Myocardial Layers Research Articles

Soft robotic artificial left ventricle simulator capable of reproducing myocardial biomechanics.

The heart's intricate myocardial architecture has been called the Gordian knot of anatomy, an impossible tangle of intricate muscle fibers. This complexity dictates equally complex cardiac motions that are difficult to mimic in physical systems. If these motions could be generated by a robotic system, then cardiac device testing, cardiovascular disease studies, and surgical procedure training could reduce their reliance on animal models, saving time, costs, and lives. This work introduces a bioinspired soft robotic left ventricle simulator capable of reproducing the minutiae of cardiac motion while providing physiological pressures. This device uses thin-filament artificial muscles to mimic the multilayered myocardial architecture. To demonstrate the device's ability to follow the cardiac motions observed in the literature, we used canine myocardial strain data as input signals that were subsequently applied to each artificial myocardial layer. The device's ability to reproduce physiological volume and pressure under healthy and heart failure conditions, as well as effective simulation of a cardiac support device, were experimentally demonstrated in a left-sided mock circulation loop. This work also has the potential to deliver faithful simulated cardiac motion for preclinical device and surgical procedure testing, with the potential to simulate patient-specific myocardial architecture and motion.

Cardiac regeneration in goldfish (Carassius auratus) associated with increased expression of key extracellular matrix molecules.

Cardiac regeneration is a natural phenomenon that occurs in many species outside of humans. The goldfish (Carassius auratus) is an understudied model of cardiac wound response, despite its ubiquity as pets as well as its relationship to the better-studied zebrafish. In this study, we examined the response of the goldfish heart to a resection injury. We found that by 70 days post-injury, goldfish scarlessly heal cardiac wounds under a certain size, with local cardiomyocyte proliferation driving the restoration of the myocardial layer. We also found the upregulation of extracellular matrix components related to cardiac regeneration in the injury site. This upregulation correlated with the level of cardiomyocyte proliferation occurring in the injury site, indicating an association between the two that warrants further exploration.

Layer-specific proteomic profiling of human normal heart

BackgroundThe organized functioning of the anisotropic myocardial layers—including the inner longitudinal, middle circular, and outer longitudinal layers—is essential for stable systemic circulation. However, the proteomic profile of each myocardial layer has not been studied yet. Here, we aimed to elucidate the layer-specific proteomic profile of human cardiac tissue using microscopic sampling. MethodsNormal hearts were obtained from five autopsy cases, and cardiomyocytes were microdissected separately from the three myocardial layers of the left ventricle. Histological analysis and shotgun proteomic profiling were performed, followed by immunohistochemical analysis. ResultsHistologically, no significant changes were observed among the three layers regarding cardiomyocyte diameter and myocardial fibrosis. Totally 1220 proteins—comprising 9404 peptides—were identified from 15 samples, of which the expression levels of 92 proteins were significantly altered among the layers. Gene ontology enrichment analysis revealed that the proteins specifically elevated in the inner and outer layers mostly belonged to the actin filament-binding protein group. In particular, MYH1 was highly expressed in cardiomyocytes in the outer layer, and CTNNA3 was highly expressed at the intercalated disc in the inner layer. ConclusionsThis is the first report on layer-specific proteomic profiling of human normal hearts. Anisotropic profiles of actin filament-binding proteins in myocardial layers may contribute to the anisotropic contractile and conductive abilities of the heart. Knowledge of the layer-specific proteome profiles of a human heart in the normal state can aid in further research on cardiac pathology, such as the prognosis and treatment of focal myocardial infarction.

