Cardiovascular diseases account for one third of all deaths worldwide, more than 33% of which are related to ischemic heart disease, including myocardial infarction (MI). This thesis seeks to provide insight and understanding of mechanisms during different stages of MI by utilizing finite element (FE) modelling. Three-dimensional biventricular rat heart geometries were developed from cardiac magnetic resonance images of a healthy heart and a heart with left ventricular (LV) infarction two weeks and four weeks after infarct induction. From these geometries, FE models were established. To represent the myocardium, a structure-based constitutive model and a rule-based myofibre distribution were developed to simulate both passive mechanics and active contraction.

Introduction: The presence of melatonin in wine contributes to the cardioprotective effect of regular and moderate consumption of wine against lethal ischemia/reperfusion injury. Recently, the presence of melatonin isomers has been identified in red wine, but whether or not these isomers confer any physiological properties is unknown. Aim: The aim of our study was to establish a cell culture model of simulated ischemia to study and compare the possible cytoprotective effects of dietary melatonin and a melatonin isomer against an ischemic insult and to explore the possible role of melatonin receptors in this effect. Methods: H9C2 cardiac fibroblast cells were subjected to simulated ischemia by exposure to 1mM H₂O₂ following a 30min pre-treatment with 75ng/L (dietary concentration), 1μM (pharmacological concentration, 0.232mg/L) melatonin or/and 75mg/L (dietary concentration) melatonin isomer. To determine the role of melatonin receptors, cells were pre-treated with the melatonin receptor inhibitor, luzindole (10 μM) for 1h prior to H₂O₂ treatment. At the end of the simulated ischemic insult, cell viability was assessed using trypan blue staining. Mitochondrial respiration in permeabilized H9C2 cells was measured using the Oroboros Instrument, at two different time points: at the end of a 30min pre-treatment with either 75ng/L melatonin or 75mg/L melatonin isomer, or the afore mentioned pre-treatments prior to a 15min treatment of 1mM H₂O₂. Results: A simulated ischemic insult with 1mM H₂O₂ reduced cell viability from 92.9±1.5% to 28.4±1.4% (p<0.001 vs control). Pre-treatment with the dietary concentrations of melatonin or the melatonin isomer improved the cell viability to a similar extent as a pre-treatment with the pharmacological concentration of melatonin (74.4±3.1%, 73.9±2.7% and 69.0±1.2%, p<0.001 vs H₂O₂ and p<0.01 vs H₂O₂ respectively). A combined pre-treatment of melatonin and the melatonin isomer did not add further cytoprotective benefit. Addition of luzindole fully abolished the cytoprotective effect of dietary melatonin (29.7±2.4%, p<0.001 vs H₂O₂ + Mel), but only partially abolished the cytoprotective effect of the melatonin isomer (41.4±3.6%). Both dietary concentrations of melatonin and the melatonin isomer did not affect mitochondrial respiration in permeabilized H9C2 cells. Conclusion: Our findings suggest that both dietary melatonin and the melatonin isomer confer cytoprotection against a simulated ischemic insult, an effect which is mediated, at least in part, via the activation of melatonin receptors. Both melatonin and melatonin isomers present the advantage to be potentially safe and inexpensive therapies against ischemic heart disease.

Includes bibliographical references.

