This thesis is focused on the analysis of experimental ECG records drawn up in isolated rabbit hearts and aims to describe changes in EKG caused by ischemia and left ventricular hypertrophy. It consists of a theoretical analysis of the problems in the evaluation of ECG during ischemia and hypertrophy, and describes an experimental ECG recording. Theoretical part is followed by a practical section which describes the method for calculating morphological parameters, followed by ROC analysis to evaluate their suitability for the classification of hypertrophy and at the end is focused on classification.

Les propriétés antioxydantes du resvératrol sont d’un grand intérêt pour contrer la dysfonction endothéliale où la contribution du stress oxydant est majeure. Cette dysfonction endothéliale est d’ailleurs bien caractérisée en hypertrophie ventriculaire gauche (HVG). Cette étude vise à explorer les effets thérapeutiques du resvératrol sur la dysfonction endothéliale des artères coronaires épicardiques associée à l’HVG. L’HVG est induite suite à un cerclage aortique (CA) sur des porcelets de 2 mois. Le resvératrol est ensuite administré à 20 mg/kg/jour per os aux animaux répertoriés dans différents groupes. Le groupe 1 comprend les animaux contrôles sans CA alors que le groupe 2 représente les porcelets ayant subit le CA sans traitement. Le groupe 3 comprend les animaux traités pendant les 60 jours après la chirurgie alors que le groupe 4 est traité seulement à partir du 30ème jour jusqu’au jour 60. Des analyses échocardiographiques et histologiques ont été effectuées afin de déterminer le degré d’hypertrophie et l’impact du resvératrol sur la progression de l’HVG alors que la réactivité vasculaire a été évaluée par des expériences de chambres d’organes. La dysfonction endothéliale a été étudiée in vitro par quantification des métabolites nitriques et des niveaux de GMPc tandis que le stress oxydant est décrit par les niveaux d’angiotensine II (Ang II) et de protéines carbonylées. Les courbes dose-réponse à la sérotonine du groupe 3 traité pendant les 60 jours au resvératrol ont démontré une relaxation vasculaire significativement améliorée comparé au groupe 2 non-traité (p<0,05). Le pourcentage de changement du rapport de la masse du ventricule gauche sur la masse corporelle (LVmass/BW) a démontré une inhibition du développement de l’HVG dans le groupe 3 alors que le groupe 4 n’a pas eu d’effets bénéfiques des 30 jours de traitement au resvératrol. La biodisponibilité du NO représentée par la mesure de ses métabolites en circulation (398,71±21,74 ; 151,04±14,95 ; 241,86±15,53 ; 208,17±26,52 uM pour les groupes 1, 2, 3 et 4 respectivement, p<0,001 pour groupe 1 et 3 vs groupe 2) et par le niveau de GMPc a été augmentée avec l’administration du polyphénol (2,54±0,63 ; 0,67±0,45 ; 1,71±0,25 ; 1,98±0,29 pmol/ml pour les groupes 1, 2, 3 et 4 respectivement, p<0,05 pour groupe 1, 3 et 4 vs groupe 2). Le rôle antioxydant du resvératrol a été confirmé avec une réduction des niveaux de protéines carbonylées chez le groupe 3 comparé aux valeurs du groupe 2 (0,14±0,05 vs 0,33±0,03 nmol/mg respectivement) sans diminution des niveaux d’Ang II. Le resvératrol a aussi réduit l’hypertrophie des cardiomyocytes et la fibrose interstitielle. Ainsi, le resvératrol peut effectivement réduire la dysfonction endothéliale des artères coronaires épicardiques et limiter l’occurrence de remodelage myocardique associé à l’HVG, principalement à travers l’activation de la signalisation dépendante du NO. / Antioxidant properties of resveratrol are of great interest regarding endothelial dysfunction in which oxidative stress has a major causative role. This dysfunction is well characterized in left ventricular hypertrophy (LVH). The current study was designed to explore the effects of resveratrol as a treatment for the coronary endothelial dysfunction associated with LVH. An aortic banding (AB) was performed on swine to induce LVH on two-month-old swine for 60 days. Resveratrol was administered at 20 mg/kg/d per os to different groups. Group 1 represented healthy controls while group 2 was not treated. After AB, group 3 received resveratrol from day 1 to 60 post-surgery whereas group 4 was treated from day 30 to 60 only. Echocardiographic and histological studies were performed to evaluate the degree of LVH. Vascular reactivity of epicardial coronary arteries was assessed in organ chamber experiments. Endothelial dysfunction was evaluated in vitro by nitric oxide (NO) metabolites and cyclic guanosine-3,5-monophosphate (cGMP) while angiotensin II (Ang II) levels and protein carbonylation evaluated Oxidative stress. After treatment, the LVmass/body weight ratio was improved in group 3 associated with reduced cardiomyocyte hypertrophy and interstitial fibrosis (p<0.05). Dose-response curves to serotonin for the resveratrol treated group 3 demonstrated a greater vascular relaxation compared to LVH untreated group 2 (p<0.05). Bioavailability of NO measured by its circulating metabolites (398,71±21,74; 151,04±14,95 ; 241,86±15,53 ; 208,17±26,52 uM for groups 1, 2, 3 and 4 respectively, p<0,001 for groups 1 and 3 vs group 2) and by vascular cGMP (2,54±0,63 ; 0,67±0,45 ; 1,71±0,25 ; 1,98±0,29 pmol/ml for groups 1, 2, 3 and 4 respectively, p<0,05 for group 1,3 and 4 vs group 2) was increased. The antioxidant effect of the polyphenol was confirmed by decreased protein carbonylation with the 60 days treatment (0,14±0,05 vs 0,33±0,03 nmol/mg for group 3 vs 2) associated to unchanged Ang II levels. Therefore, resveratrol effectively reduces epicardial coronary endothelial dysfunction and limits the occurrence of cardiac remodelling associated with LVH, mainly through an NO-dependent pathway.

