Improvement of Shen'ge formula on heart function in diastolic heart failure: A protocol for randomized, double-blind, placebo-controlled clinical study.

INTRODUCTION: Diastolic heart failure (DHF) is an important pathological type of heart failure, that involves multiple organ dysfunction and multiple complications. The prevalence of DHF is high, and effective treatments are lacking. Chinese herbs are an alternative therapy for DHF. Shen'ge formula (SGF) is a classical formula from which patients can benefit, but convincing evidence of its efficacy is lacking. Therefore, we designed this randomized controlled trial protocol. METHODS/DESIGN: This randomized, double-blind, placebo-controlled clinical trial will evaluate the efficacy and safety of SGF in the treatment of DHF. A total of 130 patients with DHF will be enrolled in the trial and treated with SGF granules or placebo for 12 weeks and followed up for 12 weeks. The primary outcome measurement will be to changes in plasma N-terminal brain natriuretic peptide precursor before versus after treatment, while the second primary outcome measurement will be changes in heart function before versus after treatment and the 12-week follow-up period. It will also include echocardiography, a cardiopulmonary exercise test, cardiac function grading, traditional Chinese medicine syndrome score, and the Minnesota Heart Failure Quality of Life Scale. Adverse events will be evaluated throughout the trial. DISCUSSION: The results of this trial will demonstrate whether SGF could alleviate symptoms, improve cardiac function, reduce readmission rates, and improve quality of life of patients with DHF. TRIAL REGISTRATION: Chinese Clinical Trial Register, ChiCTR2000036533, registered on August 24, 2020.

Canola oil rich in oleic acid improves diastolic heart function in diet-induced obese rats.

Obesity is a leading cause of cardiovascular disease. It directly affects heart structure and function and contributes to heart failure. Diet is a major factor involved in the development of obesity along with genetic factors. We examined the effects of monounsaturated and polyunsaturated fatty acid-rich oils on cardiac structure and function in the diet-induced rodent model of obesity (DIO). Obese prone (OP) rats were fed a high-fat diet (HF; 55% of kcal) for 12 weeks; Sprague-Dawley rats fed commercial chow served as control. Echocardiography was performed to assess the cardiac structure and function in all rats at 12 weeks. OP rats fed the HF diet showed significant impairment in diastolic function compared to control rats. The HF diet containing high oleic canola oil significantly improved diastolic function of OP rats compared to the HF diet with lard. In conclusion, canola oil rich in oleic acid, when incorporated into an HF diet, prevents the development of diastolic dysfunction in DIO rats.

[Effect of Kanli Granule on Myocardial Mechanics in Pressure Overload Induced Diastolic Heart Failure Rats].

OBJECTIVE: To observe the effect of Kanli Granule (KG) on myocardial mechanics in pressure overload induced diastolic heart failure (DHF) rats. METHODS: Totally 60 male Wistar rats were divided into the sham-operation group, the model group, the KG group, and the Valsartan group according to random digit table, 15 in each group. The pressure overload induced DHF model was established in all groups except the sham-operation group using abdominal aortic constriction surgery. Totally 7 rats died after modeling (with the mortality of 10. 67%) , and the rest 53 finished the following test. Rats in the KG group were administered with KG extract (calculated as 6. 75 g crude drug/kg) by gastrogavage. Rats in the Valsartan group were administered with Valsartan (7.2 µg/g) by gastrogavage. Equal volume of double distilled water was administered to rats in the model group and the sham-operation group by gastrogavage. All rats were intervened for 32 weeks. The response of isolated heart papillary muscle tonus to isoprenaline (ISO) and adenylate cyclase (Forskolin) was respectively observed. The enhancement phenomenon after resting development force (DF) of isolated heart papillary muscle tonus, and changes of DF in different Ca²âº concentrations were observed. RESULTS: (1) In the ISO response test: Compared with the sham-operation group, the amplifications of DF, ±df/dt, -df/dt were obviously elevated in the model group (P < 0.05). Compared with the model group, the amplifications of DF and ±df/dt were obviously lowered in the KG group (P < 0.01), and the amplification of ±df/dt was also reduced in the Valsartan group (P < 0.01). (2) In the Forskolin response test: Compared with the sham-operation group, the amplifications of DF and ±df/dt obviously increased in the model group (P < 0.05). Compared with the model group, the amplifications of DF and ±df/dt were obviously reduced in the KG group (P < 0.01), and the amplification of DF was also reduced in the Valsartan group (P < 0.05). (3) In post-resting DF enhancement test: Compared with the sham-operation group, the amplification of DF showed gradually decreasing tendency along with prolonged resting time in the model group, and they were obviously lowered at all time points (P < 0.05). Compared with the model group, the amplification of DF was gradually increasing along with prolonged resting time in the KG group. The amplification of DF at post-resting 240 s was obviously larger in the KG group than in the model group (P < 0.05). The amplification of post-resting DF still showed gradually decreasing tendency along with prolonged resting time in the Valsartan group, with increased amplifications of DF at post-resting 60 s and 120 s (P < 0. 05) (4) The amplifications of DF in different Ca²âº concentrations: Compared with the sham-operation group, the amplifications of DF were significantly elevated in different Ca²âº concentrations (1.75, 3.5, 7.0 mmol/L ) (P < 0.05, P < 0.01). Compared with the model group, there was no statistical difference in amplification of DF in different Ca²âº concentrations in the KG group (P > 0.05). The amplifications of DF in different Ca²âº concentrations were significantly reduced in the Valsartan group (P < 0.05). CONCLUSIONS: The ISO response and the Forskolin response were enhanced in isolated heart papillary muscle tonus of pressure overload induced DHF rats; enhanced post-resting DF was reduced; DF in different supra-physiologic levels of Ca²âº was still enhanced. KG could significantly improve excessive enhancement of pressure overload induced DHF rats in ISO response and Forskolin response, and improve enhancement of post-resting myocardium.

