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Mutations affecting the formation and function of the cardiovascular system in the zebrafish embryo.

As part of a large-scale mutagenesis screen of the zebrafish genome, we have identified 58 mutations that affect the formation and function of the cardiovascular system. The cardiovascular system is particularly amenable for screening in the transparent zebrafish embryo because the heart and blood vessels are prominent and their function easily examined. We have classified the mutations affecting the heart into those that affect primarily either morphogenesis or function. Nine mutations clearly disrupt the formation of the heart. cloche deletes the endocardium. In cloche mutants, the myocardial layer forms in the absence of the endocardium but is dysmorphic and exhibits a weak contractility. Two loci, miles apart and bonnie and clyde, play a critical role in the fusion of the bilateral tubular primordia. Three mutations lead to an abnormally large heart and one to the formation of a diminutive, dysmorphic heart. We have found no mutation that deletes the myocardial cells altogether, but one, pandora, appears to eliminate the ventricle selectively. Seven mutations interfere with vascular integrity, as indicated by hemorrhage at particular sites. In terms of cardiac function, one large group exhibits a weak beat. In this group, five loci affect both chambers and seven a specific chamber (the atrium or ventricle). For example, the weak atrium mutation exhibits an atrium that becomes silent but has a normally beating ventricle. Seven mutations affect the rhythm of the heart causing, for example, a slow rate, a fibrillating pattern or an apparent block to conduction. In several other mutants, regurgitation of blood flow from ventricle to atrium is the most prominent abnormality, due either to the absence of valves or to poor coordination between the chambers with regard to the timing of contraction. The mutations identified in this screen point to discrete and critical steps in the formation and function of the heart and vasculature.

Animals↗

Genetics-Informed Mapping Identifies a CRIM1-Associated Endocardial Inflammatory Remodeling State in Acute Myocardial Infarction.

BACKGROUND Acute myocardial infarction (AMI) reflects inherited susceptibility and inflammatory remodeling, but the cellular contexts linking genetic risk to disease remain unclear. MATERIAL AND METHODS We integrated a meta-transcriptome-wide association study (TWAS) with a human cardiac single-nucleus RNA-sequencing atlas contained 11 individuals (5 AMI and 6 donor) to identify genetics-informed cellular programs. Composite program states were defined by global score quartiles. A fixed 5-gene panel was evaluated for nucleus-level endocardial low-transcriptional-state (Endo_LTS) vs endocardial high-transcriptional-state (Endo_HTS) discrimination within the AMI endocardium using 5-fold leave-1-patient-out cross-validation. Functional follow-up used CRIM1 silencing in hypoxia-treated human induced pluripotent stem cell (hiPSC)-derived endocardial endothelial-like cells and complementary peripheral blood analyses. RESULTS The endocardium exhibited the most prominent infarction-associated increase in TWAS-anchored program activity, with expansion of program-high states and higher CytoTRACE scores. A consensus 5-gene panel (RPS8, PLEC, CFDP1, CRIM1, TNS2) was identified. Among 2163 AMI endocardial nuclei from 5 patients, the state classifier included 364 Endo_LTS and 751 Endo_HTS nuclei; 1048 Endo_MTS nuclei were excluded. Pooled out-of-fold ROC-AUCs ranged from 0.665 to 0.831. The panel also showed discriminatory value in an independent peripheral-blood AMI-vs-control cohort. CRIM1 was prioritized as a candidate linked to the remodeling program. CRIM1 silencing attenuated ACTA2/alpha-SMA, vimentin, LDHA, CCL2, and VEGFA and partially restored CD31, whereas TGF-ß remained elevated. CONCLUSIONS These findings identify a genetics-informed endocardial inflammatory remodeling state in AMI and define a 5-gene surrogate of its activated state. CRIM1 is prioritized as a candidate linked to selected inflammatory, metabolic, and structural outputs. Persistent TGF-b elevation after CRIM1 silencing argues against a simple linear regulatory model and indicates that further mechanistic validation is required.

Humans↗

Pathological studies in experimental Candida endocarditis.

