Integrative echocardiographic assessment of post-operative obstruction severity and restenosis after balloon valvuloplasty in 81 dogs with pulmonary stenosis.

INTRODUCTION/OBJECTIVES: Pulmonary stenosis (PS) is a congenital defect in the dog that is managed with balloon valvuloplasty (BV). Obstruction severity is routinely assessed using transthoracic echocardiography. The objectives of this study were to describe the short-term changes and long-term restenosis by retrospectively evaluating flow-dependent and flow-independent echocardiographic variables for dogs with PS after BV. ANIMALS, MATERIALS, AND METHODS: Medical records and stored echocardiographic images were reviewed from dogs that received BV for PS. The following echocardiographic variables were measured or calculated: maximum systolic ejection velocity (VmaxPV) and velocity-derived maximal pressure gradient (PV maxPG) across the pulmonary valve; ratio of aortic to pulmonary velocity time integral (VTIAV/VTIPV); ratio of aortic to pulmonary maximal velocity. RESULTS: Eighty-one dogs with PS that had a BV were included. Each of these dogs had pulmonary obstruction severity assessed in at least three timepoints. Forty-nine dogs had at least one additional examination performed, the last of which occurred a median of 504 days after the BV. Echocardiographic variables at the first follow-up had increased by a clinically relevant quantity in 20-34% of the dogs when comparing to the immediate post-BV examination. The last follow-up examination identified valve restenosis in 18-38% of the dogs in this study. Valve type and pre-BV obstruction severity did not have a significant effect (P > 0.1). CONCLUSIONS: For the assessment of BV efficacy, the immediate post-BV echocardiogram may not be as useful as the first follow-up examination several months later. Pulmonary restenosis after BV may be more prevalent than previously reported.

Hybrid balloon valvuloplasty for management of severe mitral stenosis in four symptomatic, adult dogs.

Four adult dogs weighing <10 kg presented for the evaluation of severe mitral valve stenosis with clinical signs. Owing to the size of the dogs, a hybrid surgical and interventional approach was utilized for balloon valvuloplasty. A left lateral thoracotomy was performed to allow direct entry through the left atrial wall. Transesophageal echocardiography was utilized for the entirety of the procedure in all dogs, and fluoroscopy was additionally used in two dogs. One dog had mild to moderate intra-operative bleeding from the left atrial wall during the procedure, but no other intra-operative complications were observed. No dogs developed a clinically relevant amount of worsened mitral regurgitation. Based on mitral leaflet mobility and transmitral flow profiles, there was perceived improvement in all four dogs. One dog died 6 h after extubation due to respiratory arrest. The remaining dogs survived to discharge and had resolution of clinical signs at home and discontinuation of heart failure medications. One dog died of an unknown cause at five months and another developed atrial fibrillation, and the owners elected to euthanize at ten months after the procedure. One dog continues to do well six months after the procedure as of the time of this writing. Hybrid balloon valvuloplasty can be a viable management option for small breed dogs with severe mitral stenosis exhibiting clinical signs, and both transesophageal echocardiography and fluoroscopy can be used intra-operatively to assist in successful procedural outcomes.

Long-term relief of obstruction in a dog with double-chambered right ventricle using combined cutting balloon and high-pressure balloon dilation.

A 4-month-old intact female Golden Retriever dog was diagnosed with double-chambered right ventricle (DCRV) without infundibular stenosis, tricuspid valve dysplasia, and subsequent severe right atrial enlargement and was referred for combined cutting balloon and high-pressure balloon dilation. On presentation, these diagnoses were confirmed, and the peak systolic pressure gradient across the DCRV obstructive lesion assessed by continuous wave Doppler interrogation was 80 mm Hg. The obstructive lesion within the mid-right ventricle had a diameter of 6 mm through which blood flowed from the proximal right ventricular (RV) chamber to the distal RV chamber. The following day, general anesthesia was induced, and a minimally invasive balloon dilation was performed. A cutting balloon was inflated across the mid-RV obstructive lesion, followed by an inflation of a high-pressure balloon across this lesion. The high-pressure balloon catheter that was used had a diameter roughly 1.5 times the diameter of the pulmonary annulus. The following day, echocardiographic evaluation of the patient revealed a peak systolic pressure gradient across the DCRV obstructive lesion of 16 mm Hg, with a RV diameter at the level of obstruction of 11 mm. Twelve months later, the dog remains asymptomatic, right atrial size has decreased, and has a peak systolic pressure gradient across the DCRV lesion of 20 mm Hg.

