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Intercellular conduction velocity variability as the basis for re-entrant arrhythmias in the ischemic myocardium.

Re-entrant arrhythmias are the major cause of death from cardiovascular disease. A number of models or mechanisms have been proposed to explain the generation of re-entrant arrhythmias in the ischemic or damaged heart. However, none of these models can qualitatively predict the formation of re-entry movements with no modifications of the basic electrophysiologic characteristics of the myocardium. In this presentation we evaluate the concept that the generation of re-entrant arrhythmias is due to increased variance in the conduction characteristics of the cardiac tissue, rather than to modification of these properties. Using a model of a homogeneous two-dimensional matrix of excitable conducting cells, we derived the relationship between the relative standard deviation (RSD) and the probability of occurrence of a local ordered dispersion of velocities shown to have the potential to result in circular propagation. This probability was found to be insignificant when the RSD was lower than 10%, but increased dramatically for RSDs greater than 10%. On the basis of experimental RSD, the calculated probability for circus movement formation is one in 10,000 normal heart beats and one in two ischemic heart beats. The model provides new insight into the mechanism of re-entrant arrhythmias as well as new tools for diagnosis.

Arrhythmias, Cardiac↗

ECM gene expression correlates with in vitro tissue growth and development in fibrin gel remodeled by neonatal smooth muscle cells.

A tissue growth and development process occurred in neonatal SMC-fibrin gel constructs when cultured in DMEM supplemented with TGF-beta1 and insulin over a 5 week period. These constructs may thus serve as the basis for cardiovascular tissue replacements and future models of cardiovascular tissue growth, repair and regeneration. Following fibrin gel contraction during week 1, peak rates of SMC proliferation, collagen production and tropoelastin production occurred between weeks 1-4. Organized, cross-linked collagen and elastic fibers replaced the degrading fibrin over weeks 3-5 and were manifested as increased mechanical strength. The peak rate of SMC proliferation (weeks 1-2) preceded that for maximum collagen production (weeks 2-4), which was consistent with the 3 week time point of maximum expression of collagen type I and III from qRT-PCR. Insoluble elastin quantification revealed that the majority of elastic fibers were produced by week 4, which was also consistent with the qRT-PCR data showing a dramatic down-regulation of tropoelastin expression by week 4, indicating elastogenesis occurred during the early stages of tissue growth and development. There was a strong up-regulation of lysyl oxidase expression during weeks 1-3 with a peak in expression at week 3, correlating with the phases of collagen and tropoelastin production. An increase in MMP-2 expression over weeks 1-5 suggested an increase in ECM remodeling as the tissue developed. Mechanical strength doubled over weeks 4-5 when production of collagen and elastic fibers and expression of lysyl oxidase were subsiding. This may have been due in part to the more organized collagen fibrils evident from the histological sections in weeks 3-5.

Animals↗

Functional analysis of histamine receptor subtypes involved in endothelium-mediated relaxation of the human uterine artery.

1. This work was designed to introduce human uterine arteries as a new model for cardiovascular research. Advantages of this model include considerable availability of tissue because of the appearance of uterus myomatosus in post-menopausal women who undergo surgery and the chance to work on dysfunctional and healthy vessels. 2. Histamine evoked relaxation of the uterine artery that was prevented by removal of the endothelium or by the presence of N(G)-nitro-L-arginine. 3. Receptor antagonists for histamine H(1) (mepyramine) and H(2) (ranitidine) receptors increased the EC(50) of histamine by 112- and 67-fold, respectively. 4. Remarkably, isolated uterine arteries could be stored in incubators for 5 days without any change in contractility to phenylephrine and endothelium-dependent relaxation to acetylcholine and histamine. 5. Endothelial cells could be isolated and cultured in high purity, as demonstrated by histochemical staining of factor VIII, low CD45-RO for macrophages and no smooth muscle alpha-actin. In addition, cultured human uterine artery endothelial cells could be used for single cell Ca(2+) measurements. 6. In agreement with our findings in the intact vessel, histamine-initiated elevation of the intracellular free Ca(2+) concentration was reduced in the presence of mepyramine and ranitidine by 59 and 55%, respectively. 7. These data indicate that, in the human uterine artery, H(1) and H(2) receptors are involved in histamine-induced endothelium-dependent relaxation that is mediated by nitric oxide. 8. In addition, this vessel can be stored for possible virus-mediated gene expression for 5 days without any loss of reagibility. 9. Finally, endothelial cells can be isolated and cultured from the human uterine artery and maintain their reactivity to histamine in culture.

