Roberto M. Saraiva

Xanthine Oxidoreductase Inhibition Causes Reverse Remodeling in Rats With Dilated Cardiomyopathy

Increased reactive oxygen species (ROS) generation is implicated in cardiac remodeling in heart failure (HF). As xanthine oxidoreductase (XOR) is 1 of the major sources of ROS, we tested whether XOR inhibition could improve cardiac performance and induce reverse remodeling in a model of established HF, the spontaneously hypertensive/HF (SHHF) rat. We randomized Wistar Kyoto (WKY, controls, 18 to 21 months) and SHHF (19 to 21 months) rats to oxypurinol (1 mmol/L; n=4 and n=15, respectively) or placebo (n=3 and n=10, respectively) orally for 4 weeks. At baseline, SHHF rats had decreased fractional shortening (FS) (31±3% versus 67±3% in WKY, P<0.0001) and increased left-ventricular (LV) end-diastolic dimension (9.7±0.2 mm versus 7.0±0.4 mm in WKY, P<0.0001). Whereas placebo and oxypurinol did not change cardiac architecture in WKY, oxypurinol attenuated decreased FS and elevated LV end-diastolic dimension, LV end-systolic dimension, and LV mass in SHHF. Increased myocyte width in SHHF was reduced by oxypurinol. Additionally, fetal gene activation, altered calcium cycling proteins, and upregulated phospho–extracellular signal–regulated kinase were restored toward normal by oxypurinol (P<0.05 versus placebo-SHHF). Importantly, SHHF rats exhibited increased XOR mRNA expression and activity, and oxypurinol treatment reduced XOR activity and superoxide production toward normal, but not expression. On the other hand, NADPH oxidase activity remained unchanged, despite elevated subunit protein abundance in treated and untreated SHHF rats. Together these data demonstrate that chronic XOR inhibition restores cardiac structure and function and offsets alterations in fetal gene expression/Ca2+ handling pathways, supporting the idea that inhibiting XOR-derived oxidative stress substantially improves the HF phenotype.

Nitric oxide signaling in the cardiovascular system: implications for heart failure.

Purpose of review The role played by nitric oxide (NO) in cardiovascular physiology remains highly controversial. Following the discovery that NO is the prototypic endothelium-derived relaxing factor, this signaling molecule was implicated as possessing many other biological actions within the cardiovascular system, including effects on cardiac contraction, relaxation, and energetics. Here, we discuss new concepts regarding NO signaling, its effector pathways, and interactions between NO and the redox milieu within a framework of cardiac physiology and pathophysiology. Recent findings Major recent insights that have advanced understanding of the mechanisms of NO bioactivity include the following. (1) NO acts in subcellular signaling compartments or modules. (2) S-nitrosylation (covalent modification of cysteine thiol moieties) of proteins represents a prototypic second messenger signaling mode in biologic systems. (3) Reactive oxygen and nitrogen species work together to facilitate signaling. (4) Disruption of physiologic signaling can occur by either increased formation of reactive oxygen species or decreased production of reactive nitrogen species, a situation of nitroso–redox imbalance. Summary These insights, which challenge classically held views that NO acts as a freely diffusible molecule regulated primarily by concentration and exerting signaling primarily through cyclic GMP production, offer a new perspective on the pathophysiology and treatment of congestive heart failure.

Swimming training attenuates remodeling, contractile dysfunction and congestive heart failure in rats with moderate and large myocardial infarctions.