Mycotic endocarditis was produced in rabbits by indwelling intracardiac catheters filled with a suspension of Candida albicans. Grossly, cardiac lesions consisted of massive fungoid valvular vegetations and/or "sleeve thrombi" surrounding the catheter. Microscopically, platelet-fibrin aggregates were observed to be loosely attached to the valvular cusps. With time, the vegetations became organized and more firmly attached against the endocardium. Also observed was a heavy neutrophylic collar often containing Candida cells which infiltrate the subendothelial tissues of the valvular cusps. Sterile endocardial lesions were produced by retained catheters. The lesions consisted of discrete, glistening, hemispherical nodules in the right heart; and similar elevated plaques on the mural endocardium of the left ventricle. Microscopically, these lesions consisted of fibrous connective tissues devoid of inflammatory cells. The lesions in the left ventricle were more extensive, extending into the myocardium.

Animals↗

Nonuniform action potential durations at different sites in canine left ventricle.

We studied the action potential duration (APD) of isolated ventricular muscle fibers. Action potentials were recorded from four different sites (endocardium and epicardium at the apex and the base) in the canine left ventricle by microelectrode techniques. Action potentials from endocardial and corresponding epicardial specimens, and the differential potential between them were recorded simultaneously. The APDs at 60% and 90% repolarization (APD60 and APD90) were measured during superfusion with normal (K+ = 2.7 mM) and altered (K+ = 5.4 mM) Tyrode's solutions. Results were: 1) the distributions of APDs agreed with previous descriptions from in vivo studies; 2) endo-epicardial APD gradients were different between the apex and the base, and apico-basal APD gradients were different between endocardium and epicardium; 3) the shapes of the differential potentials in normal and altered Tyrode's solution were similar to the electrocardiographic T wave form in normal and in mild hyperkalemia. It was concluded that nonhomogeneous APDs may be due to the inherent characteristics of cardiac muscle and the nonuniform endo-epicardial APD gradient helps to account for the genesis of the electrocardiographic T wave form.

Action Potentials↗

Distribution of action potential durations in the canine left ventricle.

The distribution of action potential durations (APD) in the left ventricle were investigated and compared to the spatial orientation of the maximum T vector (MaxTv). Eight dogs with similar vectorcardiographic spatial orientations of MaxTv were used. Action potentials were recorded from 42 to 64 sites on each isolated endocardial and epicardial specimen with glass microelectrodes. Preparations included the entire left ventricular free wall. The APD50 and APD90 had similar distributions, but the APD90 distribution was less uniform in all 8 dogs. On the endocardium, APDs were longest between the roots of the papillary muscles, and progressively shorter toward the upper edge (base) where the shortest APDs were found. On the epicardium, APDs were longest in the lower lateral region, and gradually shortened, approximately concentrically, toward the anterior and posterior bases. APDs were longer in the endocardium than in the corresponding epicardium. Maximum APD endocardial-epicardial differences were found in the lower lateral region of the ventricular free wall. Results agree with reports of ventricular recovery properties in vivo, and partly account for the spatial orientation of the MaxTv. This study adds new details, and delineates the longest and shortest distributions of APDs.

Action Potentials↗

Contracted form of primary endocardial fibroelastosis in a young adult without congestive heart failure.

A case of a 24-year-old man with the contracted form of primary endocardial fibroelastosis diagnosed by left ventricular endomyocardial biopsy showing a markedly thickened endocardium with fibroelastic proliferation is reported. He had no evident symptoms of congestive heart failure except for shortness of breath on moderate exertion. Echocardiogram showed thickened and dense echoes from the left side of the septum and from the posterior left ventricular endocardium. Hemodynamic and angiographic studies revealed marked elevation of right and left ventricular end-diastolic pressures with dip and plateau pressure contours, moderate pulmonary hypertension, left atrial enlargement and mild mitral regurgitation. Further elevation of right and left ventricular diastolic pressures and pulmonary artery pressure was observed at the second evaluation after 5 years. Our patient suggests that primary endocardial fibroelastosis should be included in the differential diagnosis of adult patients with obscure types of cardiac disease.

Adult↗

Determination of hydroxyproline content in human heart muscle.

