Afterload plays important roles during heart development and disease progression, however, studying these effects in a laboratory setting is challenging. Current techniques lack the ability to precisely and reversibly alter afterload over time. Here, we describe a magnetics-based approach for achieving this control and present results from experiments in which this device was employed to sequentially increase afterload applied to rat engineered heart tissues (rEHTs) over a 7-day period. The contractile properties of rEHTs grown on control posts marginally increased over the observation period. The average post deflection, fractional shortening, and twitch velocities measured for afterload-affected tissues initially followed this same trend, but fell below control tissue values at high magnitudes of afterload. However, the average force, force production rate, and force relaxation rate for these rEHTs were consistently up to 3-fold higher than in control tissues. Transcript levels of hypertrophic or fibrotic markers and cell size remained unaffected by afterload, suggesting that the increased force output was not accompanied by pathological remodeling. Accordingly, the increased force output was fully reversed to control levels during a stepwise decrease in afterload over 4 hours. Afterload application did not affect systolic or diastolic tissue lengths, indicating that the afterload system was likely not a source of changes in preload strain. In summary, the afterload system developed herein is capable of fine-tuning EHT afterload while simultaneously allowing optical force measurements. Using this system, we found that small daily alterations in afterload can enhance the contractile properties of rEHTs, while larger increases can have temporary undesirable effects. Overall, these findings demonstrate the significant role that afterload plays in cardiac force regulation. Future studies with this system may allow for novel insights into the mechanisms that underlie afterload-induced adaptations in cardiac force development.
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http://dx.doi.org/10.1021/acsbiomaterials.8b01568 | DOI Listing |
J Clin Med
January 2025
Cardiology Department, University Hospital Alvaro Cunqueiro, 36312 Vigo, Spain.
A significant proportion of elderly patients referred to transcatheter aortic valve replacement (TAVR) do not experience an improvement of their symptoms. New tools are needed to better select candidates and avoid futile procedures. The objective of this study was to evaluate the impact of a new echocardiographic classification which assesses the consequences of chronic elevation of afterload on mortality and hospitalizations for heart failure (HF) in patients with severe AS undergoing TAVR.
View Article and Find Full Text PDFMinerva Anestesiol
January 2025
Transplant Anesthesia and Critical Care, Pisa NHS and University Hospitals, Pisa, Italy -
Intraoperative hemodynamic monitoring is crucial for managing patients with end-stage liver disease (ESLD) undergoing orthotopic liver transplantation (OLT) due to their complex cardiovascular and pulmonary abnormalities. Traditionally, pulmonary artery catheterization (PAC) has been the standard for hemodynamic monitoring during OLT. However, the use of transesophageal echocardiography (TEE) has increased due to its real-time visualization of cardiac and vascular structures, which aids in managing hemodynamic instability during the three surgical phases of OLT: pre-anhepatic, anhepatic, and neo-hepatic.
View Article and Find Full Text PDFEur Heart J Cardiovasc Imaging
January 2025
Faculty of Health and Medicine, Wallace Wurth Building (C27), Cnr High St & Botany St, UNSW Sydney, Kensington, NSW 2033, Australia.
Aims: Although an association between the systemic circulation and transaortic flow rate (TFR) is frequently hypothesized in patients with aortic stenosis (AS), it has not been demonstrated previously. We sought to explore the relationship between blood pressure (BP), vascular afterload measures, clinical history of hypertension, TFR, and survival in patients with severe AS (aortic valve area ≤ 1 cm²).
Methods And Results: We studied 323 patients ≥ 65 years (110 prospective, 213 registry analysis) who underwent transcatheter aortic valve replacement over a 5-year period.
Med Sci (Basel)
January 2025
Faculty of Medicine, University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina.
Background: CPAP has been shown to be particularly beneficial in the management of acute cardiogenic pulmonary edema by reducing both preload and afterload, thus decreasing the work of breathing and improving oxygenation.
Methods: This study was a prospective observational study, conducted in the period from 2022 to 2024, assessing the effectiveness and safety of prehospital CPAP therapy use in patients with acute cardiogenic pulmonary edema, administered alongside standard care.
Results: In this study, 50 patients with acute cardiogenic pulmonary edema were treated by physician-led emergency teams in the Canton of Sarajevo.
Patients presenting with severe acute cardiogenic pulmonary edema with hypoxia commonly require intubation until heart failure treatments take effect. A new term describing similar condition is called sympathetic crashing acute pulmonary edema (SCAPE). It is also called Flash pulmonary edema.
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