01 vs. 0.21±0.01, migration capability (cells/MP): 79.20±3.34 vs. 48.80±2.13, differentiation ability (α-smooth muscle actin, α-SMA; fluorescence intensity): 1.56±0.03 vs. 1.00±0.02, all P < 0.05]. ② In vivo: echocardiographic analysis showed that exosomes derived from activated CD4 + T cells aggravated the deterioration of cardiac dysfunction post-MI than MI group, as indicated by left ventricular ejection fraction (LVEF) and fractional shortening (FS) decreased significantly [LVEF: 0.185±0.008 vs. 0.257±0.022, FS: (9.72±1.72)% vs. (14.08±1.08)%, both P < 0.05], left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) increased significantly [LVEDD (mm): 5.43±0.29 vs. 4.62±0.35, LVESD (mm): 4.94±0.12 vs. 3.69±0.29, both P < 0.05]. Additionally, qPCR showed that exosomes derived from activated CD4 + T cells remarkably promoted myocardial fibrosis post-MI than MI group, as indicated by the mRNA expression of α-SMA, collagens (Col1a1, Col3a1) in MI+Exo group was significantly higher than that in MI group [α-SMA (2 -ΔΔCT): 4.72±0.89 vs. 3.58±0.78, Col1a1 (2 -ΔΔCT): 6.59±0.56 vs. 4.23±0.42, Col3a1 (2 -ΔΔCT): 13.40±1.03 vs.4.96±0.36, all P < 0.05]. Conclusion:Activated CD4 + T cells promote cardiac remodeling following MI through transferring exosomes to CFs.

Protective effects of rice bran hydrolysates on heart rate variability, cardiac oxidative stress, and cardiac remodeling in high fat and high fructose diet-fed rats

Objective: To examine the ameliorative effect of rice bran hydrolysates (RBH) on metabolic disorders, cardiac oxidative stress, heart rate variability (HRV), and cardiac structural changes in high fat and high fructose (HFHF)-fed rats.Methods: Male Sprague-Dawley rats were daily fed either standard chow diet with tap water or an HFHF diet with 10％ fructose in drinking water over 16 weeks. RBH (500 and 1000 mg/kg/day) was orally administered to the HFHF-diet-fed rats during the last 6 weeks of the study period. At the end of the treatment, metabolic parameters, oxidative stress, HRV, and cardiac structural changes were examined. Results: RBH administration significantly ameliorated metabolic disorders by improving lipid profiles, insulin sensitivity, and hemodynamic parameters. Moreover, RBH restored HRV, as evidenced by decreasing the ratio of low-frequency to high-frequency power of HRV, a marker of autonomic imbalance. Cardiac oxidative stress was also mitigated after RBH supplementation by decreasing cardiac malondialdehyde and protein carbonyl, upregulating eNOS expression, and increasing catalase activity in the heart. Furthermore, RBH mitigated cardiac structural changes by reducing cardiac hypertrophy and myocardial fibrosis in HFHF-diet-fed rats. Conclusions: The present findings suggest that consumption of RBH may exert cardioprotective effects against autonomic imbalances, cardiac oxidative stress, and structural changes in metabolic syndrome.

Effects of PNU 282987 on Improving Cardiac Remodeling and JAK 2/STAT3 Signaling Pathway / 中国药房

