Background: Heart failure causes great suffering and costs for the society each year. Structured care of patients with heart failure can improve treatment, reduce hospitalization and increase quality of life. Patients with heart failure who are compliant can maintain health and well-being to a greater extent but requires patient education. Aim: The aim of the study was to investigate whether patients with heart failure, at an HF outpatient clinic, have high compliance with recommended self-care actions. The study also investigate statistical differences between sex, education level and marital status amongst participants with high compliance. Method: A quantitative approach was used, where patients´ self-care ability was measured using the European Heart Failure Self-Care Behaviour Scale (EHFScBS). Sixtyfour patients were asked for participation and 46 approved (72%). Result: The result showed low compliance with self-care actions in general. The claims regarding medication and limited fluid-intake showed high compliance. Among the participants with high compliance, four statistical differences (p ≤0.05) were identified regarding gender, marital status and education level. The results are in part consistent with previous research, showing that, despite education strategies, it may be difficult for HF-patients to deal with their own self-care. Conclusion: Based on the fact that patients with HF show low compliance with self-care actions, knowledge about different factors affecting the self-care ability in order to provide optimal care for each individual patient is of importance. EHFScBS used in the study can also be used as a measuring instrument for heart failure in the HF-outpatient clinic. / Bakgrund: Hjärtsvikt orsakar stort lidande och kostar samhället stora belopp varje år. Ett strukturerat omhändertagande av patienter med hjärtsvikt kan förbättra behandling, minska antalet sjukhusinläggningar och ge ökad livskvalitet. Patienter med hjärtsvikt som är följsamma till egenvårdsråd kan i högre grad bibehålla hälsa och välbefinnande. För att uppnå detta krävs patientutbildning. Syfte: Syftet med studien var att undersöka om patienter med hjärtsvikt, vilka regelbundet följs upp på hjärtsviktsmottagning, har hög följsamhet till rekommenderade egenvårdsråd. Studien avsåg också att undersöka om det fanns några statistiska skillnader mellan kön, utbildningsnivå och civilstatus vad gäller hög följsamhet till egenvårdsråd. Metod: En kvantitativ ansats tillämpades där patienternas egenvårdförmåga mättes med Europeiska beteendeskalan för egenvård vid hjärtsvikt (EHFScBS). 64 patienter tillfrågades om deltagande och 46 av dessa valde att delta (72%). Resultat: Resultatet av studien visade låg följsamhet till egenvårdsråd överlag. Endast för påståendena med avseende på medicinering och begränsat vätskeintag påvisades hög följsamhet. Bland de deltagare som hade hög följsamhet påvisades fyra statistiska skillnader (p ≤ 0,05) med avseende på kön, civilstatus och utbildningsnivå. Resultaten överensstämmer till viss del med tidigare forskning som påvisat, att det trots utbildningsstrategier kan vara svårt för hjärtsviktspatienter att sköta sin egenvård. Slutsats: Utifrån att patienter med hjärtsvikt har låg följsamhet till egenvårdsråd är det viktigt att som vårdgivare ha kännedom om olika faktorer som påverkar egenvårdsförmågan för att kunna erbjuda varje enskild patient ett så optimalt omhändertagande som möjligt. Egenvårdsskalan (EHFScBS) som använts i studien kan med fördel användas som ett mätinstrument på hjärtsviktsmottagningar.

Ischemic injury in the heart is followed by an increase in SNS activity and the higher this activity, the poorer patient outcomes. An index of SNS activity in models of ischemia can be achieved by measuring NE, β-AR, and perhaps indirectly PDE4 to give an intracellular aspect on SNS signaling. A 20 minute ischemia-reperfusion was induced in a rat model with physiological measurements at 2-5 weeks post IR. At 3 weeks post IR, rats displayed increased PDE4 expression, decreased β 1-AR expression, increased plasma NE, decreased tissue NE storage, increased Doppler E/A ratio and unchanged LV ejection fraction. PET analysis with FDG revealed no infarct at 2 weeks, while analysis with [13N]NH3 displayed no resting flow defect but revealed trends in flow reserve impairment as early as 2.5 weeks with recovery at 5 weeks post-surgery. Applications of this model could be non-invasive imaging of PDE4 with (R)-[11C]Rolipram PET at early time points for development towards prognostic and therapy guidance in humans.