Hydroxyproline content was chemically determined on 45 human hearts obtained at autopsy in order to study whether hydroxyproline contents vary in proportion to heart weight or not. There were no significant differences in the mean hydroxyproline content between the epicardium and the endocardium, between the left ventricle and the right ventricle, or among cardiovascular and renal disease group, malignant disease group and miscellaneous disease group. Total hydroxyproline content per mg dry weight of the left ventricle increased proportionally with heart weight. Hydroxyproline content in neutral salt soluble fraction increased more proportionally than that in acid soluble fraction. This tendency was more evident in the endocardium than in the epicardium of the left ventricle. These results seem to be well consistent with those of histometrical estimation of scar tissue in human heart muscle. Hydroxyproline content in acid soluble fraction of the right ventricle was increased proportionally with heart weight.

Adolescent↗

Endocardial damage induced by lactate, lowered pH and lactic acid in non-ischemic beating hearts.

The left ventricular lumen of isolated perfused beating hearts was perfused for up to 8 h with either Krebs Henseleit buffer (KHB, pH 7.4), KHB including 33 mumol/ml of lactic acid at pH 7.4 or 6.4, or with KHB including hydrochloric acid to reduce the pH to 6.4. Scanning and transmission electron microscopy showed that whereas control hearts maintained an intact endocardium, those groups exposed to increased concentrations of lactate, hydrogen ions or both, developed endothelial cell separation and exfoliation with exposure first of basal lamina and then of endocardial collagen. The underlying myocytes also showed evidence of irreversible cell injury. The extent and severity of damage was greater in hearts exposed to lactic acid than to either lactate or lowered pH alone. These findings suggest that the increased concentrations of metabolites which accumulate in developing myocardial infarcts can diffuse through and damage the endocardium in ways which are likely to predispose in vivo to the development of mural thrombosis.

Acidosis↗

[Distinguishing between physiologic hypertrophy in athletes and primary hypertrophic cardiomyopathies. Importance of tissue color Doppler].

In order to assess the value of Doppler tissue imaging (DTI) in the differentiation of physiological hypertrophy of athletes from primary hypertrophic cardiomyopathy (HCM), the authors compared a group of 20 normal, non-athletic subjects, a group of 43 competitive athletes and a group of 20 patients with mild HCM. In addition to the conventional echocardiographic criteria, the velocity of wall motion at the endocardium and epicardium of the interventricular septum and the posterior wall as well as their gradients, were measured throughout the cardiac cycle. No significant difference was observed between normal subjects and the athletes with respect to velocities and the gradients of velocity. Early diastolic velocities of the posterior wall and interventricular septum were significantly lower than those of normal subjects and athletes. The systolic and early diastolic gradients of velocity of the posterior wall were significantly lower in HCM compared with the normal subjects and athletes. The gradient of velocity between the endocardium and epicardium of the interventricular septum was significantly lower in HCM compared with normal subjects in early diastole and with athletes in systole and early diastole. The best Doppler tissue imaging parameter to differentiate pathological hypertrophy of HCM from physiological hypertrophy of athletes was analysis of the gradient of velocity in early diastole of the posterior wall. A value of 0.7 sec-1 differentiated HCM with a sensitivity of 89%, a specificity of 95% and a diagnostic accuracy of 94%. Doppler tissue imaging is a more sensitive and specific technique than conventional Doppler echocardiography for detecting moderate forms of HCM.

Adult↗

[Hemodynamic effects on embryonic endocardial morphology].

The modifications of endocardial cells on bulbar cushions of the chick embryonic heart have been studied using the SEM following an experimental stenosis of the pulmonary artery. This stenosis was produced by the occlusion of both 6th aortic arches on the 4th day of incubation by silver microclips. The formation of small craterlike defects was observed on the distal ventral and proximal left bulbar cushions. Giant intercellular openings appeared on the top of the proximal left bulbar cushion indicating some acceleration of the blood flow in this region. Phagocytes traversing the endocardium have been seen more frequently than in controls. It seems that the endocardium is relatively resistant to the described hemodynamic changes. These changes modify the passage of phagocytes into the blood stream as well as cell movements and exocytosis.

Animals↗

Characteristics of apyrase (EC 3.6.1.5) on cultured bovine endocardial endothelial cells.

