P-003 GENDER-RELATED DIFFERENCES OF ARTERIAL STIFFNESS AND VENTRICULAR WALL STRESS ON CONTRACTILE FUNCTION AND TRIGGERED RELEASE OF N-TERMINAL PRO-BNP IN HYPERTENSION AND DIASTOLIC HEART FAILURE

Introduction: Plasma B-type natriuretic peptide (BNP) is a biomarker used to diagnose and monitor ventricular dysfunction and heart failure. However, the response of the allograft to produce BNP from ventricular wall stress and inflammation may be different, particularly in an understudied population such as pediatric recipients. Hypothesis: BNP levels decrease over time after transplant as the allograft recovers; but BNP will be higher during rejection. Methods: Enrolled all heart recipients from January 2007 to December 2016. Rejection surveillance included serial echocardiography, annual biopsy, and BNP q 1-3 months. Rejection is defined as requiring augmentation of immunosuppression from biopsy grade ≥ 2R or ≥ pAMR2 or from clinical diagnosis. Results: Among 114 patients studied, 60% were male with age at transplant 5.8 ± SD 6.5 yrs. Follow-up was 3.7 ± 2.7 yrs and 37 patients (32%) experienced 75 episodes of rejection. A total of 8358 BNP samples were obtained. BNP decreased linearly after transplant leveling off after 2 years (Fig 1). BNP was 671 ± 1115 (n=75) at rejection vs. 187 ± 423 pg/mL (n=501) without rejection confirmed by biopsy. By multivariable analysis, Ln BNP was associated with rejection (RR 1.56; 95% CI 1.35-1.80). Figure 2 shows the relationship between change in BNP and risk of rejection. Multivariable longitudinal Cox proportional model incorporating BNPs leading to 1 st rejection showed Ln BNP to be associated with rejection (HR 2.22; 95% CI 1.53-3.23, p<0.001). Conclusion: BNP continues to decrease in the 1 st 2 years after transplant. At rejection, BNP is elevated, and this test can be further developed to screen for rejection.

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Left ventricular wall stress and contractile function in transposition of the great arteries after the Rastelli operation

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/s0022-5223(19)36360-3 ◽

1987 ◽

Vol 93 (5) ◽

pp. 775-784 ◽

Cited By ~ 27

Author(s):

Thomas P. Graham ◽

Rodney C.G. Franklin ◽

Richard K.H. Wyse ◽

Vanda Gooch ◽

John E. Deanfield

Keyword(s):

Contractile Function ◽

Wall Stress ◽

Left Ventricular ◽

Left Ventricular Wall ◽

Ventricular Wall ◽

Rastelli Operation

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Treatment of sleep-disordered breathing in heart failure: reduction of high ventricular wall stress should be a diagnostic and therapeutic target

European Journal of Heart Failure ◽

10.1093/eurjhf/hfs131 ◽

2012 ◽

Vol 14 (10) ◽

pp. 1189-1189 ◽

Cited By ~ 2

Author(s):

Peter Alter ◽

Heinz Rupp

Keyword(s):

Heart Failure ◽

Therapeutic Target ◽

Sleep Disordered Breathing ◽

Wall Stress ◽

Ventricular Wall ◽

Disordered Breathing

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Relationship of arterial stiffness and early mild diastolic heart failure in general middle and aged population

European Heart Journal ◽

10.1093/eurheartj/ehq296 ◽

2010 ◽

Vol 31 (22) ◽

pp. 2799-2807 ◽

Cited By ~ 45

Author(s):

Sheng Kang ◽

Hui-Min Fan ◽

Jue Li ◽

Lie-Ying Fan ◽

Ai-Yu Miao ◽

...