Background-Pulmonary artery hypertension (PAH) is characterized by progressive vascular changes causing increased pulmonary resistance and eventual right heart failure (HF). It has been suggested that altered myocardial substrate utilization may be associated with right HF, however these changes have not yet been well characterized. The aim of this study was to evaluate in vivo right ventricular (RV) function and RV glucose and fatty acid metabolism in an experimental model of PAH using non-invasive positron emission tomography (PET) imaging and to investigate the effect of a novel endothelin receptor antagonist, Macitentan, on the development of PAH and RV energetics. Methods and Results-Severe PAH was induced in a total of 11 male Sprague-Dawley rats using a single injection of Sugen5416 followed by chronic hypoxia. The rats were then randomized to treatment or no treatment with Macitentan (30 mg/kg daily) Five and eight weeks post injection, substrate utilization was serially assessed with 2-[18F]fluoro-2-deoxyglucose (FDG) and 4-[18F]fluoro-6-thia-heptadecanoate (FTHA) PET scans for glucose and fatty acid metabolism respectively, and reported as a standardized uptake value (SUV). This data was correlated with in vivo functional measurements with echocardiography and multi gated acquisition scans. The Sugen-hypoxia (SuHx) model resulted in an increase in RV FDG uptake over 8 weeks (SUV control: 1.56 ± 0.38, week 5 SuHx: 4.06 ± 1.90, week 8 SuHx: 4.00 ± 1.60, p<0.005 between control and week 5 SuHx). RV FTHA data showed a trend towards increased uptake with onset of PAH at week 5 SuHx (SUV control: 1.50 ± 0.40, week 5 SuHx: 3.06 ± 1.10, p>0.05). Macitentan significantly decreased RV FDG uptake (SUV week 8 SuHx: 4.00 ± 1.60, week 8 SuHx +ERA: 2.54 ± 0.90, p<0.05). This was associated with improved RV ejection fraction (PAH week 8 untreated: 53.15 ± 9.9% vs PAH week 8 treated: 73.22 ± 4.8%, p<0.01) and improved pulmonary artery pressures measured by pulmonary artery acceleration time (PAH week 8 untreated: 17.32 ± 2.30 ms vs. PAH week 8 treated: 24.38 ± 3.90 ms, p<0.001). There was a strong correlation between increased pulmonary artery pressures and increased RV FDG uptake (r=0.87, p=0.001) as well as a significant inverse relationship between improved RV ejection fraction and decreased RV FDG uptake (r=-0.72, p=0.01). Conclusion-PAH is associated with metabolic changes in the RV, characterized by increased glucose uptake and a trend towards increased RV fatty acid uptake with onset of PAH. Macitentan attenuated RV FDG uptake and significantly increased RV function as well as hemodynamics compared to untreated group.

La fonction cardiaque est finement régulée par des hormones de type monoamines qui constituent des régulateurs cruciaux de l’activité cardiaque (chronotropie et inotropie). Ces hormones dérivées d’acides aminés aromatiques comprenant les catécholamines et la sérotonine maintiennent l’activité du myocarde dans un cadre physiologique tout en lui permettant de s’adapter aux contraintes environnementales. Les récepteurs cellulaires des monoamines sont couplés à des voies de signalisation qui impliquent un nucléotide cyclique, l’AMPc, et modulent la contractilité des cardiomyocytes par l’intermédiaire de multiples phosphorylations des protéines régulatrices du cycle du calcium (canal calcique de type L, RyR2 ou phospholamban) par la protéine kinase A AMPc-dépendante. Lorsque les monoamines voient leurs activités dérégulées en contextes pathologiques tels que l’insuffisance cardiaque (IC) ou un lors d'un traitement antidépresseur, elles conduisent à une hyperstimulation de leurs récepteurs spécifiques. Cette dernière altère alors les voies impliquant l’AMPc et les flux calciques engendrant des évènements ectopiques proarythmogéniques nommés post-dépolarisations. Ces dysfonctions de la contractilité cellulaire et de l'homéostasie calcique peuvent être à l’origine d’arythmies tissulaires et de morts subites cardiaques. Les altérations de l’homéostasie calcique subsistent en dépit des approches thérapeutiques actuelles (!