Arteries↗

Definition of reference frames on human skeleton.

In our modeling study of the human cardiovascular system, some forms of subject motion or posture, e.g., those experienced or assumed by a fighter pilot, can not be neglected in considering the overall system dynamics. This investigation aims at establishing a set of reference frames on the human skeleton which are based on the observations and measurements taken on four skeleton systems. These frames are coupled together at the articulation positions to form a base of operation of 3-D translation and rotation. The coupling at a specified reference position was verified against the proportional measurements taken from X-ray films, CAT scan films, atlases and two human cadavers. A program was written to perform the forementioned transformations on the frames coupled at the reference position such that any posture can be achieved as long as the necessary angular anthropometric measurements are provided. If a set of angular profiles at all involved joints are given, the human motion can be mathematically animated to a certain degree of accuracy appropriate for specified computer simulation studies. Under this definition, any major segment of our cardiovascular system model can be specified in terms of spatial position and orientation. [table: see text]

Anthropometry↗

A mathematical model of CO2 effect on cardiovascular regulation.

The effect of changes in arterial CO2 tension on the cardiovascular system is analyzed by means of a mathematical model. The model is an extension of a previous one that already incorporated the main reflex and local mechanisms triggered by O2 changes. The new aspects covered by the model are the O2-CO2 interaction at the peripheral chemoreceptors, the effect of local CO2 changes on peripheral resistances, the direct central neural system (CNS) response to CO2, and the control of central chemoreceptors on ventilation and tidal volume. A statistical comparison between model simulation results and various experimental data has been performed. This comparison suggests that the model is able to simulate the acute cardiovascular response to changes in blood gas content in a variety of conditions (normoxic hypercapnia, hypercapnia during artificial ventilation, hypocapnic hypoxia, and hypercapnic hypoxia). The model ascribes the observed responses to the complex superimposition of many mechanisms simultaneously working (baroreflex, peripheral chemoreflex, CNS response, lung-stretch receptors, local gas tension effect), which may be differently activated depending on the specific stimulus under study. However, although some experiments can be reproduced using a single basal set of parameters, reproduction of other experiments requires a different combination of the mechanism strengths (particularly, a different strength of the local CO2 mechanism on peripheral resistances and of the CNS response to CO2). Starting from these results, some assumptions to explain the striking differences reported in the literature are presented. The model may represent a valid support for the interpretation of physiological data on acute cardiovascular regulation and may favor the synthesis of contradictory results into a single theoretical setting.

Animals↗

Combined effects of cocaine and nicotine on cardiovascular performance in a canine model.