1 The aim of the present study was to evaluate the effect of swimming on myocardial remodelling after myocardial infarction (MI) in female rats induced by coronary occlusion, which was not performed in sham rats. 2 Rats were divided in six groups, three sedentary (sham (SSh; n = 14), moderate infarct (SMI; n = 8) and large infarct (SLI; n = 10)) and three trained (sham (TSh; n = 16), moderate infarct (TMI; n = 9) and large infarct (TLI; n = 8)) groups. Training (8 weeks, 60 min/day, 5 days/week) was initiated 4 weeks after MI or sham operation. Training did not affect mortality rate, but attenuated the increases in atrial/bodyweight (SSh: 0.07 ± 0.02; TSh: 0.07 ± 0.02; SMI: 0.11 ± 0.03; TMI: 0.09 ± 0.03; SLI: 0.17 ± 0.09; TLI: 0.10 ± 0.05 mg/g) and right ventricular/bodyweight (SSh: 0.15 ± 0.02; TSh: 0.17 ± 0.02; SMI: 0.17 ± 0.07; TMI: 0.20 ± 0.03; SLI: 0.29 ± 0.13; TLI: 0.22 ± 0.08 mg/g) ratios. Myocardial infarction increased pulmonary and myocardial water content in infarcted sedentary animals, whereas no changes were observed in trained infarcted rats. Sedentary infarcted rats showed inotropic and lusitropic depression proportional to the size of the infarct (SSh > SMI > SLI), whereas no differences were noted in trained rats (TLI = TMI = TSh). Indeed, in sedentary rats there was depression of +dT/dt (SSh: 68 ± 25; TSh: 72 ± 21; SMI: 53 ± 20; TMI: 77 ± 30; SLI: 33 ± 15; TLI: 57 ± 22 g/mm2 per s) and –dT/dt (SSh: 33 ± 13; TSh: 36 ± 11; SMI: 24 ± 5; TMI: 35 ± 11; SLI: 15 ± 4; TLI: 32 ± 11 g/mm2 per s) compared with trained rats. 3 In conclusion, swimming clearly favoured post‐MI cardiac remodelling, attenuated myocardial hypertrophy, contractile and relaxation dysfunction and prevented pulmonary congestion.

A função mecânica do miocárdio remanescente a um infarto do miocárdio é normal durante o período de cicatrização, embora exista insuficiência cardíaca

OBJECTIVEnThe temporal relation between ventricular dysfunction (VD) after myocardial infarction (MI) and remanent myocardium mechanics is not yet clear. The present work investigated--through Doppler echocardiography (ECHO)--ventricular function in rats with extensive MI, as well as the mechanical function of papillary muscles (PM) at the end of the healing period.nnnMETHODSnECHO and PM of 9 Wistar rats (MI) were studied against 9 controls (C) three weeks after LV myocardial infarction. The following were determined: developed tension (DT) and its first negative and positive derivative, time-to-peak tension (TPT), resting tension (RT), and relaxation time at 50% of DT at 0.5, 1.0, 1.5, 2.0 and 2.5 calcium concentrations (mM). Tetanic contractions were carried out after ryanodine administration at 1.5, 2.5 and 5.0 calcium concentrations.nnnRESULTSnVD was characterized by ECHO, with marked abnormality of diastolic volume and LV and ejection fraction in addition to clear restrictive pattern of blood flow through the mitral valve. No significant difference was found in myocardial mechanics data either for MI or for C rats.nnnCONCLUSIONnThe heart failure (HF) reported by MI rats with > 40% MI at the end of the healing period is not myocardial function dependent. Chamber structural changes and lower population of myocites should base VD and HF.

Rats with high left ventricular end-diastolic pressure can be identified by Doppler echocardiography one week after myocardial infarction

The severity of left ventricular (LV) dysfunction in rats with myocardial infarction (MI) varies widely. Because homogeneity in baseline parameters is essential for experimental investigations, a study was conducted to establish whether Doppler echocardiography (DE) could accurately identify animals with high LV end-diastolic pressure as a marker of LV dysfunction soon after MI. Direct measurements of LV end-diastolic pressure were made and DE was performed simultaneously 1 week after surgically induced MI (N = 16) or sham-operation (N = 17) in female Wistar rats (200 to 250 g). The ratio of peak early (E) to late (A) diastolic LV filling velocities and the ratio of E velocity to peak early (Em) diastolic myocardial velocity were the best predictors of high LV end-diastolic pressure (>12 mmHg) soon after MI. Cut-off values of 1.77 for the E/A ratio (P = 0.001) identified rats with elevated LV end-diastolic pressure with 90% sensitivity and 80% specificity. Cut-off values of 20.4 for the E/Em ratio (P = 0.0001) identified rats with elevated LV end-diastolic pressure with 81.8% sensitivity and 80% specificity. Moreover, E/A and E/Em ratios were the only echocardiographic parameters independently associated with LV end-diastolic pressure in multiple linear regression analysis. Therefore, DE identifies rats with high LV end-diastolic pressure soon after MI. These findings have implications for using serial DE in animal selection and in the assessment of their response to experimental therapies.