-bloquants, inhibiteurs de l’enzyme de conversion de l’angiotensine) qui vise à freiner le remodelage myocardique post-ischémique et constituent donc une cible active de la recherche cardiovasculaire. Les Rycals, stabilisateurs pharmacologiques du RyR2, représentent une nouvelle approche visant à remédier à ces altérations. Au sein de ces travaux de recherche, nous avons axé nos études sur les deux voies monoaminergiques AMPc cardiaques majeures, les voies adrénergiques et sérotoninergiques. Un premier axe d’étude a consisté en l’évaluation des bénéfices potentiels d’un nouveau Rycal, le S44121, sur la survenue d’arythmies cellulaires et tissulaires en comparaison d’un !-bloquant de référence, le métoprolol, dans un contexte d’IC post-infarctus chez le rat. L’étude n’a cependant pas mise en évidence de bénéfices du S44121 mais a confirmé la cardioprotection exercée par le métoprolol. Un deuxième axe d’étude a évalué l’implication potentielle au niveau cardiaque de la protéine S100A10 dans la modulation de la voie du récepteur à la sérotonine de type 4 (5-HT4R) en conditions physiologiques ou en contexte d’IC. Cette étude originale a mis en avant pour la première fois dans le coeur sain un rôle de la S100A10 dans l’apparition d’une voie 5-HT4R proarythmogène lorsque son expression est induite par une neurotrophine (Brain-derived neurotrophic factor) ou un antidépresseur (imipramine). En revanche, le rôle de la S100A10 dans la modulation de la voie 5-HT4R en contexte d’IC n’a pas été déterminé de façon certaine. / Cardiac function is tightly regulated by hormones such as monoamines which are substantial modulators of cardiac activity (chronotropy and inotropy). These hormones, derived from aromatic amino acids, maintain myocardial activity in a physiological range and allow the cardiac adaptation to environmental conditions. The cellular receptors to monoamines are coupled to signaling pathways involving a cyclic nucleotide, cAMP, and modulate cardiac activity by phosphorylating several key proteins of calcium handling (L-type calcium channel, RyR2 or phospholamban) by the cAMP-dependent protein kinase A. Deregulation of monoamines in pathological conditions such as heart failure (HF) or during antidepressanttreatment leads to a hyperstimulation of their specific receptors. It therefore induces alterations of the cAMP signaling pathway and calcium handling leading to the occurrence of proarrhythmogenic ectopic cellular events known as afterdepolarizations. These dysfunctions in cellular contractility and calcium handling may cause tissue arrhythmias andeven sudden cardiac death. Calcium handling alterations leading to cardiac arrhythmias remain a clinically relevant issue despite the current therapeutical approaches (!-blockers, angiotensin-converting-enzyme inhibitors) which slow the post-ischemic myocardial remodeling and thus represent an active target in the cardiovascular research field. Rycals, RyR2 pharmacological stabilisers, are a new approach to prevent these alterations. In this work, we focused on the two major monoaminergic cAMP-dependent pathways in the heart, the adrenergic and serotoninergic pathways. In the first part of this work, we aimed to evaluate the potential benefits of a new Rycal, S44121, on cellular and tissue arrhythmias occurrence in post-myocardial infarction rat model. These effects were compared to those of the well-known !-blocker, metoprolol. This study failed to show any strong benefit of S44121 but confirmed the cardioprotection associated with the metoprolol use. In a second part of the work presented here, we aimed to evaluate the potential involvement of the S100A10 protein in the modulation of the cardiac serotonin receptor 4 pathway (5-HT4R) in physiological conditions or during HF. This original study unraveled for the first time a new role for S100A10 in the healthy heart by revealing a functional 5-HT4R pathway when S100A10 expression is induced by neurotrophins such as brain-derived neurotrophic factor or by antidepressant drugs such as imipramine. However, we failed to conclude on a direct evidence for a role of S100A10 in the modulation of the 5-HT4R pathway in the failingheart.