FRAX calculated without BMD does not correctly identify Caucasian men with densitometric evidence of osteoporosis.

The FRAX algorithm assesses the patient's probability of sustaining an osteoporotic fracture and can be calculated with or without densitometric data. This study seeks to determine whether in men, FRAX scores calculated without BMD, correctly identify patients with BMD-defined osteoporosis. INTRODUCTION: The diagnosis of osteoporosis is based on densitometric data, the presence of a fragility fracture or increased fracture risk. The FRAX algorithm estimates the patient's 10-year probability of sustaining an osteoporotic fracture and can be calculated with or without BMD data. The purpose of this study is to determine whether in men, FRAX calculated without BMD, can correctly identify patients with BMD-defined osteoporosis. METHODS: Retrospectively retrieved data from 726 consecutive Caucasian males, 50 to 70 years old referred to our Osteoporosis Center. RESULTS: In the population studied, 11.8 and 25.3% had BMD-defined osteoporosis when female and male reference populations were used respectively. When the National Osteoporosis Foundation thresholds to initiate treatment are used, only 27% of patients with BMD-defined osteoporosis, but 4% with normal BMD reached/exceeded these thresholds. Lowering the threshold increased sensitivity, but decreased specificity. CONCLUSIONS: Our results suggest that FRAX without BMD is not sensitive/specific enough to be used to identify Caucasian men 50 to 70 years old with BMD-defined osteoporosis.

X-ray diffraction study of low-temperature phase transformations in nickel-titanium orthodontic wires.

OBJECTIVES: Employ conventional X-ray diffraction (XRD) to analyze three clinically important nickel-titanium orthodontic wire alloys over a range of temperatures between 25 and -110 degrees C, for comparison with previous results from temperature-modulated differential scanning calorimetry (TMDSC) studies. METHODS: The archwires selected were 35 degrees C Copper Ni-Ti (Ormco), Neo Sentalloy (GAC International), and Nitinol SE (3M Unitek). Neo Sentalloy, which exhibits superelastic behavior, is marketed as having shape memory in the oral environment, and Nitinol SE and 35 degrees C Copper Ni-Ti also exhibit superelastic behavior. All archwires had dimensions of 0.016in.x0.022in. (0.41 mm x 0.56 mm). Straight segments cut with a water-cooled diamond saw were placed side-by-side to yield a 1 cm x 1cm test sample of each wire product for XRD analysis (Rint-Ultima(+), Rigaku) over a 2theta range from 30 degrees to 130 degrees and at successive temperatures of 25, -110, -60, -20, 0 and 25 degrees C. RESULTS: The phases revealed by XRD at the different analysis temperatures were in good agreement with those found in previous TMDSC studies of transformations in these alloys, in particular verifying the presence of R-phase at 25 degrees C. Precise comparisons are not possible because of the approximate nature of the transformation temperatures determined by TMDSC and the preferred crystallographic orientation present in the wires. New XRD peaks appear to result from low-temperature transformation in martensite, which a recent transmission electron microscopy (TEM) study has shown to arise from twinning. SIGNIFICANCE: While XRD is a useful technique to study phases in nickel-titanium orthodontic wires and their transformations as a function of temperature, optimum insight is obtained when XRD analyses are combined with complementary TMDSC and TEM study of the wires.

Annealing study of palladium-silver dental alloys: Vickers hardness measurements and SEM microstructural observations.