Sumaary in English. / Includes bibliographical references. / Background: Due to the geographic distance between abattoirs and commercial valve plants delays between harvest and fixation usually range from 48 to 72 hours. In order to assess the pre-fixation tissue damage arising from the hypoxic period and the resulting calcific degeneration after implantation, we used an ultrastructural damage score and transmission electron microscopy. Materials and Methods: In a step by step manner, three major issues were clarified: 1) The degree of pre-fixation tissue damage was determined in the four most widely used commercially produced tissue heart valves. Since stentless bioprostheses represent the latest promising trend in the development of biological heart valves, stentless models of the following makes were compared: Baxter, Medtronic, St. Jude and Biocor. Due to the fact that the aortic wall component of these valves proved most resistant to all anticalcification treatments, aortic wall tissue stood in the centre of our analyses. 2) Subsequently, three main determinants of the fixation process namely: delay, temperature and fixative-concentration were varied with the goal of significantly improving the ultrastructural preservation of the bioprosthetic tissue. 3) Eventually, the influence of improved ultrastructural preservation on calcific degeneration was evaluated under in vivo conditions in the non-human primate and the rat model. Results: The comparison of the four most commonly used stentless bioprosthetic heart valves revealed a disturbing degree of tissue damage in all valves. Using a damage score from 1 to 21 (21 being the worst), aortic wall tissue of commercial valves ranged from 10 to 18 and that of leaflet tissue from 12 to 20. When fixation conditions were permutated, tissue damage could almost be abolished by immediate fixation (within 30 minutes of slaughter), low-temperature fixation(4°C) and high glutaraldehyde concentrations (> 1 %). Our in vivo experiments confirmed that commercially used fixation (delayed fixation, room-temperature and I ow concentrations of glutaraldehyde) with its concomitant high degree of tissue damage results in high levels of calcification. Apart from a distinctly improved calcification potential in ultrastructurally well preserved tissue, there was also an inverse correlation between tissue calcification and the concentration of glutaraldehyde used for fixation. Conclusion: We could demonstrate that commercially produced bioprosthetic heart valves uniformly show badly damaged tissue and that tissue damage contributes to the calcific degeneration of these valves. We were also able to determine ideal fixation conditions which in turn significantly reduced tissue calcification.

Cardiovascular disease is currently the foremost cause of death within the United States. Heart failure (HF) is a syndrome defined by the inability of the heart to adequately execute requisite pump function in order to deliver nutrients and oxygen to peripheral tissues, irrespective of etiology. One of the most common causes of HF is chronic pressure overload due to hypertension. Ischemic heart disease is also a common driver of HF, often in conjunction with hypertension. Pressure overload initially causes compensatory metabolic changes. Structural changes follow shortly thereafter typically resulting in left ventricular hypertrophy. Eventually, the heart loses the ability to compensate for the aberrant hemodynamic load and begins failing. The failing heart is unable to supply adequate adenosine triphosphate (ATP) for contractile function as evidenced by falling phosphocreatine (PCr) levels. This energy deficit occurs concurrently with a metabolic re-programming that results in a fuel utilization pattern resembling the fetal heart. Notably, enzymes involved in catabolism of fatty acids, the chief fuel substrate for ATP generation in the normal adult heart, are downregulated in the failing heart. However, the extent to which alternative fuels compensate for decreased fatty acid oxidation (FAO) is not well-known. Furthermore, consequences of the fuel substrate switches that occur in heart failure are not well established. In this work, we discover a new paradigm for alternate fuel utilization in the failing heart and define consequences of altered fuel metabolism in HF. We discovered a post-translational modification resultant from an accumulation of acetyl groups (C2) present in a mouse model of early-stage HF and human HF. Mitochondrial proteins were found to be hyperacetylated in the failing heart, and at least some of these alterations result in diminished electron-transport chain (ETC) capacity as shown by mutagenesis studies on succinate dehydrogenase A (SDHA). We also found an accumulation of C4-OH carnitine, a by-product of ketone oxidation in HF. This metabolite aggregation occurred alongside an increase in b-hydroxybutyrate dehydrogenase 1 (BDH1) transcript and protein levels. This signature suggested that the failing heart shifted to ketone bodies as a fuel. Subsequent experiments confirmed increased capacity for myocardial ketone oxidation in compensated cardiac hypertrophy and in HF. The consequences of increased ketone oxidation were then assessed using a cardiac-specific BDH1 knockout (BDH1 KO) mouse. Despite not having any apparent defect at baseline, we found BDH1 KO mouse hearts are completely unable to oxidize 3-hydroxybutyrate. The deficit for ketone oxidation capacity became consequential upon subjugation to transverse aortic constriction with a small apical myocardial infarction (TAC/MI). The BDH1 KO mice exhibit altered pathological cardiac remodeling compared to wild-type controls. These latter data suggest the increased reliance on ketone oxidation in HF, mediated by BDH1, is an adaptive response. Together the results of these studies provide important information regarding the consequences of altered fuel metabolism in HF. Recent reports of reduced HF mortality and elevated circulating ketone levels in patients prescribed Empagliflozin make cardiac ketone metabolism research in this dissertation particularly apropos.

