Reza Mazhari

Effect of Laminar Orthotropic Myofiber Architecture on Regional Stress and Strain in the Canine Left Ventricle

Recent morphological studies have demonstrated a laminar (sheet) organization of ventricular myofibers. Multiaxial measurements of orthotropic myocardial constitutive properties have not been reported, but regional distributions of three-dimensional diastolic and systolic strains relative to fiber and sheet axes have recently been measured in the dog heart by Takayama et al. [30]. A three-dimensional finite-deformation, finite element model was used to investigate the effects of material orthotropy on regional mechanics in the canine left ventricular wall at end-diastole and end-systole. The prolate spheroidal model incorporated measured transmural distributions of fiber and sheet angles at the base and apex. Compared with transverse isotropy, the orthotropic model of passive myocardial properties yielded improved agreement with measured end-diastolic strains when: (1) normal stiffness transverse to the muscle fibers was increased tangent to the sheets and decreased normal to them; (2) shear coefficients were increased within sheet planes and decreased transverse to them. For end-systole, orthotropic passive properties had little effect, but three-dimensional systolic shear strain distributions were more accurately predicted by a model in which significant active systolic stresses were developed in directions transverse to the mean fiber axis as well as axial to them. Thus the ventricular laminar architecture may give rise to anisotropic material properties transverse to the fibers with greater resting stiffness within than between myocardial laminae. There is also evidence that intact ventricular muscle develops significant transverse stress during systole, though it remains to be seen if active stress is also orthotropic with respect to the laminar architecture.

Structural basis of regional dysfunction in acutely ischemic myocardium

OBJECTIVE Impaired systolic function in the normally perfused myocardium adjacent to an ischemic region - the functional border zone - is thought to result from mechanical interactions across the perfusion boundary. We investigated how segment orientation and vessel involved affect regional strains in the functional border zone and whether altered stresses associated with a step transition in contractility can explain the functional border zone. METHODS AND RESULTS Regional epicardial strain distributions were obtained from measured displacements of radiopaque markers in open-chest anesthetized canines, and related to local myofiber angles and blood flows. The functional border zone for fiber strain was significantly narrower than that for cross-fiber strain and significantly wider for left anterior descending (LAD) than left circumflex (LCx) coronary occlusion (1.23 vs. 0.45 cm). A detailed three-dimensional computational model with a one-to-one relation between perfusion and myofilament activation and no transitional zone of intermediate contractility showed close agreement with these observations and significantly elevated stresses in the border zone. Differences between LAD and LCx occlusions in the model were due to differences in left ventricular systolic pressure and not to differences in perfusion boundary or muscle fiber orientation. The border zone was narrower for fiber strain than cross-fiber strain because systolic stiffness is greatest along the muscle fiber direction. CONCLUSION Abnormal regional mechanics in the acute ischemic border arise from increased wall stresses without a transitional zone of intermediate contractility. Perfusion is more tightly coupled to fiber than cross-fiber strain, and a wider functional border zone of fiber strain during LAD than LCx occlusion is primarily due to higher regional wall stresses rather than anatomic variations.

Transmural Distribution of Three-Dimensional Systolic Strains in Stunned Myocardium

Background—Regional function in stunned myocardium is usually thought to be more depressed in the endocardium than the epicardium. This has been attributed to the greater loss of blood flow at the endocardium during ischemia. Methods and Results—We measured transmural distributions of 3D systolic strains relative to local myofiber axes in open-chest anesthetized dogs before 15 minutes of left anterior descending coronary artery occlusion and during 2 hours of reperfusion. During ischemia, regional myocardial blood flow was reduced 84% at the endocardium and 32% at the epicardium (P <0.005, n=7), but changes in end-systolic fiber length from baseline were transmurally uniform. Relative to baseline, radial segments in stunned tissue were significantly thinner at the endocardium than the epicardium at end systole (24±5% versus 16±3%;P <0.05, n=8), consistent with previous reports. Unlike radial and cross-fiber segments, however, the increase of end-systolic fiber lengths in stunned myocardium had no significant transmural gradient (23±8% epicardium versus 21±4% endocardium). We also observed significant 3D diastolic dysfunction in the ischemic-reperfused region transmurally. Conclusions—Myocardial ischemia/reperfusion in the dog results in a significant transmural gradient of dysfunction between epicardial and endocardial layers in radial and cross-fiber segments, but not for fiber segments, despite a gradient in blood flow reduction during ischemia. Perhaps systolic fiber dysfunction rather than the degree of perfusion deficit during the preceding ischemic period may be the main determinant of myocardial dysfunction during reperfusion.