Abstract The β1-adrenergic receptor (β1AR) belongs to the large family of G protein-coupled receptors. It is activated by epinephrine and norepinephrine and thus has a central role in mediating the effects of the sympathetic nervous system. β1AR is the predominant adrenergic receptor in the heart, where it mediates positive inotropy and chronotropy. Thus, it is the most important target receptor for β-adrenergic antagonists, which are widely used in the treatment of cardiovascular diseases. Furthermore, β1AR is also expressed in the brain, where it has a crucial role in regulating memory formation and synaptic plasticity. Human β1AR (hβ1AR) has two polymorphisms, one at each terminus. The carboxyl-terminal (C-terminal) Arg389Gly8.56 polymorphism has previously been shown to have functional significance. Despite the clinical importance of hβ1AR, its biosynthetic profile and post-translational processing have not been well characterized to date. The aims of the present study were to shed light on these events, focusing on the limited proteolysis of hβ1AR and the impact of β-adrenergic ligands on receptor processing. In addition, the C-terminal polymorphism and its associations with certain parameters were investigated in a population consisting of survivors of acute myocardial infarction (AMI). By using a heterologous expression system, hβ1AR biosynthesis was revealed to be efficient and rapid. The N-terminus of the mature receptor was modified with O-glycans and one N-glycan, but despite these modifications it was subject to cleavage at the cell surface that resulted in two C-terminal fragments. The cleavage was mediated by a metalloproteinase, and importantly, it also occurred in vivo. Moreover, receptor activation enhanced the cleavage, which suggests that it represents a novel regulatory mechanism of hβ1AR. Interestingly, those ligands that enhanced the cleavage stabilized intracellular hβ1AR precursors, possibly via a pharmacological chaperone activity. Thus, the present study demonstrates that β-adrenergic ligands can have different regulatory effects on distinct hβ1AR forms. Among the AMI survivors, the Arg3898.56 homozygotes had significantly increased left ventricular mass indexes, when compared to the Gly3898.56 carriers, which suggests an association between Arg3898.56 and left ventricular hypertrophy (LVH). When euglycemic and diabetic patients were analyzed separately, the association existed among the euglycemic patients but was not present in diabetic patients. Diabetes is one of several risk factors that have previously been shown to influence the progression of LVH. Here, diabetes was shown to have a stronger effect on the development of LVH, when compared with the Arg3898.56 variant of hβ1AR. / Tiivistelmä β1-adrenerginen reseptori (β1AR) kuuluu laajaan G-proteiineihin kytkettyjen reseptorien perheeseen. β1AR on tärkeässä asemassa sympaattisen hermoston toiminnassa. Sydämessä β1AR on vallitseva adrenerginen reseptori, ja sydänlihaksen supistusvireys sekä -taajuus voimistuvat β1AR:n aktivaation kautta. Siten se edustaa sydän- ja verisuonisairauksissa käytettävien β-salpaajien tärkeintä kohdereseptoria. β1AR:n luontaisia agonisteja ovat lisämunuaisytimestä ja hermopäätteistä vapautuvat adrenaliini ja noradrenaliini. Sydänlihaksen lisäksi β1AR:a ilmennetään myös aivoissa, jossa reseptorilla on keskeinen asema muistin ja synaptisen muovautuvuuden kannalta. Ihmisen β1AR (hβ1AR) sisältää kaksi polymorfismia, joista toinen (Arg389Gly8.56) sijaitsee reseptorin karboksyyli- (C-) terminaalissa solulimassa. Tällä polymorfismilla on havaittu olevan toiminnallista merkitystä. Vaikka hβ1AR:n kliininen merkitys on huomattava, sen biosynteesistä ja translaationjälkeisestä muokkauksesta ei ole tähän mennessä ollut juurikaan tutkimustietoa. Tämän väitöskirjatyön tavoite oli kuvata näitä tapahtumia ja erityisesti keskittyä hβ1AR:n solunulkoisen amino- (N-) terminaalin rajoitettuun proteolyysiin. Lisäksi haluttiin tutkia, onko β-adrenergisillä ligandeilla vaikutusta reseptorin prosessointiin. Tutkimuksen kliinisessä osiossa kartoitettiin C-terminaalisen polymorfian yhteyttä valikoituihin muuttujiin aineistossa, joka koostui akuutin sydäninfarktin (AMI) sairastaneista potilaista. hβ1AR:n biosynteesin havaittiin olevan tehokas ja nopea heterologisessa systeemissä. Kypsän reseptorin N-terminaalissa havaittiin useita O-kytkennäisiä ja yksi N-kytkennäinen glykaani. Glykosyloinnista huolimatta N-terminaali pilkkoutui solun pinnalla, mikä tuotti kaksi solukalvolla sijaitsevaa, C-terminaalista reseptoripalasta. Pilkkoutumista, joka havaittiin myös in vivo, katalysoi metalloproteinaasi. Reseptorin aktivaatio kiihdytti pilkkoutumista, joka siten todennäköisesti edustaa uudenlaista hβ1AR:n säätelymekanismia. Ligandit, jotka kiihdyttivät pilkkoutumista, toisaalta stabiloivat solunsisäisiä hβ1AR:n epäkypsiä muotoja toimien luultavasti ns. farmakologisina kaperoneina. Näin ollen väitöskirjatyö osoittaa, että β-adrenergisillä ligandeilla voi olla erilaisia säätelyvaikutuksia eri hβ1AR-muotoihin. Kliinisessä tutkimuksessa Arg3898.56-homotsygooteilla potilailla havaittiin merkittävästi suurentunut vasemman kammion massaindeksi Gly3898.56-kantajiin verrattuina, mikä puoltaa Arg3898.56-polymorfismin ja vasemman kammion hypertrofian (LVH) välistä yhteyttä. Kun euglykeemisiä potilaita ja diabeetikkoja tutkittiin erikseen, yhteys ilmeni vain euglykeemisessä ryhmässä. Diabetes on riskitekijä, joka vaikuttaa LVH:n kehittymiseen. Tässä tutkimuksessa diabeteksellä havaittiin olevan voimakkaampi vaikutus LVH:n kehittymiseen Arg3898.56 -polymorfismiin verrattuna.