Myocardial energetics and ubiquinol in diastolic heart failure.

Diastolic heart failure, or heart failure with preserved ejection fraction, is a leading cause of morbidity and mortality. There are no current therapies effective in improving outcomes for these patients. The aim of this article is to review the literature and examine the role of coenzyme Q10 in heart failure with preserved ejection fraction related to mitochondrial synthesis of adenosine triphosphate and reactive oxygen species production. The study results reflect that myocardial energetics alters in diastolic heart failure and that there is defective energy metabolism and increased oxidative stress. Studies are emerging to evaluate coenzyme Q10 , particularly ubiquinol, as a supplemental treatment for heart-failure patients. In diastolic heart-failure patients, clinicians are beginning to use supplemental therapies to improve patient outcomes, and one promising complementary treatment to improve left ventricular diastolic function is ubiquinol. Additional studies are needed using large-scale randomized models to confirm if ubiquinol would be beneficial. Since ubiquinol is an antioxidant and is required for adenosine triphosphate production, clinicians and health scientists should be aware of the potential role of this supplement in the treatment of diastolic heart failure.

Tetrahydrobiopterin improves diastolic dysfunction by reversing changes in myofilament properties.

Despite the increasing prevalence of heart failure with preserved left ventricular function, there are no specific treatments, partially because the mechanism of impaired relaxation is incompletely understood. Evidence indicates that cardiac relaxation may depend on nitric oxide (NO), generated by NO synthase (NOS) requiring the co-factor tetrahydrobiopterin (BH(4)). Recently, we reported that hypertension-induced diastolic dysfunction was accompanied by cardiac BH(4) depletion, NOS uncoupling, a depression in myofilament cross-bridge kinetics, and S-glutathionylation of myosin binding protein C (MyBP-C). We hypothesized that the mechanism by which BH(4) ameliorates diastolic dysfunction is by preventing glutathionylation of MyBP-C and thus reversing changes of myofilament properties that occur during diastolic dysfunction. We used the deoxycorticosterone acetate (DOCA)-salt mouse model, which demonstrates mild hypertension, myocardial oxidative stress, and diastolic dysfunction. Mice were divided into two groups that received control diet and two groups that received BH(4) supplement for 7days after developing diastolic dysfunction at post-operative day 11. Mice were assessed by echocardiography. Left ventricular papillary detergent-extracted fiber bundles were isolated for simultaneous determination of force and ATPase activity. Sarcomeric protein glutathionylation was assessed by immunoblotting. DOCA-salt mice exhibited diastolic dysfunction that was reversed after BH(4) treatment. Diastolic sarcomere length (DOCA-salt 1.70±0.01 vs. DOCA-salt+BH(4) 1.77±0.01µm, P<0.001) and relengthening (relaxation constant, τ, DOCA-salt 0.28±0.02 vs. DOCA-salt+BH(4) 0.08±0.01, P<0.001) were also restored to control by BH(4) treatment. pCa(50) for tension increased in DOCA-salt compared to sham but reverted to sham levels after BH(4) treatment. Maximum ATPase rate and tension cost (ΔATPase/ΔTension) decreased in DOCA-salt compared to sham, but increased after BH(4) treatment. Cardiac MyBP-C glutathionylation increased in DOCA-salt compared to sham, but decreased with BH(4) treatment. MyBP-C glutathionylation correlated with the presence of diastolic dysfunction. Our results suggest that by depressing S-glutathionylation of MyBP-C, BH(4) ameliorates diastolic dysfunction by reversing a decrease in cross-bridge turnover kinetics. These data provide evidence for modulation of cardiac relaxation by post-translational modification of myofilament proteins.