Regional myocardial perfusion and mechanics: A model-based method of analysis

AbstractA new parametric model-based method has been developed that allows epicardial strain distributions to be computed on the left ventricular free wall in normal and ischemic myocardium and integrated with the regional distributions of anatomic and physiological measurements so that underlying relationships can be explored. An array of radiopaque markers was sewn on the anterior wall of the left ventricle (LV) in three anesthetized open-chest canines, and their positions were recorded using biplane video fluoroscopy before and 2 min after occlusion of the left anterior descending coronary artery. The three-dimensional (3D) anatomy of the LV and epicardial fiber angles were measured post-mortem using a 3D probe. A prolate spheroidal finite element model was fitted to the epicardial surface points (with <0.2 mm accuracy) and fiber angles (<5° error). Regional myocardial blood flows (MBFs) were measured using fluorescent microspheres and fitted into the model(<0.3 ml min−1 g−1 error). Epicardial fiber and cross-fiber strain distributions were computed by allowing the model to deform from end-diastole to end-systole according to the recorded motion of the surface markers. Systolic fiber strain varied from −0.05 to 0.01 within the region of the markers during baseline, and regional MBF varied from 1.5 to 2.0 min−1 g−1. During 2 min ischemia, regional MBF was less than 0.3 min−1 g−1 in the ischemic region and 1.0 ml min−1 g−1 in the nonischemic region, and fiber strain ranged from 0.05 in the central ischemic zone to −0.025 in the remote nonischemic tissue. This analysis revealed a zone of impaired fiber shortening extending into the normally perfused myocardium that was significantly wider at the base than the apex. A validation analysis showed that a regularizing function can be optimized to minimize both fitting errors and numerical oscillations in the computed strain fields.

Integrative Models for Understanding the Structural Basis of Regional Mechanical Dysfunction in Ischemic Myocardium

AbstractMyocardial ischemia and many other cardiac pathologies are associated with regional ventricular dysfunction. Since the distributions of stress and material properties cannot be measured directly in intact myocardium, understanding how regional alterations in myocardial strain or segment function are related to underlying cellular dysfunction must be deduced from theoretical models. Here, we describe how anatomically detailed, three-dimensional computational models can be used in conjunction with experimental or clinical studies to elucidate the structural basis of regional dysfunction in acutely ischemic and ischemic-reperfused (“stunned”) myocardium in vivo. Integrative experimental and computational analysis shows that: (1) in acutely ischemic myocardium, the transition from abnormal systolic strain in the ischemic region to normal shortening in adjacent, normally perfused tissue is governed primarily by systolic blood pressure and regional fiber orientation rather than the geometry of the perfusion boundary; and (2) in stunned myocardium, the degree of reperfusion injury to the contractile apparatus may be uniform across the wall thickness despite observations that the extent of ischemia and the impairment of regional strain during reperfusion are both significantly greater in the subendocardium.

CXL-1020, a Novel Nitroxyl (HNO) Prodrug, Is More Effective than Milrinone in Models of Diastolic Dysfunction—A Cardiovascular Therapeutic: An Efficacy and Safety Study in the Rat

The nitroxyl (HNO) prodrug, CXL-1020, induces vasorelaxation and improves cardiac function in canine models and patients with systolic heart failure (HF). HNOs unique mechanism of action may be applicable to a broader subset of cardiac patients. This study investigated the load-independent safety and efficacy of CXL-1020 in two rodent (rat) models of diastolic heart failure and explored potential drug interactions with common HF background therapies. In vivo left-ventricular hemodynamics/pressure-volume relationships assessed before/during a 30 min IV infusion of CXL-1020 demonstrated acute load-independent positive inotropic, lusitropic, and vasodilatory effects in normal rats. In rats with only diastolic dysfunction due to bilateral renal wrapping (RW) or pronounced diastolic and mild systolic dysfunction due to 4 weeks of chronic isoproterenol exposure (ISO), CXL-1020 attenuated the elevated LV filling pressures, improved the end diastolic pressure volume relationship, and accelerated relaxation. CXL-1020 facilitated Ca2+ re-uptake and enhanced myocyte relaxation in isolated cardiomyocytes from ISO rats. Compared to milrinone, CXL-1020 more effectively improved Ca2+ reuptake in ISO rats without concomitant chronotropy, and did not enhance Ca2+ entry via L-type Ca2+ channels nor increase myocardial arrhythmias/ectopic activity. Acute-therapy with CXL-1020 improved ventricular relaxation and Ca2+ cycling, in the setting of chronic induced diastolic dysfunction. CXL-1020s lusitropic effects were greater than those seen with the cAMP-dependent agent milrinone, and unlike milrinone it did not produce chronotropy or increased ectopy. HNO is a promising new potential therapy for both systolic and diastolic heart failure.