The utility of novel STE parameters in echocardiographic assessment of single ventricle after Fontan palliation

Background and aims of the study A functionally single ventricle (FSV) refers to a group of congenital heart defects that are not amenable for biventricular correction. The Fontan operation is utilized as surgical treatment for most of FSV patients. The evaluation of FSV function is extremely difficult due to its unique pathophysiology. This study aimed to explore the efficacy of speckle tracking echocardiography (STE) parameters measured at rest and during exercise for comprehensive assessment of univentricular heart. MethodsWe enrolled 37 patients with a functionally single ventricle after the Fontan operation, hospitalized in the Department of Congenital Heart Defects between years 2019 and 2021.The echocardiographic stress tests were performed in the Echocardiography Laboratory of the Congenital Heart Defects Department. The study was conducted on a bicycle ergometer in a semi-recumbent position. The parameters obtained by speckle tracking echocardiography (STE): the longitudinal strain of the FSV free wall (Ɛ) and the longitudinal strain of myocardial layers: subendocardial, medial and subepicardial were analyzed. A transmural longitudinal strain gradient (TG) was calculated as the difference between longitudinal deformation of the subendocardial and subepicardial layers. Current results of cardiac magnetic resonance imaging (CMR) and cardio-pulmonary test (CPET) were also incorporated. Demographic data, past interventions, pharmacological treatment and comorbidities were extracted from medical records. ResultsƐ at rest and during exercise were not related to the parameters of physical capacity obtained on CPET nor to the CMR results. The transmural strain gradient was dependent on physical performance parameter- peak oxygen uptake- and related to the FSV ejection fraction calculated by magnetic resonance imaging. ConclusionsThe transmural strain gradient and FSV free wall strain are readily measurable and suitable for evaluating single ventricle function. The TG is positively correlated with peak oxygen uptake during the cardiopulmonary test and with the ejection fraction derived from cardiac magnetic resonance imaging. The applicability of these findings in patients undergoing the Fontan procedure warrants further exploration.

A novel DSP zebrafish model reveals training- and drug-induced modulation of arrhythmogenic cardiomyopathy phenotypes

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Associazione Italiana per la Ricerca sul Cancro [AIRC grant IG-2017-19928], Italian Ministry of University and Research [grant PRIN 20173ZWACS] Introduction Arrhythmogenic cardiomyopathy (AC) is an inherited disorder characterized by progressive loss of the ventricular myocardium causing life-threatening ventricular arrhythmias, syncope and sudden cardiac death in young and athletes. About 40% of AC cases carry one or more mutations in genes encoding for desmosomal proteins, including Desmoplakin (Dsp). Methods We generated the first stable Dsp knock-out (KO) zebrafish line able to model cardiac alterations and cell signalling dysregulation, characteristic of the AC disease. Results Our stable Dsp knock-out (KO) zebrafish line was characterized by cardiac alterations, edema and bradycardia at larval stages. Histological analysis of mutated adult hearts showed reduced contractile structures and abnormal shape of the ventricle, with thinning of the myocardial layer, vessels dilation and presence of adipocytes within the myocardium. Moreover, TEM analysis revealed "pale", disorganized and delocalized desmosomes. Intensive physical training protocol caused a global worsening of the cardiac phenotype, accelerating the progression of the disease. Of note, we detected a decrease of Wnt/β-catenin signalling, recently associated with AC pathogenesis, as well as Hippo/YAP-TAZ and TGF-β pathway dysregulation. Pharmacological treatment of mutated larvae with SB216763, a Wnt/β-catenin agonist, rescued pathway expression and cardiac abnormalities, stabilizing the heart rhythm. Conclusion Our Dsp KO zebrafish line recapitulates many AC features observed in human patients, pointing at zebrafish as a suitable system for in vivo analysis of environmental modulators, such as the physical exercise, and the screening of pathway-targeted drugs, especially related to the Wnt/β-catenin signalling cascade.

Identification of Spinal Afferent Innervation in the Rat Heart: Atria and Ventricles: Anterograde Tracing