L'insuffisance cardiaque (IC) est une maladie dont la prévalence est élevée, cette prévalence augmente avec l'âge. La découverte de la maladie se fait le plus souvent lors d'un épisode de décompensation (ou insuffisance) cardiaque aiguë (ICA). L'ICA est très fréquente chez les sujets âgés et est caractérisée par des difficultés diagnostiques quand le patient est admis avec une dyspnée aiguë. L'apport de biomarqueurs plasmatiques tels que le BNP ou le NT-proBNP a été majeur pour le diagnostic de l'ICA. La décompensation cardiaque aiguë est suivie d'un taux de réhospitalisations et d'une mortalité très élevés. Les objectifs de la thèse était 1- de préciser l'épidémiologie de l'ICA en France lors d'un observatoire d'une journée des hospitalisations pour ICA dans 170 hôpitaux français (OFICA), 2- d'identifier la puissance diagnostiques et pronostiques des peptides natriurétiques lors de l'ICA, 3-de définir l'importance des modifications post-transcriptionnelles de ces PNs lors de l'ICA, 4- de rechercher de nouveaux biomarqueurs.La comparaison des propriétés diagnostiques et pronostiques des peptides natriurétiques révèle que les 4 peptides natriurétiques commercialement accessibles (BNP, NT-proBNP, proBNP et MR-proANP) ont des qualités diagnostiques et pronostiques globalement très similaires. Néanmoins, proBNP et BNP semblent meilleurs pour le diagnostic tandis que MR-proANP apparaît meilleur pour son association avec la mortalité à 5 ans.Parmi les modifications post-transcriptionnelles du BNP, nous avons étudié l'impact de la glycosylation du pro-BNP. La O glycosylation en 71 inactive proBNP, qui est libéré hors de la cellule sans action préalable des enzymes de « cleavage » la corine ou la furine. En revanche, le proBNP non-glycosylé est scindé en BNP et NT-proBNP par la corine ou la furine. Nous avons pu montrer que la non-glycosylation du proBNP et l'activation de la furine étaient deux mécanismes très importants d'accélération de la production de peptides natriurétiques lors de l'ICA. On a pu également montrer que la production du NT-proBNP était beaucoup plus liée au niveau glycosylation du proBNP que ne l'est la production de BNP. Ainsi, nos résultats suggèrent fortement d'utiliser le NT-proBNP pour toute étude future souhaitant explorer le concept de « biomarker-guided therapy » dans l'ICA.Pour la recherche de nouveaux biomarqueurs, nous avons exploré 1-la concentration plasmatique de 5 microRNAs (miR-l/-21/-23/-126/-423-5p), chez des patients avec dyspnée aiguë. Aucun de ces miR n'a de valeur diagnostique, en revanche, le miR-423-5p apparaît être un marqueur pronostique de réhospitalisation à un an ; 2-les conséquences de la congestion cardiaque sur le foie. Les marqueurs hépatiques étudiés étaient la phosphatase alcaline et les transaminases : les marqueurs de la cholestase étaient associés à une congestion hépatique tandis que ceux de la nécrose cellulaires (transaminases) étaient liés à l'hypotension artérielle et au bas débit cardiaque. L'augmentation des transaminases a été associée à divers critères dont une surmortalité à court terme / Heart failure (HF) is highly prevalent disease, and prevalence increases with age. HF is generally discovered on presentation of an acute episode of decompensation (or insufficiency). Acute decompensated heart failure (ADHF) is very frequent in elderly subjects and is difficult to diagnose when the patient is admitted with acute dyspnoea. The advent of plasma biomarkers, such as BNP or NT-proBNP represents a major advancement in the diagnostic of ADHF. ADHF leads to high rates of re-admission and mortality. The objectives of this doctoral thesis were: (1) to describe the epidemiology of ADHF in France in a one-day observational study of admissions for ADHF in 170 French hospitals; (2) to evaluate the prognostic and diagnostic value of natriuretic peptides (NPs) in ADHF; (3) to describe the extent of post-transcriptional modifications in these NPs in ADHF; and (4) to search for new biomarkers.The comparison of the prognostic and diagnostic properties of NPs showed that the 4 commercially available NPs (namely BNP, NT-proBNP, proBNP and MR-proANP) overall have very similar prognostic and diagnostic abilities. However, proBNP and BNP seem to be more useful for diagnosis, while MR-proANP appears to be better for the association with 5-year mortality.Amongthe post-transcriptional modifications of BNP, we studied the impact of glycosylation of pro¬BNP. Threonin 71 0-glycosylation prevents cleavage of proBNP into BNP and NT-proBNP, resulting in the release of