Three Pd-Ag dental alloys for metal-ceramic restorations, W-1 (Ivoclar Vivadent), Rx 91 (Pentron) and Super Star (Heraeus Kulzer), were subjected to isothermal annealing for 0.5 hr periods in a nitrogen atmosphere at temperatures from approximately 400 degrees to 950 degrees C. The annealing behavior was investigated by Vickers hardness measurements (1 kg load) and SEM microstructural observations. The highest Vickers hardness occurred at approximately 700 degrees C for W-1 and 650 degrees C for Rx 91. For Super Star, there were two peaks in hardness at approximately 500 degrees and 650 degrees C. Additional use of light indenting loads (25 g for W-1; 10 g for Rx 91 and Super Star) revealed that hardness variations during annealing for W-1 and Rx 91 were related to the palladium solid solution matrix phase. For Super Star, the lower-temperature peak was controlled by multi-phase regions and the higher-temperature peak by the matrix phase. While microstructural changes due to annealing were evident with the SEM for Rx 91 and Super Star, no correlation was possible for W-1 because of its finer-scale microstructure. Although commercial Pd-Ag alloys have a relatively narrow composition range, their microstructures and annealing behavior can vary because of differences in proportions of secondary elements utilized for porcelain adherence and grain refinement elements, as well as other proprietary strategies employed by the manufacturers.

Transmission electron microscopic studies of deformed high-palladium dental alloys.

Objective. The purpose of this study was to employ transmission electron microscopy (TEM) to investigate the microstructures of Pd-Cu-Ga and Pd-Ga dental alloys that had been permanently deformed, in order to obtain information about the deformation behavior of individual phases and changes in microstructure brought about by that deformation.Methods. Heavily deformed regions taken from fractured tensile test bars of the two alloys in the as-cast condition were prepared for TEM analysis, using mechanical grinding and polishing, ion milling, and plasma cleaning. The specimens were examined in the TEM using bright-field and dark-field diffraction contrast imaging. Selected-area and convergent-beam electron diffraction patterns were employed to analyze the structures of the phases, and standardless energy-dispersive X-ray spectrometry was used to determine their mean compositions.Results. For both alloys, tweed structures underwent permanent deformation by twinning, whereas dislocation movement occurred in the face-centered cubic (fcc) palladium solid solution matrix. A body-centered cubic (bcc) phase, previously unreported in our TEM studies and containing a high density of dislocations, was identified in the Pd-Cu-Ga alloy, while fine-scale, stress-induced precipitates were found in some regions of the fcc matrix in the Pd-Ga alloy.Significance. The present results have provided novel information about the mechanical deformation behavior of high-palladium alloys. The stress-induced precipitation in the Pd-Ga dental alloy studied may be a critical component of strengthening mechanisms.

Transmission electron microscopic investigation of a Pd-Ag-In-Sn dental alloy.

With the price volatility of palladium, there has been renewed interest in palladium-silver alloys for metal-ceramic restorations in dentistry. The microstructures of a popular Pd-Ag dental alloy were investigated in the as-cast and simulated porcelain-firing heat-treated conditions, using transmission electron microscopy. In the as-cast condition, the microstructure was strongly influenced by microsegregation, and contained the face-centered cubic Pd solid solution matrix, a eutectic structure with lattice parameters that varied for the two phases, and a face-centered tetragonal (fct) precipitate. After heat treatment, the lattice parameters for the two phases in the eutectic structure were uniform, and discontinuous precipitates with [011](matrix) habit planes and dislocations appeared in the matrix. An unusual nanostructured constituent was found in the fct set of eutectic lamellae in the heat-treated alloys.

Fatigue studies of high-palladium dental casting alloys: Part II. Transmission electron microscopic observations.

The microstructures of two representative high-palladium dental alloys, a Pd-Cu-Ga alloy and a Pd-Ga alloy, which had been subjected to cyclic fatigue in uniaxial tension were investigated by transmission electron microscopy (TEM). Two different mechanisms were found to dominate microplastic deformation during fatigue: twinning in the Pd-Cu-Ga alloy, and planar slip of dislocations in the Pd-Ga alloy. In addition, stress-induced precipitation occurred in the Pd-Ga alloy during cyclic loading. Heat treatment simulating the firing cycles for dental porcelain resulted in the formation of a previously unreported bcc phase in the Pd-Cu-Ga alloy, and in the elimination of the characteristic tweed structure found in the Pd-Ga alloy for the as-cast condition.