Three-dimensional models of regionally ischemic left ventricle

Regional wall mechanics were analyzed in a finite element model of the canine left ventricle that included measured three-dimensional geometry and myofiber angles, nonlinear anisotropic material properties, calcium-activated systolic myofilament tension development, and the newly reported observation of significant active stress transverse to the myofiber axis. Strain distributions in the model agreed well with experimental measurements in anesthetized dogs during left anterior descending (LAD) coronary artery occlusion.

Nitroxyl (HNO)Clinical Perspective

Background— The nitroxyl (HNO) donor, Angeli’s salt, exerts positive inotropic, lusitropic, and vasodilator effects in vivo that are cAMP independent. Its clinical usefulness is limited by chemical instability and cogeneration of nitrite which itself has vascular effects. Here, we report on effects of a novel, stable, pure HNO donor (CXL-1020) in isolated myoctyes and intact hearts in experimental models and in patients with heart failure (HF). Methods and Results— CXL-1020 converts solely to HNO and inactive CXL-1051 with a t1/2 of 2 minutes. In adult mouse ventricular myocytes, it dose dependently increased sarcomere shortening by 75% to 210% (50–500 μmol/L), with a ≈30% rise in the peak Ca2+ transient only at higher doses. Neither inhibition of protein kinase A nor soluble guanylate cyclase altered this contractile response. Unlike isoproterenol, CXL-1020 was equally effective in myocytes from normal or failing hearts. In anesthetized dogs with coronary microembolization-induced HF, CXL-1020 reduced left ventricular end-diastolic pressure and myocardial oxygen consumption while increasing ejection fraction from 27% to 40% and maximal ventricular power index by 42% (both P <0.05). In conscious dogs with tachypacing-induced HF, CXL-1020 increased contractility assessed by end-systolic elastance and provided venoarterial dilation. Heart rate was minimally altered. In patients with systolic HF, CXL-1020 reduced both left and right heart filling pressures and systemic vascular resistance, while increasing cardiac and stroke volume index. Heart rate was unchanged, and arterial pressure declined modestly. Conclusions— These data show the functional efficacy of a novel pure HNO donor to enhance myocardial function and present first-in-man evidence for its potential usefulness in HF. Clinical Trial Registration— URL: . Unique identifiers: [NCT01096043][1], [NCT01092325][2]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT01096043&atom=%2Fcirchf%2F6%2F6%2F1250.atom [2]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT01092325&atom=%2Fcirchf%2F6%2F6%2F1250.atomBackground—The nitroxyl (HNO) donor, Angeli’s salt, exerts positive inotropic, lusitropic, and vasodilator effects in vivo that are cAMP independent. Its clinical usefulness is limited by chemical instability and cogeneration of nitrite which itself has vascular effects. Here, we report on effects of a novel, stable, pure HNO donor (CXL-1020) in isolated myoctyes and intact hearts in experimental models and in patients with heart failure (HF). Methods and Results—CXL-1020 converts solely to HNO and inactive CXL-1051 with a t1/2 of 2 minutes. In adult mouse ventricular myocytes, it dose dependently increased sarcomere shortening by 75% to 210% (50–500 &mgr;mol/L), with a ≈30% rise in the peak Ca2+ transient only at higher doses. Neither inhibition of protein kinase A nor soluble guanylate cyclase altered this contractile response. Unlike isoproterenol, CXL-1020 was equally effective in myocytes from normal or failing hearts. In anesthetized dogs with coronary microembolization-induced HF, CXL-1020 reduced left ventricular end-diastolic pressure and myocardial oxygen consumption while increasing ejection fraction from 27% to 40% and maximal ventricular power index by 42% (both P<0.05). In conscious dogs with tachypacing-induced HF, CXL-1020 increased contractility assessed by end-systolic elastance and provided venoarterial dilation. Heart rate was minimally altered. In patients with systolic HF, CXL-1020 reduced both left and right heart filling pressures and systemic vascular resistance, while increasing cardiac and stroke volume index. Heart rate was unchanged, and arterial pressure declined modestly. Conclusions—These data show the functional efficacy of a novel pure HNO donor to enhance myocardial function and present first-in-man evidence for its potential usefulness in HF. Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifiers: NCT01096043, NCT01092325.