The spinal afferent innervation of the heart regulates cardiac functions by sending sensory information from the dorsal root ganglia (DRG) to the brain. However, the distribution and morphology of spinal afferents in the whole heart are not well characterized. The challenges here are: 1) diffculty in surgically accessing the upper thoracic DRG to label only cardiac spinal afferents. 2) handling flat-mounts of whole atria and ventricles (thickness ~850 μm) without using sections or partial tissues that could disrupt the continuity of axonal structures. To overcome these challenges, we injected anterograde tracer dextran biotin (DB) into the left DRG (C8-T3) of male SD rats (3-5 months) and allowed them to recover for 14 days for tracer transportation. Flat-mounts of the left and right atria and ventricles were prepared, and DAB (3,3′-Diaminobenzidine) stained, followed by imaging, tracing, and digitization using the Neurolucida system. Our findings are: In the atria, the DB-labeled axons entered the atria potentially through the left precaval vein (LPCV), with predominant innervation of the left side of the atrial wall and extended their projection towards the auricles, middle region of the atrium, and pulmonary veins. Most of the spinal afferent axons were present in the myocardial layer. Varicose DB-labeled axons were also observed on cardiac targets at different regions, and distinct morphological structures were found. In the cardiac muscle, DB-labeled axons ran mainly in the direction of muscle fibers. Also, varicose axons ran along the small vasculature on the atria. Spinal afferents formed varicose contacts with individual principal neurons within some intrinsic cardiac ganglia (ICG). In the ventricles, DB-labeled axons were present in the left and right ventricles, which ramified and expressed spherical-like varicosities on the cardiac muscle. In both the atria and ventricles, spinal afferent axons formed simple, branching, and complex terminal structures. Thus, our work, for the first time, successfully labeled, traced, and digitized the spinal cardiac afferents in the flat-mounts of whole atria and ventricles, which will provide a foundation for specific labeling of cardiac spinal afferent fibers. In addition, it will lead to the future study of topographical cardiac spinal afferent innervation, functional studies, and their remodeling in pathological conditions. This study was supported by NIH HEAL/SPARC U01 NS113867-01, NIH R15 R15HL137143-01A1, and UCF dissertation completion Fellowships. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Remodeling of Ventricular Catecholaminergic Axons Following Chronic Intermittent Hypoxia in Mice

Chronic intermittent hypoxia (CIH) is a widely employed model for sleep apnea. The imbalance of autonomic control may contribute to CIH-induced cardiovascular diseases. Previously, we demonstrated that CIH increases sympathetic innervation of the atria. In this study, we determined whether CIH remodels peripheral cardiac tyrosine hydroxylase (TH, a marker for sympathetic efferent axons) innervation in the whole ventricles. The two challenges here were: 1) labeling the entire TH-IR axon innervation in the full thickness (~500 μm) of whole flat-mount ventricles. 2) Quantifying the topographical distribution of TH-IR axons through the thick ventricular walls at the single axon/varicosity scale. In this study, C57BL/6J mice (male, 2 months old, n=7/group) were exposed to room air (RA, 21% O2) or CIH (alternating between 21% and 5.7% O2 every 6 minutes for 10 hours/day) for 8-10 weeks. We prepared flat-mounts of the whole ventricles and septum and processed them with immunohistochemical labeling for TH. Using the Zeiss M2 Imager, confocal microscope, Zeiss Arivis Vision 4D, and Neurolucida system, we traced and digitized the TH-IR axons. We found that: 1) In RA and CIH mice, several large TH-immunoreactive (TH-IR) bundles from the base area entered the ventricles and septum. These large bundles branched into numerous smaller bundles as they traveled downward toward the apex and finally developed into fine varicose axons and terminals in the epicardial and myocardial layers. 2) Using Vision 4D, we were able to accurately detect, trace, and digitize all TH-IR axons in the ventricle walls with high accuracy. 3) CIH increased overall TH-IR axon density and network complexity of the whole ventricles and septum. 3) Abnormal CIH TH-IR axon terminal structures were frequently seen. 4) We geometrically and precisely registered the tracing data into a scaffold map for presentation and comparison in 3D. Altogether, CIH increased sympathetic innervation of the heart which may contribute to the augmented sympathetic drive. Our success in mapping data in the 3D heart scaffold will establish a heart-brain connectome/atlas. Supported by NIH 1 U01 NS113867-01 NIH R15 1R15HL137143-01A1, 2R01HL137832-05 and Carl Zeiss. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Incremental value of myocardial global longitudinal strain in predicting major adverse cardiac events among patients with hypertrophic cardiomyopathy.