Keyword(s):

Heart Failure ◽

Arterial Stiffness ◽

Diastolic Heart Failure ◽

Aged Population ◽

Relationship Of

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Abstract 11217: A New Treatment for Diastolic Heart Failure: Trabecular Cutting

Circulation ◽

10.1161/circ.130.suppl_2.11217 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

David L Halaney ◽

Pedro J Acevedo ◽

William Pérez ◽

Marc D Feldman

Keyword(s):

Heart Failure ◽

Diastolic Dysfunction ◽

Ex Vivo ◽

Diastolic Heart Failure ◽

Wall Stress ◽

Mitral Annulus ◽

Cardiac Titin ◽

Before And After ◽

Diastolic Compliance ◽

Lv Diastolic Dysfunction

Background: Heart failure with preserved ejection fraction remains a leading cause of hospitalization, without development of new medications and operative procedures to treat these patients. We hypothesize that trabeculae carneae serve an important role in modulating LV diastolic compliance, and during hypertrophy of the myocardium, trabeculae contribute to abnormal compliance. Methods and Results: Eight ex vivo human hearts from patients with LV diastolic dysfunction were perfused at 37[[Unable to Display Character: ⁰]]C and had a balloon inserted into the LV through the mitral annulus. Diastolic LV pressure-volume compliance curves were measured at baseline and following trabecular cutting. LV compliance improved significantly (n=6, p<0.001), but not in the control hearts without trabecular cutting (n=2, p=0.85). The figure shows aggregate data from the six hearts before and after trabecular cutting. To determine if trabeculae serve a similar role in all mammals, 28 hearts from 10 species were obtained. We demonstrate significant relationships between circumferential wall stress and the number of trabeculae in these species, particularly trabeculae which attach nets of trabeculae to the ventricle walls (p=0.02, n=733) and trabeculae located at the apex and free wall (p=0.02, n=602). The percent of LV cardiac titin of the stiff isoform (%N2B), a determinate of LV diastolic compliance, also demonstrated a significant relationship with the number of trabeculae with the same anatomic subsets (p=0.04, n=597; and p=0.02, n=488, respectively). Conclusions: We demonstrate for the first time that rather than being an embryologic remnant, trabeculae carneae serve an important role in the maintenance of passive LV diastolic compliance, and can contribute to LV diastolic dysfunction. A new procedure, cutting trabeculae, is proposed to improve LV diastolic compliance.

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Effect of Transmural Differences in Excitation-Contraction Delay and Contraction Velocity on Left Ventricle Isovolumic Contraction: A Simulation Study

BioMed Research International ◽

10.1155/2018/4798512 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 2

Author(s):

J. Vaverka ◽

J. Burša ◽

J. Šumbera ◽

M. Pásek

Keyword(s):

Heart Failure ◽

Left Ventricle ◽

Wall Stress ◽

Element Model ◽

Ventricular Wall ◽

Shortening Velocity ◽

Electromechanical Delay ◽

Contraction Coupling ◽

Physiological Importance ◽

Isovolumic Contraction

Recent studies have shown that left ventricle (LV) exhibits considerable transmural differences in active mechanical properties induced by transmural differences in electrical activity, excitation-contraction coupling, and contractile properties of individual myocytes. It was shown that the time between electrical and mechanical activation of myocytes (electromechanical delay: EMD) decreases from subendocardium to subepicardium and, on the contrary, the myocyte shortening velocity (MSV) increases in the same direction. To investigate the physiological importance of this inhomogeneity, we developed a new finite element model of LV incorporating the observed transmural gradients in EMD and MSV. Comparative simulations with the model showed that when EMD or MSV or both were set constant across the LV wall, the LV contractility during isovolumic contraction (IVC) decreased significantly (dp/dtmax⁡ was reduced by 2 to 38% and IVC was prolonged by 18 to 73%). This was accompanied by an increase of transmural differences in wall stress. These results suggest that the transmural differences in EMD and MSV play an important role in physiological contractility of LV by synchronising the contraction of individual layers of ventricular wall during the systole. Reduction or enhancement of these differences may therefore impair the function of LV and contribute to heart failure.

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