A routine electrocardiogram cannot be used to determine the size of myocardial infarction in the rat

Nine lead electrocardiograms of non-infarcted (N = 61) and infarcted (N = 71) female Wistar rats (200-250 g) were analyzed in order to distinguish left ventricle myocardial infarction (MI) larger than 40% (LMI) from MI smaller than 40% (SMI). MI larger than 40% clearly caused a deviation of AQRS and AT from normal values of 270-360 degrees to 90-270 degrees. Infarcted rats showed Q wave in D1 larger than 1 mm with 94% sensitivity and 100% specificity. The sum of QRS positivity in V1, V2 and V6 lower than 10 mm identified MI with 82% sensitivity and 100% specificity. The data showed that MI can be easily and reliably diagnosed by electrocardiogram in the rat. However, contradicting what is frequently believed, when specificity and sensitivity were analyzed focusing on MI size, none of these current electrocardiographic indices of MI size adequately discriminates LMI from SMI.

Doppler tecidual como índice prognóstico em longo prazo na disfunção sistólica do ventrículo esquerdo

BACKGROUNDnTissue Doppler parameters correlate with left ventricular (LV) filling pressure and can be useful as prognostic indexes for patients with heart failure.nnnOBJECTIVEnDetermine whether tissue Doppler parameters can predict events during long term follow-up of outpatients with LV systolic dysfunction.nnnMETHODSnRetrospective study with 73 patients (aged 60.9+/-12.1 years) who underwent Doppler echocardiogram between March 2001 and May 2004. The primary endpoint studied was death or hospitalization due to heart failure worsening.nnnRESULTSnThe mean follow-up period was 1,367+/-665 days. After logistic stepwise multivariate analysis, including echocardiographic parameters, the ratio of maximal early diastolic filling wave velocity to maximal early diastolic myocardial velocity (E/E; ratio; p=0.0007), and LV ejection fraction (EF; p=0.01) remained significant predictors of the primary outcome. The optimal cutoffs for primary endpoint prediction for E/E ratio (AUC 0.77; p=0.0001) and EF (AUC 0.68, p=0.006) were respectively 12.7 and 30%. Accordingly, patients with E/E ratio > 12.7 (hazard ratio=3.8, p =0.001) or EF <30% (hazard ratio=2.3, p=0.03) had a poorer outcome by survival curve analysis. It is noteworthy that 47% of the patients with EF above the optimal cutoff point, but with high E/E ratio, presented events during follow-up.nnnCONCLUSIONnE/E ratio is an important independent long-term prognostic index of death or hospitalization due to worsening heart failure in outpatients with LV systolic dysfunction. Therefore, we recommend the measurement of this variable in the routine evaluation of such patients.

Incidence of heart failure in infarcted rats that die spontaneously

The present study reports for the first time the incidence of congestive heart failure (CHF) in previously infarcted rats that died spontaneously. Previously, pulmonary (PWC) and hepatic (HWC) water contents were determined in normal rats: 14 control animals were evaluated immediately after sacrifice, 8 placed in a refrigerator for 24 h, and 10 left at room temperature for 24 h. In the infarcted group, 9 rats died before (acute) and 28 died 48 h after (chronic) myocardial infarction. Thirteen chronic animals were submitted only to autopsy (N = 13), whereas PWC and HWC were also determined in the others (N = 15). Seven rats survived 48 h and died during anesthesia. Notably, PWC differed in normal rats: ambient (75.7 +/- 1.3%) < control (77.5 +/- 0.7%) < refrigerator (79.1 +/- 1.4%) and there were no differences with respect to HWC. No clinical signs of CHF (dyspnea, lethargy or foot edema) were observed in infarcted rats before death. PWC was elevated in all chronic and anesthetized rats. HWC was increased in 48% of chronic and in all anesthetized rats. Our data showed that PWC needs to be evaluated before 24 h post mortem and that CHF is the rule in chronic infarcted rats suffering natural death. The congestive syndrome cannot be diagnosed correctly in rats by clinical signs alone, as previously proposed.