Endocardial global longitudinal strain (endo-GLS) measured with echocardiography (echo) has been demonstrated to be associated with myocardial fibrosis (MF) and is a prognostic predictor in patients with hypertrophic cardiomyopathy (HCM). Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging showed that MF is primarily located in the myocardial layer of the extremely hypertrophic septal or ventricular wall. We hypothesized that GLS of the myocardial layer (myo-GLS) is more strongly correlated with the extent of LGE (%LGE) and is a more powerful prognostic factor than endo-GLS. A total of 177 inpatients (54.0 [IQR: 43.0, 64.0] years, female 37.3%) with HCM were retrospectively included from May 2019 to April 2021. Among them, 162 patients underwent echocardiographic examination and contrast-enhanced CMR within 7 days. Myo-GLS and %LGE were blindly assessed in a core laboratory. All the patients were followed after they were discharged. During a mean follow-up of 33.77 [IQR 30.05, 35.40] months, 14 participants (7.91%) experienced major adverse cardiac events (MACE). The MACE (+) group showed lower absolute endo-GLS and myo-GLS than the MACE (-) group. Myo-GLS was more associated with %LGE (r=-.68, P<.001) than endo-GLS (r=-.64, P<.001). Cox multivariable analysis indicated that absolute myo-GLS was independently associated with MACE (adjusted hazard ratio=.75, P<.05). Myo-GLS was better than endo-GLS at detecting MACE (+) patients (-8.64%, AUC.939vs. - 16.375%, AUC.898, P<.05). Myo-GLS is a stronger predictor of MACE than endo-GLS in patients with HCM and is highly correlated with %LGE.

Descripción y prevalencia de la disyunción del anillo mitral y el ventrículo: ¿variante de la normalidad o patológica?

Introduction and objectivesThe aim of this study was to investigate a new variation of the atrial wall-mitral annulus-ventricular wall junction along the mural mitral leaflet and commissures: the ventricular mitral annular disjunction (v-MAD). This new variant is characterized by spatial displacement of the mitral leaflet hinge line by more than 2mm toward the left ventricle. MethodsWe examined a cohort of autopsied human hearts (n=224, 21.9% females, 47.9±17.6 years) from patients without known cardiovascular disease to identify the presence of v-MAD. ResultsMore than half (57.1%) of the hearts showed no signs of MAD in the mural mitral leaflet or mitral commissures. However, v-MAD was found in 23.6% of cases, located within 20.1% of mural leaflets, 2.2% in superolateral commissures, and 1.3% in inferoseptal commissures. V-MAD was not uniformly distributed along the mitral annulus circumference, with the most frequent site being the P2 scallop (19.6% of hearts). The v-MAD height was significantly greater in mural leaflets than in commissures (4.4 mm±1.2 mm vs 2.1 mm±0.1 mm; P<.001). No specific variations in mitral valve morphology or anthropometrical features of donors were associated with the presence or distribution of v-MADs. Microscopic examinations revealed the overlap of the thin layer of atrial myocardium over ventricular myocardium in areas of v-MAD. ConclusionsOur study is the first to present a detailed definition and morphometric description of v-MAD. Further studies should focus on the clinical significance of v-MAD to elucidate whether it represents a benign anatomical variant or a significant clinical anomaly.

Description and prevalence of ventricular mitral annular disjunction: variation of normality or pathological variant?

Introduction and objectivesThe aim of this study was to investigate a new variation of the atrial wall-mitral annulus-ventricular wall junction along the mural mitral leaflet and commissures: the ventricular mitral annular disjunction (v-MAD). This new variant is characterized by spatial displacement of the mitral leaflet hinge line by more than 2mm toward the left ventricle. MethodsWe examined a cohort of autopsied human hearts (n=224, 21.9% females, 47.9±17.6 years) from patients without known cardiovascular disease to identify the presence of v-MAD. ResultsMore than half (57.1%) of the hearts showed no signs of MAD in the mural mitral leaflet or mitral commissures. However, v-MAD was found in 23.6% of cases, located within 20.1% of mural leaflets, 2.2% in superolateral commissures, and 1.3% in inferoseptal commissures. V-MAD was not uniformly distributed along the mitral annulus circumference, with the most frequent site being the P2 scallop (19.6% of hearts). The v-MAD height was significantly greater in mural leaflets than in commissures (4.4 mm±1.2 mm vs 2.1 mm±0.1 mm; P<.001). No specific variations in mitral valve morphology or anthropometrical features of donors were associated with the presence or distribution of v-MADs. Microscopic examinations revealed the overlap of the thin layer of atrial myocardium over ventricular myocardium in areas of v-MAD. ConclusionsOur study is the first to present a detailed definition and morphometric description of v-MAD. Further studies should focus on the clinical significance of v-MAD to elucidate whether it represents a benign anatomical variant or a significant clinical anomaly.