proBNP from the cell without being cleaved. Conversely, non-glycosylated proBNP is cleaved into BNP and NT-proBNP by corin or furin. We showed that non-glycosylation of proBNP and activation of furin are two important mechanisms in the acceleration of production of NPs during ADHF. We also showed that production of NT-proBNP was more closely linked to the rate of glycosylation of proBNP than to the production of BNP. Thus, our results strongly suggest that NT-proBNP should be used in future studies exploring the concept of "biomarker-guided therapy" in ADHF.To investigate new biomarkers, we explored plasma concentrations of 5 microRNAs (miR-l/-21/-23/-126/-423-5p), in patients with acute dyspnoea. None of these microRNAs were shown to have any diagnostic value. Conversely, miR-423-5p appears to be a prognostic marker for re-admission at 1 year. Secondly, we investigated the consequences of cardiac congestion on the liver. The hepatic markers studied were alkaline phosphatise and transaminases. Markers of cholestasis were associated with hepatic congestive while markers of cellular necrosis (transaminases) were related to arterial hypertension and low cardiac output. An increase in transaminases was associated with various criteria of excess mortality in the short term

No description available.

Hydrogen sulfide (H2S) is a gasotransmitter that has shown cardioprotective effects in the setting of myocardial injury such as acute myocardial infarction (MI) and pressure overload-induced heart failure. However, there are shortcomings in precision and control release from the use of traditional formulations of H2S in the form of inorganic salts. In this thesis, we sought to determine if the novel, orally active, slow-releasing H2S-compound SG1002 plays a role in attenuating MI-induced left ventricular (LV) dysfunction and adverse remodeling. We also evaluated the effect of SG1002 on changes in ECG parameters such as QT interval, in addition to 28-day survival post MI. SG1002 protects against ischemic cardiomyopathy in mice by mitigating LV dysfunction as measured by echocardiography and decreasing LV scar size as measured by histopathological methods. The improvement in survival might be due to the reduction in QT interval prolongation hence lessening the likelihood of forming lethal arrhythmias post MI. Western blot analyses of SG1002 treated mice showed restoration of VEGF levels indicating a pivotal role played by pro-angiogenic signaling in the improvement of cardiac function and attenuation of adverse remodeling. We propose that SG1002 can be a promising pharmacotherapeutic means for the treatment of ischemic heart failure.

Outre son role majeur dans la resistance cellulaire au stress oxydant, le tripeptide glutathion (L-ƒÁ glutamyl- cysteinyl-glycine) est essentiel a la survie cellulaire. Un deficit en glutathion, associe a un stress oxydant, est un trait commun a plusieurs maladies chroniques inflammatoires et degeneratives. Dans le cadre de ces differentes pathologies, plusieurs etudes ont montre que la prise orale de N-acetylcysteine (NAC), un precurseur de glutathion, ameliorait l'etat des patients. Le stress oxydant et l'inflammation sont deux caracteristiques principales de l'insuffisance cardiaque et des dystrophies musculaires. Nous avons pose l'hypothese d'un deficit en glutathion dans ces maladies et les benefices possibles d'un traitement par le NAC. Dans le modele du rat developpant une insuffisance cardiaque post-infarctus, nous montrons qu'il existe un deficit en glutathion tissulaire. Un mois de traitement oral par le NAC, donne en curatif post-infarctus, restaure le taux de glutathion cardiaque, reduit le stress oxydant, et interrompt le cycle vicieux inflammation/mort cellulaire, TNF/TNF-R1/NSMase/ caspase-3/apoptose. Un deficit en glutathion systemique et tissulaire caracterise aussi les souris LmnaH222P/H222P de 6-7 mois developpant une cardiomyopathie dilatee, modele de la cardiomyopathie associee a la dystrophie musculaire dfEmery Dreifuss. Un mois de traitement oral par le NAC reduit chez les souris de 7 mois la dilatation ventriculaire gauche et la dysfonction contractile, limite la progression de la fibrose cardiaque et lfinflammation. Ceci est associe a une repletion en glutathion et une normalisation de l'expression des enzymes du metabolisme du glutathion, a une diminution du stress oxydant et de l'expression du TNF. Une premiere etude chez les patients de chirurgie cardiaque (n=91) nous a permis de mettre en evidence que : d'une part, il existait un deficit en glutathion