BACKGROUND: With the proliferation of cocaine abuse, increased incidence of catastrophic cardiovascular events such as angina pectoris, myocardial infarction, ventricular arrhythmias, or sudden death are reported. Many of these patients also smoke cigarettes before and after cocaine use, leading to a high frequency of simultaneous exposure to both drugs. Cocaine's and nicotine's independent effects on cardiodynamics are well documented, but combined effects of both on complete cardiovascular hemodynamics remain unknown. HYPOTHESIS: The study aimed to determine whether these effects are additive, synergistic, or antagonistic and was therefore designed to investigate the cardiovascular changes produced as a result of combined administration of cocaine and nicotine in a canine model. METHODS: Initially, in phase 1, 30 experiments were performed to study the dose-response curve of both drugs. In phase II and III, 12 dogs were subjected to 30 experiments. In phase II, cocaine was given intravenously (IV) followed by nicotine. In phase III, sequence of drug administration was reversed to study the effects on hemodynamics and coronary artery blood flow reserve. RESULTS: Hemodynamic parameters observed were Phase I: Dose-response curve established the IV bolus dose of cocaine 2 mg/kg and nicotine 50 microg/kg. Phase II: Cocaine increased heart rate, blood pressure, and dP/dt, but nicotine administration after cocaine produced marked significant synergistic excitatory effects: dP/dt increased from 1,810 +/- 210 to 6,300 +/- 460 (p < 0.003). Phase III: Nicotine significantly increased heart rate, mean arterial pressures, left ventricular end-diastolic pressure, pulmonary artery, pulmonary capillary wedge, and right atrial pressures. Nicotine increased dP/dt (1,810 +/- 192 to 5,000 +/- 160 mmHg/s; p < 0.004). These excitatory effects of nicotine were attenuated by cocaine when administered as a second drug (dP/dt decreased to 1,925 +/- 144 from 5,000 +/- 160 mmHg/s;p < 0.004). CONCLUSIONS: Cocaine, when administered alone, caused increase in heart rate, blood pressure, and dP/dt, but nicotine showed a significant increase in all the hemodynamic parameters. Both drugs reduced coronary blood flow reserve. In combination, cocaine plus nicotine administration had synergistic excitatory effects in dogs. A reversed drug combination, that is, nicotine plus cocaine, attenuated the excitatory effects of nicotine.

Animals↗

An introduction to biofluid mechanics--basic models and applications.

Cardiovascular disease is the primary cause of morbidity and mortality in the western world. Complex hemodynamics play a critical role in the development of atherosclerosis and the processes of aging, as well as many other disease processes. Biofluid mechanics play a major role in the cardiovascular system and it is important to understand the forces and movement of blood cells and whole blood as well as the interaction between blood cells and the vessel wall. Fundamental fluid mechanical, which are important for the understanding of the blood flow in the cardiovascular circulatory system of the human body aspects are presented. Measurement techniques for model studies such as LDA, ultrasound, and MRI studies will be discussed. Viscosity and flow behavior changes specifically the creation of vortices and flow disturbances can be used to show how medication can influence flow behavior. Experiments have shown that hemodynamics may have a strong influence on the creation of aneurysms and varicose veins. Other factors such as vessel wall structure are also important. In preliminary studies, it has been demonstrated that geometry and elasticity of vessel walls help determine flow behavior. High velocity fluctuations indicate flow disturbances that should be avoided. Health care practitioners must understand fluid dynamic factors such as flow rate ratio, pressure and velocity gradients, and flow behavior, velocity distribution, shear stress on the wall and on blood cells. These mechanical factors are largely responsible for the deposit of blood cells and lipids, a leading cause of atherosclerosis. The interaction between blood cells and of the cells with the vessel, leads to the formation of plaques and agglomerations. These deposits are found predominantly at arterial bends and bifurcations where blood flow is disturbed, where a secondary flow is created, and where flow separation regions are found. Experiments on hemodynamic effects in elastic silicon rubber models of the cardiovascular system with flow wire, stents, or patches for vessel surgery will be discussed. These studies can be important in improving diagnostics and therapeutic applications.

Animals↗

Prediction of incident heart failure in established atherosclerotic cardiovascular disease: the SMART2-HF model.