OBJECTIVE：To st udy the effects of α7 nicotinic acetylcholine receptor agonists （PNU282987）on improving cardiac remodeling of mice and Janus kinase 2/signal transducer and activator of transcription 3（JAK2/STAT3）signaling pathway. METHODS：Male Kunming mice were randomly divided into normal control group ，model group ，propranolol group （positive control，i.g. 40 mg/kg）and PNU 282987 low-dose，medium-close and high-dose groups （intraperitoneal injection of 0.5，1.0，3.0 mg/kg），with 10 mice in each group. Except for the normal control group ，mice in the other groups were given isoproterenol （ISO，30 mg/kg） subcutaneously for 7 days to induce the cardiac remodeling model. After 30 minutes of ISO injection ， administration groups were given relevant liquid ，once a day ，for 7 consecutive days. Twelve hours after last administration ，the left ventricular ejection fraction （EF）and left ventricular short axis shortening rate （FS）of mice in each group were measured ，and the whole heart mass index （HMI）was calculated ；the pathological changes of myocardium were observed. The serum contents of lactate dehydrogenase （LDH），creatine kinase （CK），tumor necrosis factor α（TNF-α），interleukin 6（IL-6），the protein expression of intercellular adhesion molecule 1（ICAM-1）and adhesion molecule 1（VCAM-1）were also determined. The ratios of p-JAK2/JAK2，p-STAT3/STAT3 in myocardial tissue were detected. RESULTS ：Compared with normal control group ，EF and FS of model group were significantly reduced ，HMI，the contents of LDH，CK，TNF-α and IL-6，the protein expression of ICAM- 1 and VCAM- 1，the ratio of p-JAK 2/JAK2 and p-STAT 3/STAT3 were increased significantly （P＜0.05 or P＜0.01）； blue collagen deposition in the interstitium of myocardium was obvious，and the degree of fibrosis was severe. Compared with model group ， the EF and FS of the mice in the medium-dose and high-dose groups were increased significantly ， HMI （except for PNU 282987 medium-dose group ），the contents of LDH （except for PNU 282987 medium-dose group ），CK，TNF-α and IL-6，the protein expression of ICAM- 1 and VCAM- 1，the ratio of p-JAK 2/JAK2 and p-STAT 3/STAT3 were decreased significantly （P＜0.05 or P＜ 0.01）；blue collagen deposition in the myocardial interstitium was significantly reduced ，and the degree of myocardial fibrosis was significantly reduced. There was no significant difference in the comparison of the above indicators in PNU 282987 low-dose group （P＞0.05）. CONCLUSIONS ：PNU282987 can improve cardiac remodeling of mice ，the mechanism of which may be associated with inhibiting JAK 2/STAT3 signaling pathway.

Protective effects of rice bran hydrolysates on heart rate variability, cardiac oxidative stress, and cardiac remodeling in high fat and high fructose diet-fed rats

Objective: To examine the ameliorative effect of rice bran hydrolysates (RBH) on metabolic disorders, cardiac oxidative stress, heart rate variability (HRV), and cardiac structural changes in high fat and high fructose (HFHF)-fed rats. Methods: Male Sprague-Dawley rats were daily fed either standard chow diet with tap water or an HFHF diet with 10% fructose in drinking water over 16 weeks. RBH (500 and 1 000 mg/kg/day) was orally administered to the HFHF-diet-fed rats during the last 6 weeks of the study period. At the end of the treatment, metabolic parameters, oxidative stress, HRV, and cardiac structural changes were examined. Results: RBH administration significantly ameliorated metabolic disorders by improving lipid profiles, insulin sensitivity, and hemodynamic parameters. Moreover, RBH restored HRV, as evidenced by decreasing the ratio of low-frequency to high-frequency power of HRV, a marker of autonomic imbalance. Cardiac oxidative stress was also mitigated after RBH supplementation by decreasing cardiac malondialdehyde and protein carbonyl, upregulating eNOS expression, and increasing catalase activity in the heart. Furthermore, RBH mitigated cardiac structural changes by reducing cardiac hypertrophy and myocardial fibrosis in HFHF-diet-fed rats. Conclusions: The present findings suggest that consumption of RBH may exert cardioprotective effects against autonomic imbalances, cardiac oxidative stress, and structural changes in metabolic syndrome.

Physical training attenuates right ventricular dysfunction in rats exposed to cigarette smoke

Abstract Aim: To evaluate the functional and morphological cardiac variables of rats exposed to chronic cigarette smoke (ECS) and to analyze the influence of exercise training on any cardiac remodeling. Methods: Male Wistar rats were assigned into four groups: control animals (C, n=10); control trained rats (CT, n=10), that underwent swimming physical training; ECS rats (E, n=10), that received the smoke of 40 cigarettes/day; and ECS plus trained rats (TE, n=10), that received the cigarette smoke plus the swimming training protocol, for 15 weeks. At the end of the experiment, the animals underwent hemodynamic measurements of the right ventricle (RV) and morphological examination. Results: There was a decrease in the body weight of E, TE and CT groups (p<0.05). RV pressure (maximum systolic, diastolic initial and end-diastolic) was increased in the E and ET groups (p <0.05), while there was a decrease in RV maximum derivative pressure, RV minimum derivative pressure (+dP/dt and -dP/dt) and systolic duration in the TE group (p <0.05). Heart rate increased in the E group (p<0.05). The lung weight/body weight ratio was higher in the TE group (p=0.008). Fluid retention was increased in the RV, left ventricle (LV) and lung of the E group (p<0.001). Conclusion: ECS caused right ventricular dysfunction, pulmonary hypertension and cardiac remodeling. Physical training attenuated the effects of ECS for heart rate responses and the morphological variables of the RV, LV, and the lung.