Gbetagamma affinity for bovine rhodopsin is determined by the carboxyl-terminal sequences of the gamma subunit.

Two native betagamma dimers, beta(1)gamma(1) and beta(1)gamma(2), display very different affinities for receptors. Since these gamma subunits differ in both primary structure and isoprenoid modification, we examined the relative contributions of each to Gbetagamma interaction with receptors. We constructed baculoviruses encoding gamma(1) and gamma(2) subunits with altered CAAX (where A is an aliphatic amino acid) motifs to direct alternate or no prenylation of the gamma chains and a set of gamma(1) and gamma(2) chimeras with the gamma(2) CAAX motif at the carboxyl terminus. All the gamma constructs coexpressed with beta(1) in Sf9 cells yielded beta(1)gamma dimers, which were purified to near homogeneity, and their affinities for receptors and Galpha were quantitatively determined. Whereas alteration of the isoprenoid of gamma(1) from farnesyl to geranylgeranyl and of gamma(2) from geranylgeranyl to farnesyl had no impact on the affinities of beta(1)gamma dimers for Galpha(t), the non-prenylated beta(1)gamma(2) dimer had significantly diminished affinity. Altered prenylation resulted in a <2-fold decrease in affinity of the beta(1)gamma(2) dimer for rhodopsin and a <3-fold change for the beta(1)gamma(1) dimer. In each case with identical isoprenylation, the beta(1)gamma(2) dimer displayed significantly greater affinity for rhodopsin compared with the beta(1)gamma(1) dimer. Furthermore, dimers containing chimeric Ggamma chains with identical geranylgeranyl modification displayed rhodopsin affinities largely determined by the carboxyl-terminal one-third of the protein. These results indicate that isoprenoid modification of the Ggamma subunit is essential for binding to both Galpha and receptors. The isoprenoid type influences the binding affinity for receptors, but not for Galpha. Finally, the primary structure of the Ggamma subunit provides a major contribution to receptor binding of Gbetagamma, with the carboxyl-terminal sequence conferring receptor selectivity.

Independent and synergistic interaction of retinal G-protein subunits with bovine rhodopsin measured by surface plasmon resonance.

We have used surface plasmon resonance (SPR) measurements for the kinetic analysis of G-protein-receptor interaction monitored in real time. Functionally active rhodopsin was immobilized on an SPR surface, with full retention of biochemical specific activity for catalysis of nucleotide exchange on the retinal G-protein alpha subunit, via binding to immobilized concanavalin A. The binding interactions of bovine retinal alpha(t) and beta(1)gamma(1) subunits with rhodopsin measured by SPR were profoundly synergistic. Synergistic binding of the retinal G-protein subunits to rhodopsin was not observed for guanosine 5'-[gamma-thio]triphosphate-bound Galpha(t), nor was binding observed with squid retinal Galpha(q), which is not activated by bovine rhodopsin. The binding affinity (336+/-171 nM; mean value+/-S.D.) of retinal betagamma for rhodopsin in the presence of retinal alpha subunit measured by SPR confirmed the apparent affinity of 254 nM determined previously by nucleotide exchange assays. Binding of beta(1)gamma(1), beta(1)gamma(2), and beta(1)gamma(8-olf) dimers to rhodopsin, independently of the alpha subunit, was readily observable by SPR. Further, these dimers, differing only in their gamma subunit compositions, displayed markedly distinct binding affinities and kinetics. The beta(1)gamma(2) dimer bound with a kinetically determined K(d) of 13+/-3 nM, a value nearly identical with the biochemically determined K(1/2) of 10 nM. The physiologically appropriate beta(1)gamma(1) displayed rapid association and dissociation kinetics, whereas the other beta(1)gamma dimers dissociated at a rate less than 1/100 as fast. Thus rhodopsin interaction with its native signalling partners is both rapid and transient, whereas the interaction of rhodopsin with heterologous Gbetagamma dimers is markedly prolonged. These results suggest that the duration of a G-protein-coupled receptor signalling event is an intrinsic property of the G-protein coupling partners; in particular, the betagamma dimer.