Morphometric Study of Epicardium and Myocardium Thickness in Adult Human Hearts

Background: Understanding the structural dynamics of the heart across diverse demographics sheds light on cardiac function, pathology, and therapeutic interventions. This study aimed to determine the histological and morphometric features of the heart's layers, particularly the left atrium (LA) and left ventricle. Methods: Heart samples were obtained from 32 cadavers, comprising both male and female individuals, across four age groups (≤ 29, 30-39, 40-49, and ≥50). These samples were sourced from the forensic center of Azadi Teaching Hospital in Kirkuk city between March 2023 and August 2023. Results: Morphometric analysis revealed that the mean thickness of the epicardium layer varied among the four age groups of the left atrium (LA), ranging from a minimum mean of 103.5 μm in females to a maximum mean of 928.5 μm in males. Similarly, the mean thickness of the myocardium layer of the LA ranged from a minimum mean of 1649 μm in females to a maximum mean of 3176 μm in males. In the left ventricle (LV), the minimum mean thickness of the epicardium layer across the age groups was 217.5 μm in females, while the maximum mean thickness was 1377 μm in males. The minimum mean thickness of the myocardium layer of the LV was 1666 μm in females, and the maximum mean was 4132 μm in males. Conclusion: The study findings indicate that the myocardium layer of both the left atrium and left ventricle is thicker than the epicardium layer in individuals aged between 25 and 57 years. Furthermore, the thickness of both layers was observed to be thinner in females compared to males.

Cardiac Transcriptome and Histology of the Heart of the Male Chinese Mitten Crab (Eriocheir sinensis) under High-Temperature Stress

High temperatures are important environmental stressors affecting the metabolism, growth, immunity, and mortality of Chinese mitten crabs (Eriocheir sinensis). In this study, Chinese mitten crabs were divided into two groups and exposed to temperatures of 35 °C (thermal stress group) or 25 °C (control group) for 24 h, and the transcriptome of the heart was analyzed. There were 4007 differentially expressed genes (DEGs) between the thermal stress and the control groups, including 2660 upregulated and 1347 downregulated genes. Heat shock proteins (HSPs) and transcription factors (TFs) were temperature-sensitive DEGs in Chinese mitten crabs. DEGs mainly focused on protein processing in the endoplasmic reticulum, ribosome biogenesis, glycine, serine, and threonine metabolism, protein export, and insect hormone biosynthesis pathways. A total of 28,916 SSRs and 59 TF families, including 851 TFs, were detected among all unigenes of E. sinensis transcripts. The qRT-PCR results for the HSPs and apoptotic DEGs from the heart exhibited the same trends as those in the E. sinensis transcriptome data. Results of light microscopy analyzing histological sections of the heart indicated that most myocardial fibers were lysed, and the number of nuclei and the connective tissue contents between the myocardial layers were both reduced following 35 °C exposure for 24 h.

Cardiac magnetic resonance-based layer-specific strain in immune checkpoint inhibitor-associated myocarditis.