Modificaciones anatómicas del ventrículo izquierdo en deportistas de canotaje de alto rendimiento / Anatomical modifications of the left ventricle in high performance canoeing athletes

Introducción: La adaptación del corazón humano al acondicionamiento físico ha sido un tema de interés médico-científico, pues el remodelado cardíaco que comprende variación en el tamaño, forma, grosor de las paredes, y masa ventricular responde al tipo de actividad física. Objetivo: Determinar las modificaciones anatómicas del ventrículo izquierdo en kayacistas y canoístas femeninos y masculinos de alto rendimiento. Material y Métodos: Se realizó un estudio prospectivo, descriptivo de corte transversal en deportistas de canotaje de alto rendimiento que acudieron al Instituto de Medicina del Deporte durante la preparación especial con vistas a participar en los Juegos Olímpicos de Rio de Janeiro 2016. La muestra se conformó con 20 deportistas que cumplieron los criterios de inclusión establecidos, se recogieron los resultados de los diferentes parámetros ecocardiográficos que fueron estudiados para comprobar si existía modificación anatómica del ventrículo izquierdo (MAVI). Se empleó la estadística descriptiva e inferencial. Resultados: Edad promedio 20,9 ± 1,18 años, predominio del sexo masculino (65 por ciento); kayak (60 por ciento) y velocidad (55 por ciento) fueron las disciplinas deportivas y modalidades competitivas predominantes , fue frecuente la hipertrofia concéntrica en ambos sexos (65 por ciento), la edad deportiva de igual o menos de 10 años (60 por ciento), espesor relativo de la pared aumentado (65 por ciento), el índice AKS mayor se encontró en la hipertrofia excéntrica (1,3 por ciento) y el porciento de grasa predominante fue en la hipertrofia concéntrica para un (7,9 por ciento). Conclusiones: El espesor relativo de la pared ventricular tuvo una relación significativa con la modalidad competitiva(AU)

Introduction: The adaptation of the human heart to physical conditioning has been a medical and scientific topic of interest where cardiac remodeling involving changes in size, form, thickness of the walls and ventricular mass responds to the type of physical activity. Objective: To determine the anatomical modifications of the left ventricle in high performance male and female canoeing and kayaking athletes. Material and methods: A prospective, descriptive, cross-sectional study was conducted in high performance canoeing athletes that attended the Instituto de Medicina del Deporte during the special training in view of the preparation for the Olympic Games in Rio de Janeiro, 2016. The sample was composed of 20 athletes that fulfilled the established inclusion criteria. The results of the different echocardiographic parameters were collected and analyzed in order to check whether there were anatomical modifications of the left ventricle (AMLV). Differential and descriptive statistics were used. Results: The average age was 20, 9 ± 1, 18 years, the male sex predominated in the study (65 percent), kayak (60 percent) and velocity (55 percent) were the predominant sports disciplines and competitive modalities, respectively. Concentric hypertrophy in both sexes (65 percent), sporting age of 10 years or less (60 percent), and increase in relative wall thickness (65 percent) were frequent; the highest AKS index was found in eccentric hypertrophy (1,3 percent) and predominant fat percentage was observed in concentric hypertrophy (7,9 percent). Conclusions: The relative thickness of the ventricular wall had a significant relationship with the competitive modalities(AU)

Avaliação de biomarcadores séricos e suas relações com marcadores de remodelamento cardíaco e da fibrose miocárdica na cardiopatia chagásica crônica / Assessment of serum biomarkers and their relationships with markers of cardiac remodeling and myocardial fibrosis in chronic chagasic heart disease