Percutaneous vertebroplasty: a novel treatment for acute vertebral fractures.

Acute vertebral fracture is a painful and debilitating complication of osteoporosis which has been extremely difficult to manage. Percutaneous vertebroplasty--injecting cement to stabilise the fractured end plate--represents a major management breakthrough. We report the first four patients with osteoporotic vertebral fractures treated by this technique at our hospital. They are, to our knowledge, among the first to be successfully treated in this way in Australia.

Contribution of individual projections alone and in combination for radiographic detection of ankle fractures.

OBJECTIVE: We wanted to determine whether the standard three-view ankle radiographic series could be replaced by a two-view combination, and if so, which two-view combination (anteroposterior with lateral or mortise with lateral) would be superior. MATERIALS AND METHODS: During a 12-month period, we retrospectively reviewed 556 consecutive ankle radiographic studies consisting of anteroposterior, mortise, and lateral views. One hundred twenty patients with at least one ankle fracture were paired with 140 healthy control subjects. Each image in the three-view examination was separated and sorted by view and studied independently; all images were reviewed by two skeletal radiologists and two orthopedic surgeons. Each radiograph was evaluated for fracture of the medial, lateral, and posterior malleoli and the foot using a five-point confidence rating. Performance of each view and modeled two- and three-view combinations of views was evaluated with modified receiver operating characteristic analysis. RESULTS: The data provide little support for preferring either two-view combination (anteroposterior-lateral or mortise-lateral) for any type of fracture. The three-view combination does detect significantly more fractures than some two-view combinations in some locations, and there is a statistically significant cost in diagnostic accuracy for eliminating the anteroposterior or mortise view. CONCLUSION: Reducing the ankle radiographic series from three to two views would result in a small but significant decrease in the detection of fractures of the ankle and foot. Both two-view combinations are equivalent for fracture detection.

Electrocardiographic patterns of patients with echocardiographically determined biventricular hypertrophy.

The numerous criteria proposed for the electrocardiographic (ECG) diagnosis of biventricular hypertrophy (BVH) suffer from inadequate correlative data. We used two-dimensional (2D) echocardiography to identify BVH and analyzed the ECG patterns in these patients. The study group had 69 such patients with BVH and the control group had 22 patients with isolated left ventricular hypertrophy (LVH) demonstrated by 2D echocardiography. The electrocardiograms were analyzed for the presence of established criteria used in the diagnosis of LVH and right ventricular hypertrophy (RVH). Of the 69 patients in the study group, 17 (25%) had ECG findings of BVH, 25 (36%) had LVH, and 14 (20%) had RVH. An S wave in V5/V6 of >7 mm was most the frequent finding in the 17 patients with BVH on the electrocardiogram. The sensitivity of ECG criteria for BVH was 24.6%, specificity was 86.4%, and positive predictive value was 85%. This study reemphasizes the difficulty of ECG diagnosis of BVH. The electrocardiogram has a low sensitivity but satisfactory specificity and positive predictive accuracy for BVH.

Effect of long-term beta-blockade on aortic root compliance in patients with Marfan syndrome.