To assess the different imaging characteristics between corticosteroid-sensitive (CS) and corticosteroid-refractory (CR) immune checkpoint inhibitor-associated myocarditis (ICIaM) with cardiac magnetic resonance (CMR) and the potential CMR parameters in the early detection of CR ICIaM. Thirty-five patients diagnosed with ICIaM and 30 age and gender-matched cancer patients without a history of ICI treatment were enrolled. CMR with contrast was performed within 2days of clinical suspicion. Left ventricular ejection fraction (LVEF) and late gadolinium enhancement (LGE) were assessed by CMR. LV sub-endocardial (GLSendo) and sub-epicardial (GLSepi) global longitudinal strains were quantified by offline feature tracking analysis. CS and CR ICIaM were defined based on the trend of Troponin I and clinical course during corticosteroid treatment. All 35 patients presented with non-fulminant symptoms upon initial assessment. Twenty patients (57.14%) were sensitive, and 15 (42.86%) were refractory to corticosteroids. Compared with controls, 22 patients (62.86%) with ICIaM developed LGE. LVEF decreased in CR ICIaM compared with the CS group and controls. GLSendo (-14.61±2.67 vs. -18.50±2.53, P<0.001) and GLSepi (-14.75±2.53 vs. -16.68±2.05, P<0.001) significantly increased in patients with CR ICIaM compared with the CS ICIaM. In patients with CS ICIaM, although GLSepi (-16.68±2.05 vs. -19.31±1.80, P<0.001) was impaired compared with the controls, GLSendo was preserved. There was no difference in CMR parameters between LGE-positive and negative groups. LVEF, GLSendo, and GLSepi were predictors of CR ICIaM. When LVEF, GLSendo, and GLSepi were included in multivariate analysis, only GLSendo remained an independent predictor of CR ICIaM (OR: 2.170, 95% CI: 1.189-3.962, P=0.012). A GLSendo of ≥-17.10% (sensitivity, 86.7%; specificity, 80.0%; AUC, 0.860; P<0.001) could predict CR ICIaM in the ICIaM cohort. Kaplan-Meier analysis showed that in patients with impaired GLSendo of ≥-17.10%, cardiovascular adverse events (CAEs) occurred much earlier than in patients with preserved GLSendo of <-17.10% (Log-rank test P=0.017). CR and CS ICIaM demonstrated different functional and morphological characteristics in different myocardial layers. An impaired GLSendo could be a helpful parameter in early identifying corticosteroid-refractory individuals in the ICIaM population.

ATR-FTIR Spectroscopic Analysis of Novel Fixatives and their Histological Properties On Sheep Heart

Objective: In this study, new fixative solutions that are odorless and non-toxic were tested on the hearts of sheep to preserve the cellular structure and tissue architecture in a life-like manner. Material and Method: The changes of new fixatives before and after contact with tissue were detected for the first time by the ATR-FTIR spectroscopic method. After a preliminary inspection, hearts were fixed with six different solutions. It was periodically evaluated for weight, size, color, and hardness. Samples taken from the left vertical of each heart and stained with Hematoxylin eosin were observed histologically and alterations at the cellular level were evaluated. Results: As a result of the measurements of heart weights, reduction in Solution 1 (Standard Formaldehyde Fixative), Solution 4 and Solution 5 were detected at 5.64%, 23.70% and 14.38%, respectively. In Solution 4 and Solution 5, it was observed that the integrity of the myocardium was protected in terms of morphology, the stiffness was suited for sectioning and the coronary vessels were well preserved according to Solution 1. Further, compared to solution 1, it was determined that the endocardium and myocardium layers were well preserved in the tissues fixed in Solution 4 and Solution 5. Typical transversal streaking appearance in cardiac muscle tissue existed in all three Solution 1, Solution 4 and Solution 5. Conclusion: Solution 4 and Solution 5 were found to have superior fixative properties than Solution 1 (Formaldehyde). As a result of ATR-FTIR studies, it was determined that formaldehyde was converted into toxic formic acid in Standard Solution 1, while very few and harmless changes were detected in Solution 4 and Solution 5.

3D digital polarization-holographic wavelet histology in determining the duration of mechanical damage to the myocardium.

We aimed developing and experimentally validating methods for 3D scale-selective polarimetry of multiply scattered fields in diffuse myocardium layers for mechanical myocardial injury prescription histological differential diagnostics. We used the synthesis of diffuse object field polarization-interference registration and polarization-inhomogeneous field digital holographic reconstruction and layer-by-layer complex amplitudes distributions The method for selection single and diffuse object field multiply scattered components polarization maps is proposed. The conditions for eliminating the distorting influence of a depolarized background high level are found. On the basis of еру object field single scattered component polarization maps a large-scale selective wavelet analysis the criteria (markers) for mechanical myocardial injury different prescription diagnosis was determinate. Excellent accuracy mechanical injury myocardium necrotic changes with different duration using polarization-interference wavelet differentiation were achieved.