auriculaire chez les patients de la classe NYHA IV compares aux patients de la classe NYHA I. D'autre part, les patients asymptomatiques (classe NYHA I) presentaient un deficit en glutathion sanguin, compares aux individus sains, aggrave chez les patients symptomatiques (classes NYHA II a IV). Le deficit en glutathion sanguin chez les patients asymptomatiques precede lfelevation du taux sanguin de TNFR1, un marqueur standard du degre de severite de l'insuffisance cardiaque. Une seconde etude, chez des patients porteurs dfune mutation de la lamine (n=28) et susceptibles de developper une cardiomyopathie dilatee d'Emery Dreifuss, montre que certains de ces patients presentent un deficit en glutathion sanguin, associe chez un seul de ces patients a un taux eleve de TNFR1. L'analyse comparee des donnees biochimiques et cliniques est en cours. Les souris DMDmdx4cv sont un modele experimental de la dystrophie musculaire de Duchenne (DMD), mais ne developpent que tardivement la maladie cardiaque. Nous observons une augmentation du taux du glutathion systemique chez les souris de plus de 10 semaines. Un traitement oral avec un inhibiteur de synthese du glutathion a faible dose, le Lbuthionine sulfoximine (5 mM BSO), ramene le taux de glutathion systemique chez la souris DMDmdx4cv au taux chez la souris sauvage, mais provoque des alterations des cardiomyocytes identifiees par immunohistochimie, des micronecroses, des anomalies de capillaires et des anomalies mitochondriales observees en microscopie electronique. En conclusion, le deficit en glutathion est un evenement precoce et durable au cours de l'insuffisance cardiaque, d'origine ischemique ou genetique. Les perspectives offertes par ces resultats sont: 1) le test du glutathion sanguin pour le depistage de sujets asymptomatiques a risque; 2) l'indication de NAC aux patients cardiaques, en complement du traitement courant / The tripeptide glutathione (L-? -glutamyl-cysteinyl-glycine) does not only play a major in cellular resistance to oxidative stress, but is also essential to cell survival. A deficit in glutathione, associated with oxidative stress, is a common hallmark of several chronic inflammatory and neurodegenerative diseases. In different examples, several studies reported that oral treatment with N-acetylcysteine (NAC), a glutathione precursor, improved patient status. Oxidative stress and inflammation are two main characteristics of heart failure (HF) and muscular dystrophy. We hypothesized that glutathione deficiency occurred in these diseases and that treatment with NAC might be beneficial. In post-myocardial infarction (MI) rats, with established chronic HF, we show that cardiac tissue is depleted in glutathione. Curative 1-month oral NAC treatment replenishes cardiac tissue glutathione, reduces oxidative stress and disrupts the vicious inflammation/cell death, TNF/TNF-R1/N-SMase/ caspase-3/ apoptosis cycle. Deficit in serum and cardiac glutathione also characterize 6- to 7-month old LmnaH222P/H222P mice with dilated cardiomyopathy (DCM), a model of the cardiomyopathy associated with Emery Dreifuss muscular dystrophy (EDMD), One-month oral NAC treatment reduces left ventricular dilation and contractile dysfunction, limits the progression of cardiac fibrosis and inflammation in 7-month old LmnaH222P/H222P mice. This is associated with glutathione repletion and normalization of glutathione metabolism enzymes, and reduction of oxidative stress and TNF expression. In a first study in cardiac surgery patients (n=91) we show that: on the one hand, atrial glutathione is depleted in patients of NYHA class IV compared with asymptomatic patients of NYHA class I. On the other hand, asymptomatic patients of NYHA class display a deficiency in blood glutathione compared with healthy controls that worsens in asymptomatic patients of NYHA class II-IV. Blood glutathione deficiency in asymptomatic patients precedes elevation of blood TNFR1, a standard marker of HF severity. A second study, in patients with lamin mutation (n=28), prone to develop an Emery Dreifuss DCM, shows that a number of patients display blood glutathione deficiency, with one patient having a high blood TNFR1 level. Analysis of clinical data is underway. DMDmdx4cv mice are an experimental model of Duchenne muscular dystrophy. We observe an increase in blood glutathione in 10-week-old mice and older. Oral treatment with a low dose of L-buthionine sulfoximine (5 mM BSO), an inhibitor of glutathione synthesis, resumes blood glutathione in DMDmdx4cv mice to the control value in WT mice, but produces alterations in cardiomyocytes identified by immunohistochemistry and micronecrosis, capillary and mitochondrial abnormalities observed by electronic microscopy. In conclusion, glutathione deficiency is an early and lasting event in ischemic or genetically-linked HF. These results pave the way for two possible applications: 1) blood glutathione test for the screening of asymptomatic individuals at risk for HF; 2) NAC indication to cardiac patients in addition to current treatment