BACKGROUND AND AIMS: Patients with established atherosclerotic cardiovascular disease (ASCVD) are at high risk of developing heart failure (HF). However, incident HF is not part of the risk assessment of current guideline-recommended models. The aim of this study was to develop and externally validate the SMART2-HF model for prediction of incident HF in patients with ASCVD. METHODS: SMART2-HF was developed in 7698 individuals with established ASCVD (coronary, cerebrovascular, or peripheral artery disease, or abdominal aortic aneurysm) but without prior HF from the UCC-SMART cohort. Cox proportional hazards models including sex-predictor interactions and with age as the time scale were derived to estimate the 10-year and lifetime risk of incident HF (hospitalization for HF or HF-related death), accounting for competing non-HF mortality. Predictors, limited to routinely available clinical characteristics, were aligned with the SMART2 risk model for recurrent cardiovascular (CV) risk in the same population. External validation was performed in 240 741 patients with ASCVD from six data sources: the Clinical Practice Research Datalink, the HUNT3 study, the SWEDEHEART Registry, the ASCVD-Particles cohort, the Estonian Biobank and the international REACH Registry. RESULTS: During a median follow-up of 11.2 years (interquartile range 6.1-16.4 years), 1031 incident HF events (13%) occurred in the UCC-SMART cohort. In the external validation data sources, a total of 24 885 incident HF events (10%) occurred. The pooled C-statistic was .696 (95% confidence interval .674-.717), with consistent performance in subgroups by sex and type of ASCVD. Predicted risks matched observed incidence in external validation. CONCLUSIONS: The SMART2-HF model enables the prediction of incident HF in patients with ASCVD. Aligned with the guideline-recommended SMART2 model for recurrent CV risk, SMART2-HF can be used as a complementary tool in this population.

Humans↗

Are intramural suction-squeezing effects generated by the variations in radial wall stress during each heart beat the motor of atherosclerosis? A new concept.

In the early sixties, the existence of predilection sites for atherosclerotic lesions inside the arterial circulation led to the concept that low wall shear stress (WSS) was responsible, together with systemic factors like high blood pressure, hypercholesterolemia, or diabetes, for the genesis and progression of atherosclerosis. It was found later that oscillating WSS and high WSS gradients could also be incriminated. Yet, this concept, which is broadly accepted today, fails to explains several facts, for instance that some arteries (e.g. epicardial coronary arteries) are more prone to become atherosclerotic than other ones exposed to the same systemic factors (e.g. hepatic and brain arteries). In this paper, we present a quite different concept. It is based on the fact that the increase in intravascular pressure and flow that occur in the arteries during systole generates, at the predilection sites of atherosclerotic lesions (bends, bifurcations, and branchings), an increase of radial wall stress in the outer layers of the arterial wall so that this stress becomes momentarily tensile. These cyclic stress increases have a suction effect that is likely to facilitate the diffusion of atherogenic cells and substances inside the wall. Furthermore, since arteries are not primarily structured to resist inversions of radial stress, they may also create damages (e.g. disruptions of cell membranes and elastic lamellae) followed by inflammations and micro-haemorrhages in the wall. This new concept may provide a complementary (or possibly alternative) explanation of atherosclerosis.

Animals↗

Approaches to gene therapy of complex multigenic diseases: cancer as a model and implications for cardiovascular disease and diabetes.

The general concept of gene therapy is now well established and accepted by the medical, scientific and public policy communities, and is rapidly being implemented in human experimental studies. In addition to the initial models of single gene defects, target diseases have now come to include multigenic and multifactorial diseases such as human cancer, neurodegenerative diseases such as Parkinson's disease and firms of cardiovascular disease. While many conceptual and technical obstacles must still be overcome before therapy for disorders such as coronary artery disease and diabetes mellitus will easily be approached at the genetic level, the early results with several multigenic disease models gives some cause for optimism that gene therapies for even those complicated disorders will eventually become available.

Animals↗

Cardiovascular parameters in anaesthetized guinea pigs: a safety pharmacology screening model.