BACKGROUND: This study was undertaken to assess the effect of long-term beta-blockade on the aortic root stiffness index and distensibility in patients with Marfan syndrome. METHODS: Aortic root stiffness index and distensibility were calculated according to the formulas of Stefanadis and Hirai, respectively, with 2-dimensional guided M-mode echocardiogram before and after an average of 26 months of atenolol administration. RESULTS: Twenty-three asymptomatic patients were studied (11 men and 12 women, aged 31 +/- 14.2 years). The follow-up was 4 +/- 2.2 years. The dose of atenolol was individualized (mean 43.5 +/- 21.6 mg/d). Heart rate decreased from 79 +/- 9 beats/min to 64 +/- 9 beats/min (P =. 01), and systolic blood pressure decreased from 124 +/- 13 mm Hg to 114 +/- 2 mm Hg (P =.01). Distensibility increased from 1.85 +/- 0. 70 x 10(-6) cm2/dynes-1 to 2.21 +/- 0.76 x 10-6 cm2/dynes-1 (P =.02), and the stiffness index decreased from 9.68 +/- 3.78 to 8.85 +/- 3. 15 ( P =.2). Two groups of responses to treatment were identified. Compared with baseline values 15 (65%) patients who responded to treatment had increased distensibility and decreased stiffness index of the aortic root (P =.05). Eight patients (35%) who did not respond to treatment had no significant change. Body weight >91 kg and baseline end-diastolic aortic root diameter >40 mm were significantly associated with no response (P =.05). Two patients in the nonresponding group had echocardiographic progression of aortic insufficiency. CONCLUSIONS: There was a heterogeneous response in the aortic root elastic properties after long-term treatment with atenolol in asymptomatic patients with Marfan syndrome. Stiffness index and distensibility are more likely to respond when the baseline end-diastolic aortic root diameter is <40 mm.

The bombesin receptor subtypes have distinct G protein specificities.

We used an in situ reconstitution assay to examine the receptor coupling to purified G protein alpha subunits by the bombesin receptor family, including gastrin-releasing peptide receptor (GRP-R), neuromedin B receptor (NMB-R), and bombesin receptor subtype 3 (BRS-3). Cells expressing GRP-R or NMB-R catalyzed the activation of squid retinal Galphaq and mouse Galphaq but not bovine retinal Galphat or bovine brain Galphai/o. The GRP-R- and NMB-R-catalyzed activations of Galphaq were dependent upon and enhanced by different betagamma dimers in the same rank order as follows: bovine brain betagamma > beta1gamma2 >> beta1gamma1. Despite these qualitative similarities, GRP-R and NMB-R had distinct kinetic properties in receptor-G protein coupling. GRP-R had higher affinities for bovine brain betagamma, beta1gamma1, and beta1gamma2 and squid retinal Galphaq. In addition, GRP-R showed higher catalytic activity on squid Galphaq. Like GRP-R and NMB-R, BRS-3 did not catalyze GTPgammaS binding to Galphai/o or Galphat. However, BRS-3 showed little, if any, coupling with squid Galphaq but clearly activated mouse Galphaq. GRP-R and NMB-R catalyzed GTPgammaS binding to both squid and mouse Galphaq, with GRP-R activating squid Galphaq more effectively, and NMB-R also showed slight preference for squid Galphaq. These studies reveal that the structurally similar bombesin receptor subtypes, in particular BRS-3, possess distinct coupling preferences among members of the Galphaq family.

TEM analysis of tweed structure in high-palladium dental alloys.

Transmission electron microscopy and convergent-beam electron diffraction were used to study three high-palladium dental alloys: an as-cast Pd-Ga alloy, a cast Pd-Cu-Ga alloy aged at room temperature for over 5 years, and a cast Pd-Cu-Ga alloy annealed at 1023 K for 2 h and slowly cooled to room temperature. Bands containing a tweed structure in the Pd-Ga alloy were 120degrees twins with (1 1 0 mirror planes. Within these bands the alloy had a face-centered tetragonal structure with a c/a ratio of 1.03. The aged Pd-Cu-Ga alloy contained a larger amount of tweed structure than the original as-cast alloy, along with randomly oriented bands and thin lath-like regions. The annealed Pd-Cu-Ga alloy contained rectangular particles of a secondary phase that may be Pd2Ga, Pd5Ga2 or Pd13Ga5. The microtwinned band structure relieves the strain energy arising from transformation of the f.c.c. palladium solid solution on cooling.