Apyrase activities in some tissues and cells, such as peripheral vascular endothelial cells, have been reported, but these in endocardium endothelial cells have not been reported. The present study was to characterise the properties of bovine endocardium endothelial cells (BEEC)-associated apyrase. Apyrase activity was assayed by inorganic phosphate release, which could be inhibited concentration-dependently by NaN3, an apyrase inhibitor. NaF (20 mmol/L), another inhibitor of apyrase, also markedly inhibited the activity. EDTA or EGTA (1 mmol/L) could also inhibit the activity completely. However, the inhibitor for Na+/K(+)-ATPase, ouabain (3 mmol/L) did not affect the enzyme activity. BEEC apyrase activity was dependent on divalent cations (Ca2+ or Mg2+) and pH value.

Animals↗

Extensive left atrial endoatriectomy for infective endocarditis.

The technique of extensive endoatriectomy of the left atrium and reconstruction with autologous pericardium for infective endocarditis is described. Endocardium of the left atrium with vegetations was completely excised from the valvular annulus to normal endocardium, and autologous pericardium was used to reinforce the endocardial defect and to allow less tension in the closure. This technique permits complete removal of infectious lesions and facilitates mitral valve replacement reinforcing the mitral annulus.

Adult↗

Relationship between the U wave on electrocardiogram and the midmyocardium of the left ventricular wall.

OBJECTIVE: To investigate the relationship between the U wave on electrocardiogram and the midmyocardium in rabbit left ventricle free wall in vivo. METHODS: The monophasic action potentials in the epicardium, midmyocardium, and endocardium of the left ventricle free wall were recorded simultaneously in 16 rabbits. The rabbits were then given an intravenous injection of Sotalol (1, 1.5 and 2.0 mg/kg) in 30 minutes intervals, and measurements were taken. RESULTS: In the basic condition, there were no U wave on electrocardiogram. The U wave appeared after the intravenous Sotalol at 1.5 mg/kg, and the U wave became greater with increased dosage of intravenous Sotalol (2 mg/kg). The repolarization duration of the midmyocardium was prolonged longer than that of the epicardium and endocardium by Sotalol, and the repolarization duration of the epicardium coincided with the apex of the T wave, The repolarization duration of the midmyocardium coincided with the end point of the U wave. CONCLUSION: The U wave may originate from the delayed repolarization of the midmyocardium.

Action Potentials↗

Epicardial versus endocardial "in mirror" changes in prostaglandin synthesis after short periods of ischemia and reperfusion.

Cardiac ischemia and reperfusion are associated with increased prostaglandin levels in the coronary venous effluent. This study implemented an in vivo-in vitro technique to investigate regional alterations in heart tissue PGE2 and PGF2 alpha de novo production. Canine endocardial and epicardial explants were incubated following 5 min regional ischemia, or 5 min ischemia with 10 min reperfusion, induced in vivo in two groups of animals (n = 10 and 6, respectively). Ischemia produced a significant upsurge in endocardial but not in epicardial prostaglandin synthesis as compared with the non-ischemic zone: 7.6 +/- 0.7 versus 4.5 +/- 0.5 pg/mg tissue per h in PGE2 (P < 0.001) and 8.8 +/- 1.2 versus 6.8 +/- 1.2 pg/mg per h PGF2 alpha (P < 0.01). Following reperfusion, PGE2 was higher in the apparently normal than in the affected endocardium (5.8 +/- 0.6 versus 4.4 +/- 0.5 pg/mg per h, P < 0.05). Opposite changes occurred in the reperfused epicardium: 8.2 + 0.9 versus 4.9 +/- 0.7 pg/mg per h PGE2 (P < 0.01) and 11.1 +/- 0.9 versus 6.0 +/- 0.6 pg/mg per h PGF2 alpha (P < 0.001), for the reperfused as compared to the "normal" region, respectively. Our findings imply that the left ventricular wall is not homogeneous in its eicosanoid response to ischemia and reperfusion. "In mirror" changes were found between endocardium end epicardium and between the injured and the apparently normal regions.

Animals↗

[Effect of simulated ischemia on activity and heterogeneity of Na+ channel in rabbit ventricular epicardial, midmyocardial and endocardial myocytes].