[Effect of Nuanxin Capsule on two rat models with heart failure].

OBJECTIVE: To observe the effects of Nuanxin Capsule (NC) on the rat models of heart failure induced by abdominal aorta constriction and adriamycin. METHODS: Rats were randomly divided into the following groups: model control group, low-dose and high-dose, and digoxin group. Meanwhile, the pseudo-operation and NC groups were seperately established. After treatment for 30 days, the heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), left ventricular systolic pressure (LVSP), left ventricular end-diastolic pressure (LVEDP), maximal rate of increase and decrease in left ventricular pressure (+/- dp/dt), mean peripheral blood pressure (MBP) as well as levels of serum superoxide dismustase (SOD), malondialdeh-vde (MDA), cardiac index and heart size were measured. RESULTS: SBP, LVSP, +/- dp/dt and SOD activity increased,while LVEDP,serum MDA levels decreased in high and low-dose NC groups of two models. The heart rates also decreased, but the difference was insignificant (P>0.05, compared with those of model group). Besides, the heart rate,heart size and cardiac index, as well as serum Ang II levels also decreased. The differences were significant as compared with the digoxin group (P>0.05). The high-dose NC also significatly improved MBP and SOD (P<0.05 and P<0.01). CONCLUSION: Nuanxin Capsule has good therapeutic effects on the rats models of adriamycin and abdominal aorta constriction induced heart failure.

Therapeutic inhibition of miR-208a improves cardiac function and survival during heart failure.

BACKGROUND: Diastolic dysfunction in response to hypertrophy is a major clinical syndrome with few therapeutic options. MicroRNAs act as negative regulators of gene expression by inhibiting translation or promoting degradation of target mRNAs. Previously, we reported that genetic deletion of the cardiac-specific miR-208a prevents pathological cardiac remodeling and upregulation of Myh7 in response to pressure overload. Whether this miRNA might contribute to diastolic dysfunction or other forms of heart disease is currently unknown. METHODS AND RESULTS: Here, we show that systemic delivery of an antisense oligonucleotide induces potent and sustained silencing of miR-208a in the heart. Therapeutic inhibition of miR-208a by subcutaneous delivery of antimiR-208a during hypertension-induced heart failure in Dahl hypertensive rats dose-dependently prevents pathological myosin switching and cardiac remodeling while improving cardiac function, overall health, and survival. Transcriptional profiling indicates that antimiR-208a evokes prominent effects on cardiac gene expression; plasma analysis indicates significant changes in circulating levels of miRNAs on antimiR-208a treatment. CONCLUSIONS: These studies indicate the potential of oligonucleotide-based therapies for modulating cardiac miRNAs and validate miR-208 as a potent therapeutic target for the modulation of cardiac function and remodeling during heart disease progression.

Antifibrotic effects of ω-3 fatty acids in the heart: one possible treatment for diastolic heart failure.

Half of heart failure patients have diastolic heart failure, which has no effective treatments. Several studies indicate a role for ω-3 polyunsaturated fatty acids (PUFAs) in heart failure. Recent studies suggest that ω-3 PUFAs inhibit cardiac fibrosis and attenuate diastolic dysfunction. This opens up possible new avenues for treatment of diastolic heart failure. In this review, we focus on the antifibrotic effects of ω-3 PUFAs in heart and the underlying cellular and molecular mechanisms.

Effect of Shenmai Injection on ventricular diastolic function in patients with chronic heart failure: An assessment by tissue Doppler imaging.

OBJECTIVE: To assess the effect of Shenmai Injection (SMI) on left ventricular diastolic function (LVDF) in patients with chronic heart failure (CHF) by tissue Doppler imaging (TDI). METHODS: Sixty-four CHF patients were randomly assigned to two groups, the observation group and the control group. Basic treatment including polarized liquid therapy was given to all the patients. In addition, SMI was given to patients of the observation group. The treatment duration was 14 days. TDI was performed in all the patients 3 days prior to the initiation of the treatment and one week after the medication to measure the average movement velocity of the mitral ring of the left ventricle at the early systolic stage and late diastolic stage (Ea and Aa); the outcomes were compared with the corresponding parameters obtained from blood flow Doppler echocardiography, namely, the velocity of the E-wave (E) and A-wave (A). RESULTS: After treatment, Ea and Ea/Aa increased and Aa decreased significantly in the observation group (P<0.05). In the control group, although some improvement was seen, there was no statistically significant change (P>0.05). No statistical significance was shown between groups in these parameters after treatment. CONCLUSION: TDI assessment shows that SMI could effectively improve the LVDF in CHF patients.