A cardiomiopatia chagásica crônica (CCC) é responsável pela maior morbidade e pelo pior prognóstico da doença de Chagas, além de ser a mais fibrosante das cardiopatias. Na doença de Chagas, predizer quais fatores se correlacionam com progressão da doença, morbidade e mortalidade constitui um desafio. Existe a necessidade de dispor de biomarcadores de risco simples, quantitativos e econômicos, que agreguem valor adicional aos métodos convencionais, auxiliando no diagnóstico e prognóstico de pacientes com CCC. Objetivos: Neste estudo, avaliamos os biomarcadores séricos ­ galectina-3 (Gal-3), metaloproteinases (MMP-9 e MMP-2) e seus respectivos inibidores (TIMP-1 e TIMP-2), peptídeos C-terminal do colágeno (PICP e CTXI) e correlacionamos esses biomarcadores com o remodelamento cardíaco e com a fibrose miocárdica na CCC5, através de variáveis ecocardiográficas (VEd, FEVE e relação E/e'). Métodos: Amostras de sangue de pacientes chagásicos nas formas indeterminada (FCI) e cardiomiopatia chagásica grau 5 (CCC5) e de indivíduos não infectados (NI) pelo T. cruzi foram utilizadas. A dosagem dos marcadores foi realizada pela técnica Luminex™ Xmap e por ELISA usando o kit Quantibody®. Para as análises de correlações foi utilizado o coeficiente de correlação de Pearson (r) onde foi medido o grau da correlação linear entre duas variáveis quantitativas. Resultados: Os resultados mostraram maior concentração de MMP-9 entre FCI (p<0,001) e CCC (p<0,05) comparado a NI. Para TIMP-1, verificou-se maior concentração em FCI (p<0,05) e CCC (p<0,05) comparados a NI. Constatou-se maior concentração de MMP- 2 confrontando CCC com FCI (p<0,01). Igualmente, houve maior concentração de TIMP-2 em relação a CCC com FCI (p<0,001). Não foi observada diferença estatística quanto à concentração de PICP e CTXI. E quanto à Gal-3, houve maior concentração em CCC5 (n=50) confrontados com FCI (n=61) (p<0,001). Os dados também demostraram uma correlação positiva entre MMP-2 e TIMP-2 (r=0,7283 e p<0,0001) no grupo CCC5 , uma correlação inversamente proporcional entre Gal-3 e FEVE (r=- 0,5961 e p <0,01) e correlação diretamente proporcional em pacientes com CCC5 (r=0,6656 e p < 0,01). Conclusão: Deste modo, nosso estudo concluiu que entre as moléculas avaliadas, a Gal-3 é um potencial marcador de remodelamento cardíaco e fibrose miocárdica na CCC5.

Chronic Chagas cardiomyopathy (CCC) is responsible for the highest morbidity and the worst prognosis for Chagas disease, in addition to being the most fibrous of heart diseases. In Chagas' disease, predicting which factors correlate with disease progression, morbidity and mortality is a challenge. There is a need to have simple, quantitative and economic risk biomarkers, which add additional value to conventional methods, assisting in the diagnosis and prognosis of patients with CCC. Objectives: In this study, we evaluated serum biomarkers - galectin-3 (Gal-3), metalloproteinases (MMP-9 and MMP-2) and their respective inhibitors (TIMP-1 and TIMP-2), C-terminal collagen peptides (PICP and CTXI) and correlated these biomarkers with cardiac remodeling and myocardial fibrosis in CCC 5, through echocardiographic variables (VEd, LVEF and E / e 'ratio). Methods: Blood samples from chagasic patients in the indeterminate form (FCI) and grade 5 chronic Chagas cardiomyopathy (CCC5) and from individuals not infected (NI) by T. cruzi were used. The dosage of the markers was performed by the Luminex ™ Xmap technique and by ELISA using the Quantibody® kit. For correlation analysis, Pearson's correlation coefficient (r) was used where the degree of linear correlation between two quantitative variables was measured. Results: The results showed a higher concentration of MMP-9 between FCI (p <0.001) and CCC5 (p <0.05) compared to NI. For TIMP-1, there was a higher concentration in FCI (p <0.05) and CCC5 (p <0.05) compared to NI. A higher concentration of MMP-2 was found confronting CCC with FCI (p <0.01). Likewise, there was a higher concentration of TIMP-2 in relation to CCC5 with FCI (p <0.001). There was no statistical difference regarding the concentration of PICP and CTXI. As for Gal-3, there was a higher concentration in CCC (n = 50) compared to FCI (n = 61) (p <0.001). The data also demonstrated a positive correlation between MMP-2 and TIMP-2 (r = 0.7283 and p <0.0001) in the CCC5 group, an inversely proportional correlation between Gal-3 and LVEF (r = -0.5961 and p < 0.01) and directly proportional correlation in patients with CCC5 (r = 0.6656 and p <0.01). Conclusion: Thus, our study concluded that among the evaluated molecules, Gal-3 is a potential marker of cardiac remodeling and myocardial fibrosis in CCC 5.