RCAN family member 3 deficiency contributes to noncompaction of the ventricular myocardium

Noncompaction of the ventricular myocardium (NVM), the third most diagnosed cardiomyopathy, is characterized by prominent trabeculae and intratrabecular recesses. However, the genetic etiology of 40%–60% of NVM cases remains unknown. Here, we identify two infants with NVM, in a nonconsanguineous family, with a typical clinical presentation of persistent bradycardia since the prenatal period. A homozygous missense variant (R223L) of RCAN family member 3 (RCAN3) is detected in both infants using whole-exome sequencing. In the zebrafish model, marked cardiac dysfunction is detected in rcan3 deficiency (MO-rcan3ATG-injected) and rcan−/− embryos. Developmental dysplasia of both endocardial and myocardial layers is also detected in rcan3-deficient embryos. RCAN3 R223L variant mRNAs can not rescue heart defects caused by rcan3 knockdown or knockout; however, hRCAN3 mRNAs rescue these phenotypes. RNA-seq experiments show that several genes involved in cardiomyopathies are significantly regulated through multiple signaling pathways in the rcan3-knockdown zebrafish model. In human cardiomyocytes, RCAN3 deficiency results in reduced proliferation and increased apoptosis, together with an abnormal mitochondrial ultrastructure. Thus, we suggest that RCAN3 is a susceptibility gene for cardiomyopathies, especially NVM and that the R223L mutation is a potential loss-of-function variant.

Non-compacted myocardium in an adult with acute neurological deficit in the Emergency Department: a case report

Non-Compacted Myocardium (NCM) is an uncommon cardiac condition with a genetic predisposition, often characterized by trabeculae and distinct myocardial layers. This case report discusses a 59-year-old hypertensive, diabetic male with acute neurological symptoms. Diagnosed with an ischemic stroke, subsequent investigations revealed features indicative of NCM. Confirmatory Cardiac Magnetic Resonance Imaging (CMR) and echocardiography were pivotal for diagnosis. The patient received specialized outpatient follow-up, emphasizing the importance of early diagnosis and tailored treatment. This report contributes to the understanding of NCM's diverse clinical presentations and underscores the significance of a multidisciplinary approach for effective patient care.

A fetal rat model of ventricular noncompaction caused by intrauterine hyperglycemia

BackgroundThis study aims to develop a fetal rat model of ventricular noncompaction (NVM) using streptozotocin (STZ)-induced gestational hyperglycemia and compare it with a retinoic acid (RA) model. MethodsFemale SD rats were categorized into STZ, RA, and normal control (NC) groups. The STZ group was given a high-fat diet pre-pregnancy and 35 mg/kg of 2% STZ postpregnancy. The RA group received a 90 mg/kg dose of RA on day 13 postpregnancy. Embryonic myocardial morphology was analyzed through HE staining, and embryonic cardiomyocyte ultrastructures were studied using electron microscopy. Diagnoses of NVM were based on a ratio of noncompact myocardium (N) to compact myocardium (C) >1.4, accompanied by thick myocardial trabeculae and a thin myocardial compaction layer. Kruskal-Wallis test determined N/C ratio differences among groups. ResultsBoth STZ and RA groups displayed significant NVM characteristics. The left ventricular (LV) N/C in the STZ, RA, and NC groups were 1.983 (1.423-3.527), 1.640 (1.197-2.895), and 0.927 (0.806-1.087), respectively, with a statistically significant difference (P<0.001). The right ventricular (RV) N/C in the STZ, RA, and NC groups were 2.097 (1.364-3.081), 1.897 (1.337-2.662), and 0.869 (0.732-1.022), respectively, with a significant difference (P<0.001). Electron microscopy highlighted marked endoplasmic reticulum swelling in embryonic cardiomyocytes from both STZ and RA groups. ConclusionOur model underscores the pivotal role of an adverse intrauterine developmental environment in the onset of NVM. This insight holds significant implications for future studies exploring the pathogenesis of NVM.