INTRODUCTION: Assessment of cardiovascular functions in vivo is part of the core battery of guideline ICH S7A and is thereby required by regulatory authorities. The haemodynamic effects of repeated intravenous administrations of reference compounds were analyzed in order to validate the guinea pig model for safety pharmacology studies under GLP conditions. METHODS: Male guinea pigs (n=54, weighing 565-762 g) were anaesthetized using 1.5 g/kg, i.p., urethane. Systolic arterial blood pressure (SAP), diastolic arterial blood pressure (DAP), heart rate (HR), left ventricular pressure (LVP), cardiac contractility (dp/dt(max)), and ECG (RR, QT, and QTc intervals) were recorded continuously. Animals received vehicle i.v. followed by cumulative doses of reference compounds. RESULTS: Vehicle did not produce any relevant changes, either in cardiovascular or ECG parameters. Isoproterenol caused a rapid and significant increase in HR, LVP, and dp/dt(max), in contrast to a dose-dependent decrease in SAP and DAP. Epinephrine led to a potent increase in all cardiovascular parameters. Nifedipine produced a slight decrease in HR and LVP, and a potent decrease in blood pressure and dp/dt(max). Verapamil caused a dose-dependent decrease in all cardiovascular parameters. Ouabain resulted in a significant increase in SAP, DAP, LVP, and dp/dt(max); ECG showed an atrioventricular block and arrhythmia. Terfenadine, cisapride, and sotalol prolonged QT and QTc intervals, whereas vehicle and the other tested compounds did not produce any prolongation of the QTc interval. DISCUSSION: Our results on HR, blood pressure, and ECG obtained after i.v. administration of reference compounds show the usefulness of the guinea pig in assessing cardiovascular safety. The anaesthetized guinea pig allows the measurement of cardiac contractility and the use of doses higher than in conscious animals. Using this animal model, several cardiovascular parameters can be recorded simultaneously at a modest cost in terms of test compound and the number of animals required.

Anesthesia↗

Use of artificial intelligence to identify cardiovascular compromise in a model of hemorrhagic shock.

OBJECTIVE: To determine whether a prototype artificial intelligence system can identify volume of hemorrhage in a porcine model of controlled hemorrhagic shock. DESIGN: Prospective in vivo animal model of hemorrhagic shock. SETTING: Research foundation animal surgical suite; computer laboratories of collaborating industry partner. SUBJECTS: Nineteen, juvenile, 25- to 35-kg, male and female swine. INTERVENTIONS: Anesthetized animals were instrumented for arterial and systemic venous pressure monitoring and blood sampling, and a splenectomy was performed. Following a 1-hr stabilization period, animals were hemorrhaged in aliquots to 10, 20, 30, 35, 40, 45, and 50% of total blood volume with a 10-min recovery between each aliquot. Data were downloaded directly from a commercial monitoring system into a proprietary PC-based software package for analysis. MEASUREMENTS AND MAIN RESULTS: Arterial and venous blood gas values, glucose, and cardiac output were collected at specified intervals. Electrocardiogram, electroencephalogram, mixed venous oxygen saturation, temperature (core and blood), mean arterial pressure, pulmonary artery pressure, central venous pressure, pulse oximetry, and end-tidal CO(2) were continuously monitored and downloaded. Seventeen of 19 animals (89%) died as a direct result of hemorrhage. Stored data streams were analyzed by the prototype artificial intelligence system. For this project, the artificial intelligence system identified and compared three electrocardiographic features (R-R interval, QRS amplitude, and R-S interval) from each of nine unknown samples of the QRS complex. We found that the artificial intelligence system, trained on only three electrocardiographic features, identified hemorrhage volume with an average accuracy of 91% (95% confidence interval, 84-96%). CONCLUSIONS: These experiments demonstrate that an artificial intelligence system, based solely on the analysis of QRS amplitude, R-R interval, and R-S interval of an electrocardiogram, is able to accurately identify hemorrhage volume in a porcine model of lethal hemorrhagic shock. We suggest that this technology may represent a noninvasive means of assessing the physiologic state during and immediately following hemorrhage. Point of care application of this technology may improve outcomes with earlier diagnosis and better titration of therapy of shock.

Animals↗

Idiodynamic profiles of cardiovascular activity: a P-technique approach.

A study was conducted to expand the conventional view of cardiovascular (CV) reactivity by using the idiodynamic paradigm for investigation of individuals. Patterns of autonomic CV regulation were assessed in six subjects across diverse laboratory tasks on three separate occasions. Individual CV profiles were derived from these data with P-technique factor analysis, and then group aggregated with chain P-technique. The composite pattern suggested a three-component solution consisting of cardiac rate, cardiac contractility, and peripheral resistance factors. Individual profiles were compared to the composite pattern; these profiles differed in the number of components derived, percentage variance explained by these components, and relative dominance of specific CV components. A hypothesis that emerged is that the subjects differed in the complexity of CV control. It appears that the idiodynamic framework, combined with novel research designs and statistical methods, may help expand the view of CV reactivity beyond the traditional unitary view as response magnitude.