Chronic aerobic exercise associated to low-dose L-NAME improves contractility without changing calcium handling in rat cardiomyocytes

Nitric oxide (NO) inhibition by high-dose NG-nitro-L-arginine methyl ester (L-NAME) is associated with several detrimental effects on the cardiovascular system. However, low-dose L-NAME increases NO synthesis, which in turn induces physiological cardiovascular benefits, probably by activating a protective negative feedback mechanism. Aerobic exercise, likewise, improves several cardiovascular functions in healthy hearts, but its effects are not known when chronically associated with low-dose L-NAME. Thus, we tested whether the association between low-dose L-NAME administration and chronic aerobic exercise promotes beneficial effects to the cardiovascular system, evaluating the cardiac remodeling process. Male Wistar rats were randomly assigned to control (C), L-NAME (L), chronic aerobic exercise (Ex), and chronic aerobic exercise associated to L-NAME (ExL). Aerobic training was performed with progressive intensity for 12 weeks; L-NAME (1.5 mg·kg-1·day-1) was administered by orogastric gavage. Low-dose L-NAME alone did not change systolic blood pressure (SBP), but ExL significantly increased SBP at week 8 with normalization after 12 weeks. Furthermore, ExL promoted the elevation of left ventricle (LV) end-diastolic pressure without the presence of cardiac hypertrophy and fibrosis. Time to 50% shortening and relaxation were reduced in ExL, suggesting a cardiomyocyte contractile improvement. In addition, the time to 50% Ca2+ peak was increased without alterations in Ca2+ amplitude and time to 50% Ca2+ decay. In conclusion, the association of chronic aerobic exercise and low-dose L-NAME prevented cardiac pathological remodeling and induced cardiomyocyte contractile function improvement; however, it did not alter myocyte affinity and sensitivity to intracellular Ca2+ handling.

Regulation of angiotensin-converting enzyme 2-angiotensin (1-7)-Mas axis provides a new target for the treatment of cardiac remodeling and heart failure / 中华危重病急救医学

Cardiac remodeling is a common pathological manifestation of various end-stage cardiovascular diseases, which leads to myocardial diastolic and systolic dysfunction, low ejection fraction which cannot meet the needs of systemic tissue and organ metabolism, and ultimate progress into heart failure. Excessive activation of the classical renin angiotensin system (RAS), which is the angiotensin-converting enzyme-angiotensinⅡ-type 1 angiotensinⅡ receptor axis (ACE2-AngⅡ-AT1R axis), plays a key role in the pathological process of cardiac remodeling and heart failure. Angiotensin-converting enzyme 2-angiotensin (1-7)-Mas axis [ACE2-Ang (1-7)-Mas axis] is an endogenous negative regulatory pathway of classical RAS, which can reduce its harmful effects. ACE2 is a monocarboxypeptidase that can hydrolyse AngⅡ and produce Ang (1-7), which has cardio-protective effects. Ang (1-7), via endogenous receptor Mas, plays the role of vasodilating, anti-proliferation and anti-differentiation, anti-fibrosis, anti-thrombosis and reversing myocardial remodeling. In recent years, with increasingly growing studies on the ACE2-Ang (1-7)-Mas axis, there are more understanding about their metabolic characteristics and mechanism of action. This article describes the role of ACE2 and Ang (1-7) in cardiac remodeling and heart failure and the related mechanisms, and discusses the potential benefits by regulating ACE2 activity and Ang (1-7) levels in clinical and experimental studies, hopefully providing potential therapeutic strategies.

Effect of Qutan-Tongyang decoction on cardiac function and myocardial remodeling in patients with chronic heart failure / 国际中医中药杂志

Objective@#To explore the effect of Qutan-Tongyang decoction on cardiac function and myocardial remodeling in patients with chronic heart failure.@*Methods@#According to the random table method, 96 patients with chronic heart failure were divided into the control group (n=48) and the research group (n=48). The patients in the control group were treated with conventional treatment, and the patients in the research group were treated with Qutan-Tongyang decoction on the basis of the control group. Two groups of patients were treated for 4 weeks. The clinical total effective rate of two groups of patients after treatment was counted. The LVESD, LVEDD, LVEF, IVST, LVPWT, LVMI, BNP, Ang2 were determined respectively before and after treatment. In addition, the adverse reaction incidence of two groups of patients were observed.@*Results@#The total effective rate of research group was 89.58% (43/48), while the total effective rate of control group was 72.92% (35/48), the difference between two groups was statistically significant (χ2=4.376, P=0.036). After treatment, the LVESD (45.12 ± 3.02 mm vs. 48.05 ± 3.11 mm, t=4.683), LVEDD (52.24 ± 3.65 mm vs. 56.79 ± 4.15 mm, t=5.704), IVST (7.13 ± 0.63 mm vs. 8.02 ± 0.71 mm, t=6.496), LVPWT (8.15 ± 0.58 mm vs. 8.62 ± 0.75 mm, t=3.434), LVMI (97.65 ± 6.28 g/m2 vs. 112.26 ± 8.47 g/m2, t=9.600), BNP (120.21 ± 19.87 ng/L vs. 188.95 ± 24.18 ng/L, t=15.217), Ang2 (252.52 ± 53.74 pg/ml vs. 330.39 ± 60.85 pg/ml, t=6.645) of the research group were significantly lower than those of the control group (P<0.05), while the LVEF (46.79% ± 3.88% vs. 41.52% ± 3.04%, t=7.407) of the research group were significantly higher than the control group (P<0.05). During treatment, there was no significantly difference of adverse reaction rates of the two groups (χ2=0.545, P=0.460).@*Conclusions@#The clinical curative effect of Qutan-Tongyang decoction on the basis of conventional treatment for the treatment of chronic heart failure is significantly, which can significantly improve cardiac function and inhibit cardiac remodeling. It has the high security of the curative effect.