Cardiovascular disease remains one of the most prevalent diseases in the United States and has remained as the leading cause of death. Large Mendelian randomization studies have found significant correlations between high blood pressure and cardiovascular disease (CVD). In fact, high blood pressure is the single most important independent risk factor for CVD. The purpose of this study was to determine the effect of L-citrulline on blood pressure to determine whether it could be advised as an effective treatment for high blood pressure. L-citrulline is a naturally occurring amino acid that readily converts to L-arginine within the human body. L-arginine has shown promise in decreasing both systolic blood pressure (SBP) and diastolic blood pressure (DBP) significantly by potently increasing levels of nitric oxide (NO) in the body. L-arginine, however, displays poor oral bioavailability compared to L-citrulline. Thus, L-citrulline may be a more effective method in raising plasma arginine levels, increasing NO, and decreasing SBP and DBP. A thorough systematic review and meta-analysis was conducted to extrapolate this effect. Using online databases, hundreds of articles were screened, and ultimately 11 studies were chosen, encompassing 224 total participants. Results showed an overall significant effect of L-citrulline on both resting SBP (MD: -3.74; 95% CI [-6.74, -0.74]; p=0.01) and DBP (MD: -2.00; 95% CI [-3.93, -0.06]; p=0.04). Further analysis of funnel plots was used to determine publication biases and subgroup analysis was performed to determine specific trial moderators that could have affected the overall outcome. In most cases, L-citrulline displayed a significant effect on blood pressure, and more research is warranted to investigate its potential therapeutic effect on cardiovascular health.

Determina los efectos de la rehabilitación cardiaca en la presión arterial, frecuencia cardiaca y VO2 máx. en pacientes del Centro Médico Cirujano Mayor Santiago Távara en el año 2016. Realiza un estudio de enfoque cuantitativo, tipo descriptivo y retrospectivo que incluyo a 15 pacientes que cumplen con los criterios de inclusión y exclusión que asistieron a un programa de rehabilitación cardiaca. Para la recolección de datos utilizó las fichas de datos de los pacientes del programa de rehabilitación cardiaca. Se evidencian los efectos de la rehabilitación cardiaca sobre la frecuencia cardiaca a mediano plazo (disminuyo 2,4 lpm en 16 semanas), la frecuencia cardíaca a corto plazo (aumento en 4 lpm en referencia a las medidas de reposo con las de post ejercicio), la presión arterial a mediano plazo (disminuyo 3,71 mmHg en 16 semanas), presión arterial a corto plazo (disminuyo en 1,78 mmHg en referencia a las medidas de reposo con las de post ejercicio) y VO2 máx. a mediano plazo (aumento 6,49 ml/kg/min en 16 semanas). Concluye que la rehabilitación cardiaca logró disminuir las frecuencias cardíacas a mediano plazo y la presión arterial a mediano plazo y corto plazo; aumento la frecuencia cardiaca a corto plazo y el VO2 máx. a mediano plazo. / Tesis

Thesis (Ph. D.)--School of Electrical and Computer Engineering, Georgia Institute of Technology, 2004. Directed by Paul J. Benkeser. / Vita. Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1998. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 51-63).

Thesis (M.S.)--University of Michigan, 1998. / Includes bibliographical references (leaves 51-63).