Nitroxyl (HNO)Clinical Perspective: A Novel Approach for the Acute Treatment of Heart Failure

Background— The nitroxyl (HNO) donor, Angeli’s salt, exerts positive inotropic, lusitropic, and vasodilator effects in vivo that are cAMP independent. Its clinical usefulness is limited by chemical instability and cogeneration of nitrite which itself has vascular effects. Here, we report on effects of a novel, stable, pure HNO donor (CXL-1020) in isolated myoctyes and intact hearts in experimental models and in patients with heart failure (HF). Methods and Results— CXL-1020 converts solely to HNO and inactive CXL-1051 with a t1/2 of 2 minutes. In adult mouse ventricular myocytes, it dose dependently increased sarcomere shortening by 75% to 210% (50–500 μmol/L), with a ≈30% rise in the peak Ca2+ transient only at higher doses. Neither inhibition of protein kinase A nor soluble guanylate cyclase altered this contractile response. Unlike isoproterenol, CXL-1020 was equally effective in myocytes from normal or failing hearts. In anesthetized dogs with coronary microembolization-induced HF, CXL-1020 reduced left ventricular end-diastolic pressure and myocardial oxygen consumption while increasing ejection fraction from 27% to 40% and maximal ventricular power index by 42% (both P <0.05). In conscious dogs with tachypacing-induced HF, CXL-1020 increased contractility assessed by end-systolic elastance and provided venoarterial dilation. Heart rate was minimally altered. In patients with systolic HF, CXL-1020 reduced both left and right heart filling pressures and systemic vascular resistance, while increasing cardiac and stroke volume index. Heart rate was unchanged, and arterial pressure declined modestly. Conclusions— These data show the functional efficacy of a novel pure HNO donor to enhance myocardial function and present first-in-man evidence for its potential usefulness in HF. Clinical Trial Registration— URL: . Unique identifiers: [NCT01096043][1], [NCT01092325][2]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT01096043&atom=%2Fcirchf%2F6%2F6%2F1250.atom [2]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT01092325&atom=%2Fcirchf%2F6%2F6%2F1250.atomBackground—The nitroxyl (HNO) donor, Angeli’s salt, exerts positive inotropic, lusitropic, and vasodilator effects in vivo that are cAMP independent. Its clinical usefulness is limited by chemical instability and cogeneration of nitrite which itself has vascular effects. Here, we report on effects of a novel, stable, pure HNO donor (CXL-1020) in isolated myoctyes and intact hearts in experimental models and in patients with heart failure (HF). Methods and Results—CXL-1020 converts solely to HNO and inactive CXL-1051 with a t1/2 of 2 minutes. In adult mouse ventricular myocytes, it dose dependently increased sarcomere shortening by 75% to 210% (50–500 &mgr;mol/L), with a ≈30% rise in the peak Ca2+ transient only at higher doses. Neither inhibition of protein kinase A nor soluble guanylate cyclase altered this contractile response. Unlike isoproterenol, CXL-1020 was equally effective in myocytes from normal or failing hearts. In anesthetized dogs with coronary microembolization-induced HF, CXL-1020 reduced left ventricular end-diastolic pressure and myocardial oxygen consumption while increasing ejection fraction from 27% to 40% and maximal ventricular power index by 42% (both P<0.05). In conscious dogs with tachypacing-induced HF, CXL-1020 increased contractility assessed by end-systolic elastance and provided venoarterial dilation. Heart rate was minimally altered. In patients with systolic HF, CXL-1020 reduced both left and right heart filling pressures and systemic vascular resistance, while increasing cardiac and stroke volume index. Heart rate was unchanged, and arterial pressure declined modestly. Conclusions—These data show the functional efficacy of a novel pure HNO donor to enhance myocardial function and present first-in-man evidence for its potential usefulness in HF. Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifiers: NCT01096043, NCT01092325.