Regulation of angiotensin-converting enzyme 2-angiotensin (1-7)-Mas axis provides a new target for the treatment of cardiac remodeling and heart failure / 中华危重病急救医学

Cardiac remodeling is a common pathological manifestation of various end-stage cardiovascular diseases, which leads to myocardial diastolic and systolic dysfunction, low ejection fraction which cannot meet the needs of systemic tissue and organ metabolism, and ultimate progress into heart failure. Excessive activation of the classical renin angiotensin system (RAS), which is the angiotensin-converting enzyme-angiotensinⅡ-type 1 angiotensinⅡreceptor axis (ACE2-AngⅡ-AT1R axis), plays a key role in the pathological process of cardiac remodeling and heart failure. Angiotensin-converting enzyme 2-angiotensin (1-7)-Mas axis [ACE2-Ang (1-7)-Mas axis] is an endogenous negative regulatory pathway of classical RAS, which can reduce its harmful effects. ACE2 is a monocarboxypeptidase that can hydrolyse AngⅡ and produce Ang (1-7), which has cardio-protective effects. Ang (1-7), via endogenous receptor Mas, plays the role of vasodilating, anti-proliferation and anti-differentiation, anti-fibrosis, anti-thrombosis and reversing myocardial remodeling. In recent years, with increasingly growing studies on the ACE2-Ang (1-7)-Mas axis, there are more understanding about their metabolic characteristics and mechanism of action. This article describes the role of ACE2 and Ang (1-7) in cardiac remodeling and heart failure and the related mechanisms, and discusses the potential benefits by regulating ACE2 activity and Ang (1-7) levels in clinical and experimental studies, hopefully providing potential therapeutic strategies.

YAP activation promotes the transdifferentiation of cardiac fibroblasts to myofibroblasts in matrix remodeling of dilated cardiomyopathy

Yes-associated protein (YAP) is an important regulator of cellular proliferation and transdifferentiation. However, little is known about the mechanisms underlying myofibroblast transdifferentiation in dilated cardiomyopathy (DCM). We investigated the role of YAP in the pathological process of cardiac matrix remodeling. A classic model of DCM was established in BALB/c mice by immunization with porcine cardiac myosin. Cardiac fibroblasts were isolated from neonatal Sprague-Dawley rats by density gradient centrifugation. The expression levels of α-smooth muscle actin (α-SMA) and collagen volume fraction (CVF) were significantly increased in DCM mice. Angiotensin II (Ang II)-mediated YAP activation promoted the proliferation and transdifferentiation of neonatal rat cardiac fibroblasts, and this effect was significantly suppressed in the shRNA YAP + Ang II group compared with the shRNA Control + Ang II group in vitro (2.98±0.34 ×105 vs 5.52±0.82 ×105, P<0.01). Inhibition of endogenous Ang II-stimulated YAP improved the cardiac function by targeting myofibroblast transdifferentiation to attenuate matrix remodeling in vivo. In the valsartan group, left ventricular ejection fraction and fractional shortening were significantly increased compared with the DCM group (52.72±5.51% vs 44.46±3.01%, P<0.05; 34.84±3.85% vs 26.65±3.12%, P<0.01). Our study demonstrated that YAP was a regulator of cardiac myofibroblast differentiation, and regulation of YAP signaling pathway contributed to improve cardiac function of DCM mice, possibly in part by decreasing myofibroblast transdifferentiation to inhibit matrix remodeling.