Mechanism of allosteric regulation of the rod cGMP phosphodiesterase activity by the helical domain of transducin alpha subunit.

The G protein alpha subunit (Galpha) is composed of two distinct folding domains: a GTP-binding Ras-like domain and an alpha helical domain (HD). We have recently reported that the helical domain (HDt) of the vertebrate visual transducin alpha subunit (Galphat) synergizes activation of retinal cyclic GMP phosphodiesterase (PDE) by activated Galphat (Liu, W., and Northup, J. K., (1998) Proc. Natl. Acad. Sci. U. S. A. 95, 12878-12883). Here, we examine the molecular basis for this HD-based signaling regulation, and we provide a new model for the activation of the target effector. The HD proteins derived from visual transducin or taste gustducin alpha subunits, but no other Galpha HD proteins, each attenuate the PDE catalytic core (Palphabeta) and synergize Galphat stimulation of the holoPDE (Palphabetagamma2) with similar apparent affinities. The data from studies of both HDt-mediated attenuation and stimulation indicate that the HDt and the PDE inhibitory subunit (Pgamma) interact with PDE at independent sites and that Palphabeta contains the binding sites for HD. The saturation of both processes by HDt displays positive cooperativity with Hill coefficients of 1.5 for the attenuation of Palphabeta activity and 2.1 for synergism of holoPDE activation. Our data suggest the that Galphat-HDt regulates PDE by allosterically decreasing the affinity of Palphabeta for Pgamma and thus simultaneously facilitating the interaction of the activated Galphat-Ras-like domain with Pgamma. Thus, we propose a new model for the high efficiency of PDE activation as well as deactivation, and, overall, a novel mechanism for controlling fidelity, sensitivity, and efficacy of G protein signaling.

Cell contact as an independent factor modulating cardiac myocyte hypertrophy and survival in long-term primary culture.

Cardiac myocytes maintained in cell culture develop hypertrophy both in response to mechanical loading as well as to receptor-mediated signaling mechanisms. However, it has been shown that the hypertrophic response to these stimuli may be modulated through effects of intercellular contact achieved by maintaining cells at different plating densities. In this study, we show that the myocyte plating density affects not only the hypertrophic response and features of the differentiated phenotype of isolated adult myocytes, but also plays a significant role influencing myocyte survival in vitro. The native rod-shaped phenotype of freshly isolated adult myocytes persists in an environment which minimizes myocyte attachment and spreading on the substratum. However, these conditions are not optimal for long-term maintenance of cultured adult cardiac myocytes. Conditions which promote myocyte attachment and spreading on the substratum, on the other hand, also promote the re-establishment of new intercellular contacts between myocytes. These contacts appear to play a significant role in the development of spontaneous activity, which enhances the redevelopment of highly differentiated contractile, junctional, and sarcoplasmic reticulum structures in the cultured adult cardiomyocyte. Although it has previously been shown that adult cardiac myocytes are typically quiescent in culture, the addition of beta-adrenergic agonists stimulates beating and myocyte hypertrophy, and thereby serves to increase the level of intercellular contact as well. However, in densely-plated cultures with intrinsically high levels of intercellular contact, spontaneous contractile activity develops without the addition of beta-adrenergic agonists. In this study, we compare the function, morphology, and natural history of adult feline cardiomyocytes which have been maintained in cultures with different levels of intercellular contact, with and without the addition of beta-adrenergic agonists. Intercellular contact, communication, and transmission of contractile forces between myocytes appears to play a primary role in remodeling the 2-dimensional cell layer into a parallel alignment of elongated myocytes with highly developed intercalated disk-like junctions. This highly differentiated state is very stable, and cultures which achieve this state exhibit significantly greater longevity than more sparsely plated myocytes. These myocytes typically continue beating, and survive from 6 to more than 12 weeks in culture. When this level of contact and differentiation are not achieved, even among beta-adrenergic stimulated myocytes, contractile activity is not sustained, myofibrils atrophy, there is little or no development of junctional complexes, and the period of myocyte viability is typically no more than 5 weeks in vitro.