The atrioventricular junction (AVJ) is a complex anatomical structure. It has an important role in maintaining synchronised atrioventricular conduction and protects from ventricular tachycardia, as well as bradycardia. Its embryological development and function is under tight transcription factor control. Heart failure is a chronic systemic condition, affecting one million people in the UK alone. Slowing of atrioventricular conduction in heart failure is associated with increased morbidity and mortality. The molecular and anatomical basis of abnormal atrioventricular conduction was studied in a rabbit model of heart failure due to aortic insufficiency and abdominal aortic constriction. The PR interval was significantly prolonged in heart failure animals. Using laser-assisted microdissection, the tiny tissues of the AVJ were collected for RT-PCR analysis. HCN1, Cav1.3, Cx40 and Cx43 transcripts were significantly downregulated by heart failure, with a compensatory increase in CLCN2, Nav1.1, Navβ1, SUR2A and PAK1. Immunolabelling for Cx43 showed reduction in protein level and longitudinal dissociation not only in the inferior nodal extension but also in the His bundle in heart failure animals. Anatomical studies of the AVJ have previously been limited by its small size and inaccessible location. Contrast-enhanced micro-CT scanning allowed non-destructive imaging of the AVJ anatomy. AVJ length and volume were increased in the rabbit model of heart failure, which is expected to contribute to atrioventricular conduction abnormalities. Micro-CT additionally resolved the anatomy of the canine AVJ and atria, including fibre orientation in the pulmonary vein sleeves and Bachmann’s bundle. The physiological effects of loss of T-box transcription factor 5 (Tbx5) in the AVJ were studied in a transgenic inducible Tbx5 knockout mouse model using optical mapping. Tbx5-deficient mice had a prolonged PR interval in vivo and a higher incidence of atrioventricular block and ventricular conduction abnormalities in Langendorff-perfused hearts.

Heart Failure is a common long term progressive and serious medical condition with high mortality and costly health services in the UK. By the year of 2010, there were around 90,000 people in the UK suffered from heart failure and in 2008, 10,000 heart failure patients were recorded death. Treatments of heart failure cost the National Health Service around £625 million every year. Although heart failure is highly pro-arrhythmic, the underlying mechanisms of the pro-arrhythmic effects of heart failure are not completely understood. Heart failure is associated with electrical remodelling of the properties and kinetics of some ionic channels responsible for the action potential of cardiac cells. However, it is still unclear whether this ionic channel remodelling can account for the pro-arrhythmic effects of heart failure as the complexity of the heart impedes a detailed experimental analysis. Biophysically detailed computational models have been developed in the last two decades, enabling the evaluation of experimental data. The aim of this thesis is to use arrhythmic mechanisms to investigate the pro-arrhythmic effects of heart failure-induced remodelling on the cardiac action potentials and Purkinje-ventricular junction. Single canine Purkinje fibre and ventricular cell models were developed to investigate the effects of heart failure-remodelled ionic channel currents on cell action potentials and identify optimal options for the potential clinical treatments. One-dimensional strand tissue model and three-dimensional wedge model were developed to further explore the effects of heart failure-induced remodelling in propagation of the canine Purkinje fibre, ventricle and Purkinje-ventricular junction. It was found that heart failure-induced remodelling on the Purkinje fibre and ventricle reduced the conduction safety and increased tissue’s vulnerability to the genesis of the unidirectional conduction block, especially at the Purkinje-ventricular junction, which may cause conduction failure, re-entry or both.