[Studies on protection and mechanism of tetramethylpyrazine on myocardial injury of rats with DHF].

OBJECTIVE: To study the effects of different doses of tetramethylpyrazine on injury and calcium overload in myocardial cells of diastole heart failure rat model. METHOD: Diastole heart failure model was established by the coarctation of abdominal aorta. 4 weeks after operation, forty rats with DHF were divided into four groups randomly as follows, model (physiological saline 2 mL), tetramethylpyrazine (40 mg x kg(-1) x d(-1)), tetramethylpyrazine (20 mg x kg(-1) x d(-1)), tetramethylpyrazine (10 mg x kg(-1) x d(-1)), with 10 rats for each group (n = 10), and 10 sham operation rats was taken as control (physiological saline, 2 mL). After 4 weeks administration, cardiac function was determined by catheter. The changes of myocardial ultrastructure were investigated by means of transmission electron microscope. [Ca2+ ]i was measured by laser scanning confocal microscope [LSCM]. Ca(2+) -ATPase activity of mitochondrion was measured by the method of enzymatic reaction chromatometry. RESULT: Compared with the control group, the rats of operation group have no significant changes on left ventricular systolic pressure (LVSP) and maximal rising rate of ventricular pressure (+dp/dt(max)), but left ventricular end diastolic pressure (LVEDP) increased markedly, maximal delining rate of ventricular pressure (-dp/dt(max)) decreased significantly, left ventricular relax time constant quantity (T) markedly extended, myocardial pathology injured markedly, [Ca2+]i in cardiocyte increased markedly and the Ca(2+) -ATPase activity of myocardial mitochondria decreased significantly in the model group. After 4 weeks administration, compared with the model group, LVEDP decreased significantly, -dp/dt(max) increased markedly, T markedly shortened, myocardial ultrastructure damage were significantly reduced, fluorescent value decreased and Ca(2+) -ATPase activity of mitochondrion increased significantly in TMP low-dose group and mid-dose group. CONCLUSION: Low dosage of TMP can reduced myocardial pathology injury, increased Ca(2+)-ATPase activity of myocardial mitochondria, improve cardiac function and [Ca2+]i in cardiocyte and antagonise calcium overload of rats with DHF.

[Effects of different dose berberine on hemodynamic parameters and [Ca2+]i of cardiac myocytes of diastolic heart failure rat model].

OBJECTIVE: To study the effects of different doses of berberine on hemodynamic parameters and calcium ion concentration ([Ca2+]i) of diastole heart failure rat models. METHOD: The mouse models of diastole heart failure were made by the imcomplete ligation of abdominal aorta. Forty Wistar heart failure rats were divided randomly into four groups, with 10 for each group (n = 10). Heart failure rats were treated according to different doses drugs as follows: Model (natrii chloride 2 mL), berberine (63 mg x kg(-1) x d(-1)), berberine (42 mg x kg(-1) x d(-1)), berberine (21 mg x kg(-1) x d(-1)) ig, for each of the four groups respectively, 4 weeks after coarctation of ascending aorta operation; and 10 age matched sham operation group was taken as control (natrii chloridi, 2 mL). After administration four weeks, cardiac function was determined by catheter. Isolate single cardiomyocytes of rat which were loaded with Ca(2+)-sensitive fluorescent indicator Fluo-3/AM. [Ca2+]i represented by fluorescent intensity [FI] was measured by laser scanning cofocal microscope [LSCM]. RESULT: The rats of operation group have no significant changes with those of the control on left ventricular systolic pressure (LVSP) and maximal rising rate of ventricular pressure (+dp/dt(max)), left ventricular end diastolic pressure (LVEDP) was much higher in operation group (P < 0.01), but maximal falling rate of ventricular pressure (-dp/dt(max)) was depressed (P < 0.01), left ventricular relax time constant quantity (T) was markedly extended (P < 0.01). [Ca2+]i level in carkiac muscle cell was elevated markedly (P < 0.05). Compared with operation group, high dose of Ber can decrease LEVDP, improve (-dp/dt(max)) (P < 0.01), decurtate left ventricular relax time constant quantity (P < 0.01) and decrease [Ca2+]i level better than those of middle and low dose group (P < 0.01). CONCLUSION: Berberine is an effective new potent drug for conspicuous symptom relief of heart failure with positive dose dependency and step down [Ca2+]i of myocardial cell.