Objectives: The proto-oncogenes c-fos, c-myc and H-ras have been shown to rise in a characteristic pattern in the left ventricle undergoing hypertrophy in the coarctation model of experimental hypertension and there is some evidence to suggest that they might play a role in the initiation of hypertrophic growth. However, in vivo studies do not discriminate between the direct effects of pressure and pressure-independent trophic stimuli such as angiotensin II. To examine these influences separately we studied isolated working hearts exposed to different afterloads in the presence or absence of angiotensin II.
Methods: Hearts from normotensive female Wistar rats were perfused with a modified Krebs-Henseleit solution, with and without angiotensin II (100 nmol/1) and exposed to low (60 mmHg) or high (140 mmHg) afterload (n > 17/group). Proto-oncogene mRNA induction in the left ventricle was assessed by Northern blot analysis.
Results: Aortic pressures were 101 +/- 14/63 +/- 6 mmHg (mean +/- s.d.) with low and 175 +/- 13/93 +/- 20 mmHg with high afterload; hearts in both groups maintained a stable cardiac output over 240 min, except for high afterload hearts not perfused with angiotensin II, which showed a 59% drop by the end of the experiment (P < 0.001). There was a 50% (32%, 72%) (geometric mean and 95% confidence interval) increase of c-myc and 54% (27%, 86%) increase in c-fos, but a 32% (25%, 40%) suppression of H-ras with high (140 mmHg) as compared with low (60 mmHg) afterloads (P < 0.0001 for each). There was no significant difference in c-myc and c-fos induction with different levels of high afterload (110, 120, 140 mmHg), but for H-ras suppression progressively increased with increasing afterload (P = 0.003). At high afterload, levels of c-fos rose at 30 min and peaked at 60 min, c-myc continued to rise up to 240 min, and H-ras was suppressed at all four time points. The addition of angiotensin II (100 nmol/l) to the perfusate resulted in 18% (6%, 28%; P = 0.006) lower c-myc levels, 12% (-6%, 28%; P = 0.18) lower c-fos levels and an 11% (-0.1%, 24%; P = 0.056) increase of H-ras.
Conclusion: The isolated perfused working rat heart is capable of performing stably for a period of at least 240 min at high afterload pressures comparable to those encountered in hypertension. A proto-oncogene induction similar to that seen in the hypertrophying heart can be induced by increased pressure alone, without the mediating effects of circulating angiotensin II. Hearts perfused with angiotensin II showed a more stable performance at high levels of afterload which was associated with a minor attenuation of pressure-induced changes in proto-oncogene expression.
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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 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.
bioRxiv
February 2024
Critical Care Medicine Department, Clinical Center, National Institutes of Health, (NIH, CC) Bethesda, Maryland 20892 USA.
Background: High levels of catecholamines are cardiotoxic and associated with stress-induced cardiomyopathies. Septic patients are routinely exposed to endogenously released and exogenously administered catecholamines, which may alter cardiac function and perfusion causing ischemia. Early during human septic shock, left ventricular ejection fraction (LVEF) decreases but normalizes in survivors over 7-10 days.
View Article and Find Full Text PDFAm J Cardiol
January 2025
Department of Cardiology, Inselspital, Bern University Hospital. Electronic address:
Transcatheter edge-to-edge repair (TEER) is an effective intervention for high-risk patients with severe symptomatic mitral regurgitation (MR); however, its acute impact on left ventricular (LV) function has not been well-studied using advanced echocardiographic techniques. This study investigated the immediate effects of TEER on LV volumes and functions and their influence on midterm outcomes, using high-resolution 3-dimensional transesophageal echocardiography. In 80 patients who underwent TEER for severe MR (mean age 79 ± 8 years, 49% with primary MR), LV end-diastolic volume and stroke volume significantly decreased (161 ± 61 to 147 ± 54 ml and 69 ± 18 to 50 ± 15 ml, respectively), whereas end-systolic volume increased (92 ± 60 to 97 ± 45 ml, p <0.
View Article and Find Full Text PDFAm J Emerg Med
January 2025
Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA.
Introduction: Patients with heart failure exacerbation can present in a variety of ways, including sympathetic crashing acute pulmonary edema (SCAPE). Emergency physicians play a key role in the diagnosis and management of this condition.
Objective: This narrative review evaluates key evidence-based updates concerning the diagnosis and management of SCAPE for the emergency clinician.
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