OBJECTIVE: To study the ionic mechanism of reentrant arrhythmia. METHODS: Single myocytes were enzymatically isolated from the epicardium, midmyocardium and endocardium of the left ventricle free wall of rabbit, followed by whole-cell patch-clamp recording of the Na(+) current (I(Na)) of the 3 cellular subtypes (superfused with normal and then simulated ischemia solution). The currents in the 3 cellular subtypes before and after simulated ischemia lasting for 10, 20, and 30 min, respectively, were compared. RESULTS: No changes was recorded in the configuration of the I-V curves and voltage dependence of I(Na) after simulated ischemia, and the peak I(Na) densities (- 20 mV) were significantly reduced in the 3 cellular subtypes compared with those recorded in normal condition. At the same time, the differences in I(Na) peak current densities in the 3 cellular subtypes underwent variations after simulated ischemia. Simulated ischemia resulted in obvious shift of I(Na) steady-state inactivation curves in the hyperpolarizing direction in the 3 cellular subtypes and inactivation was accelerated, and the differences in the half maximal inactivation voltages (V0.5) between the 3 cellular subtypes were also altered after simulated ischemia. After simulated ischemia, I(Na) recovery from inactivation in the epicardium, endocardium and midmyocardium was all slowed down in comparison with that in normal condition, but without statistical significance. Differences between the recovery curves of three cellular subtypes were noted after ischemia for 30 min. CONCLUSION: Ischemia can affect the activity of Na(+) channel, disrupting the balance of ion channel currents and the heterogeneity of I(Na) among the 3 cellular subtypes, which is responsible for the onset of arrhythmia and partially explains different pharmacological reactions of the 3 cellular subtypes under normal and ischemic conditions.

Animals↗

[Family myxoma of the heart with metachronic multiple growth].

A case of familial heart myxoma in 4 members of one family combined with myxomic (hamartomatous) syndrome is reported. The tumor in a proband was characterized with a multiple growth in various heart chambers. Five operations were made in the proband for 16 years and seven myxomas of different locations were removed. Myxomas originating from the endocardium of the interatrial septum oval hole were removed in 3 members of his family. The case confirms the conception of heart myxoma origin from endothelial hamartia of the endocardium.

Adolescent↗

[A useful method for the surgical treatment of active infective endocarditis--a case report using the Teflon felt reinforcing method].

In the surgical treatment for active infective endocarditis (IE), perivalvular leakage is the most severe complication. We had a 42-year-old man who had active IE and a giant vegetation in the aortic valve, and a small mycotic aneurysm in the left ventricular outflow tract. Other operative observations included slight redness and a decrease in the reflex of the annular endocardium. We made a patch closure of the mycotic aneurysm, and aortic valve replacement using the Teflon felt reinforcing method. In the postoperative course, he had a pacemaker implantation with complete AV block. Postoperative pathological examination revealed inflammatory cells and plasma infiltration, and edematous change of the interstitial tissue around the cusp surface and annular side of the resected valve. These pathological changes could explain the redness and the decrease in the reflex of the annular endocardium. The edematous changes of the annular tissue might be the cause of postoperative perivalvular leakage. Reinforcement of the prosthetic valve with Teflon felt might be a useful method to prevent perivalvular leakage. There is, however, the possibility of acceleration or elongation of infective endocarditis. In our experiences of the surgical treatment for active IE, we performed valve replacement using Teflon felt in 6 patients, and not using in 27 patients. The mean period until CRP had been normalized was no significant difference between both groups (mean days using Teflon felt were 63.5 days, and not using were 75 days).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

[Subendocardial vascular plexus of the human ventricular myocardium in ontogenesis studied by scanning electron microscopy].

By means of scanning electron microscopy of native and corrosive preparations peculiarities of endocardium of the papillary-trabecular apparatus of the human heart ventricle and its vessels have been studied in ontogenesis. Folds of the endocardium increase its contact area with blood and also increase reserve of its elasticity at diastole. The subendocardial vascular plexus is formed by capillary-like venous sinusoids. They situate in the direction to the compact myocardium at the depth of 300-500 mcm. They are supposed to perform resorptive functions of nutritive substances and oxygen from blood, which is in the ventricular cavities and to smooth blood pressure between blood in the ventricular cavities and vessels of the compact myocardium.

Adolescent↗