A novel DSP zebrafish model reveals training- and drug-induced modulation of arrhythmogenic cardiomyopathy phenotypes

Arrhythmogenic cardiomyopathy (AC) is an inherited disorder characterized by progressive loss of the ventricular myocardium causing life-threatening ventricular arrhythmias, syncope and sudden cardiac death in young and athletes. About 40% of AC cases carry one or more mutations in genes encoding for desmosomal proteins, including Desmoplakin (Dsp). We present here the first stable Dsp knock-out (KO) zebrafish line able to model cardiac alterations and cell signalling dysregulation, characteristic of the AC disease, on which environmental factors and candidate drugs can be tested. Our stable Dsp knock-out (KO) zebrafish line was characterized by cardiac alterations, oedema and bradycardia at larval stages. Histological analysis of mutated adult hearts showed reduced contractile structures and abnormal shape of the ventricle, with thinning of the myocardial layer, vessels dilation and presence of adipocytes within the myocardium. Moreover, TEM analysis revealed “pale”, disorganized and delocalized desmosomes. Intensive physical training protocol caused a global worsening of the cardiac phenotype, accelerating the progression of the disease. Of note, we detected a decrease of Wnt/β-catenin signalling, recently associated with AC pathogenesis, as well as Hippo/YAP-TAZ and TGF-β pathway dysregulation. Pharmacological treatment of mutated larvae with SB216763, a Wnt/β-catenin agonist, rescued pathway expression and cardiac abnormalities, stabilizing the heart rhythm. Overall, our Dsp KO zebrafish line recapitulates many AC features observed in human patients, pointing at zebrafish as a suitable system for in vivo analysis of environmental modulators, such as the physical exercise, and the screening of pathway-targeted drugs, especially related to the Wnt/β-catenin signalling cascade.

Thinning of compact layer and systolic dysfunction in isolated left ventricular non-compaction: A cardiac magnetic resonance study

BackgroundThe Petersen’ index reflects an excess of myocardial trabeculation which is not a specific morpho-functional feature of left ventricular non-compaction (LVNC) cardiomyopathy, but a “phenotypic trait” even observed in association with other myocardial diseases and over-loading conditions. The present study was designed to evaluate the relation between a critical thinning of compact layer and the development of systolic dysfunction and LVNC cardiomyopathy. MethodsWe compared CMR morpho-functional features and measurements of LV wall thickness using a 17 segment model of a cohort of patients fulfilling the Petersen criterion for LVNC with LV systolic dysfunction versus those of a cohort of age- and sex-matched controls with LVNC and preserved LV systolic function. All the study patients had an “isolated” LVNC defined as positive Petersen criterion in the absence of other diseases such as hypertrophic and dilated cardiomyopathy, valvular heart disease, or congenital heart disease and over-loading conditions. Resultshe study population included 33 patients with “isolated” LVNC: 11 consecutive index patients with a reduced LV ejection fraction (LVNCrEF) and 22 controls with a preserved LVEF (LVNCpEF). The compact myocardial layer was thinner in patients with LVNCrEF than in those with LVNCpEF patients, both in mid-ventricular and apical LV segments. On linear regression analysis, there was a linear correlation between median thickness of mid-ventricular free wall segments and left ventricular ejection fraction (r = 0.51, p = 0.005). On the ROC curves analysis, ≥2 segments with a compact myocardial layer <5 mm in the free wall mid-ventricular segments showed the best accuracy for reduced LVEF (100% sensitivity and 60% specificity; AUC 0.81, p < 0.01). The negative predictive value for LV systolic dysfunction of <2 free wall mid ventricular segments <5 mm was 100%. On quantitative analysis, the mass of papillary muscles was lower in patients with LVNCrEF [1.2 (0.8–1.4) versus 1.6 (1.1–1.8) g/mq; p = 0.08]. Conclusions: A thinned compact layer of mid-ventricular segments of the LV free wall was associated with a reduced systolic function and “isolated” LVNC cardiomyopathy.