Adult↗

Mean aortic pressure is the geometric mean of systolic and diastolic aortic pressure in resting humans.

The aim of our study was twofold: 1) to establish a mathematical link between mean aortic pressure (MAP) and systolic (SAP) and diastolic aortic pressures (DAP) by testing the hypothesis that either the geometric mean or the harmonic mean of SAP and DAP were reliable MAP estimates; and 2) to critically evaluate three empirical formulas recently proposed to estimate MAP. High-fidelity pressures were recorded at rest at the aortic root level in controls (n = 31) and in subjects with various forms of cardiovascular diseases (n = 108). The time-averaged MAP and the pulse pressure (PP = SAP - DAP) were calculated. The MAP ranged from 66 to 160 mmHg [mean = 107.9 mmHg (SD 18.2)]. The geometric mean, i.e., the square root of the product of SAP and DAP, furnished a reliable estimate of MAP [mean bias = 0.3 mmHg (SD 2.7)]. The harmonic mean was inaccurate. The following MAP formulas were also tested: DAP + 0.412 PP (Meaney E, Alva F, Meaney A, Alva J, and Webel R. Heart 84: 64, 2000), DAP + 0.33 PP + 5 mmHg [Chemla D, Hébert JL, Aptecar E, Mazoit JX, Zamani K, Frank R, Fontaine G, Nitenberg A, and Lecarpentier Y. Clin Sci (Lond) 103: 7-13, 2002], and DAP + [0.33 + (heart rate x 0.0012)] PP (Razminia M, Trivedi A, Molnar J, Elbzour M, Guerrero M, Salem Y, Ahmed A, Khosla S, Lubell DL. Catheter Cardiovasc Interv 63: 419-425, 2004). They all provided accurate and precise estimates of MAP [mean bias = -0.2 (SD 2.9), -0.3 (SD 2.7), and 0.1 mmHg (SD 2.9), respectively]. The implications of the geometric mean pressure strictly pertained to the central (not peripheral) level. It was demonstrated that the fractional systolic (SAP/MAP) and diastolic (DAP/MAP) pressures were reciprocal estimates of aortic pulsatility and that the SAP times DAP product matched the total peripheral resistance times cardiac power product. In conclusion, although the previously described thumb-rules applied, the "geometric MAP" appears more valuable as it established a simple mathematical link between the steady and pulsatile component of aortic pressure.

Adult↗

Acute cardiovascular response to isocapnic hypoxia. I. A mathematical model.

A mathematical model of the acute cardiovascular response to isocapnic hypoxia is presented. It includes a pulsating heart, the systemic and pulmonary circulation, a separate description of the vascular bed in organs with the higher metabolic need, and the local effect of O(2) on these organs. Moreover, the model also includes the action of several reflex regulatory mechanisms: the peripheral chemoreceptors, the lung stretch receptors, the arterial baroreceptors, and the hypoxic response of the central nervous system. All parameters in the model are given in accordance with the physiological literature. The simulated overall response to a deep hypoxia (28 mmHg) agrees with the experimental data quite well, showing a biphasic pattern. The early phase (8-10 s), caused by activation of peripheral chemoreceptors, exhibits a moderate increase in mean systemic arterial pressure, a decrease in heart rate, a quite constant cardiac output, and a redistribution of blood flow to the organs with higher metabolic need at the expense of other organs. The later phase (20 s) is characterized by the activation of lung stretch receptors and by the central nervous system hypoxic response. During this phase, cardiac output and heart rate increase together, and blood flow is restored to normal levels also in organs with lower metabolic need. The model may be used to gain a deeper understanding of the role of each mechanism in the overall cardiovascular response to hypoxia.

Afferent Pathways↗