Part I. The aldosterone synthase gene (CYP11B2) polymorphism T-344C in blood pressure and left ventricular hypertrophy. BACKGROUND: Aldosterone is a key cardovascular hormone, it significantly influences volume, pressure and electrolyte balance. Aldosterone plays an important role in development of left ventricular (LV) hypertrophy and myocardial fibrosis. The aldosterone synthase gene (CYP11B2) is an important candidate gene region in essential hypertension. DESIGN AND METHODS: We assessed the influence of the T-344C polymorphism of aldosterone synthase - the rate-limiting enzyme in aldosterone biosynthesis - on the structure of the left ventricle in young normotensive men. The population included 113 normotensive mid-European Caucasian men aged 18-40 years (mean 27 +/- 5 years). We also studied the association of -344T/C polymorphism of the CYP11B2 gene with the presence and severity of hypertension in 369 individuals, of whom 213 were hypertensive patients (139 controlled hypertensive, 74 resistant hypertensive) and 156 were healthy normotensive subjects. The genotype was assessed using polymerase chain reaction with subsequent cleavage with restriction enzyme HAEIII (restriction fragment length polymorphism method) and visualization with ethidium bromide. Plasma renin activity (PRA) and plasma...

Short summary: Background: High cardiovascular risk in patients with chronic kidney disease is partly due to mineral dysbalance, microinflammation and oxidative stress. CKD patients accumulate traditional and non-traditional CV risk factors. FGF23, MMPs and PlGF belong among these non-traditional biomarkers of CV risk. FGF23 is a phosphaturic hormone and inhibitor of calcitriol synthesis. It is associated with vascular calcifications. Matrix-metalloproteinases (e.g. MMP-2, MMP-9) are proteolytic, proinflammatory enzymes, contributing to myocardial remodelation. Placental growth factor (PlGF) is a proangiogenic cytokine that is associated with LV hypertrophy in animal model. Plasmatic FGF23, MMPs and PlGF are elevated in CKD. Aim: We aimed to describe dynamic changes between several novel biomarkers of CV risk (FGF23, MMP-2, MMP-9 and PlGF) in CKD stages 1-5, to describe their mutual correlations and possible association with traditional CV risk markers. We studied possible association of laboratory and echocardiographic parameters in patients with CKD stages 2-4. Methods: In a cross-sectional study we evaluated 80 patiens with CKD 1-5 and 44 healthy controls. In a prospective study we evaluated echocardiographic and laboratory parameters in 62 patients with CKD 2-4 for an average study period of 36±10...

Short summary: Background: High cardiovascular risk in patients with chronic kidney disease is partly due to mineral dysbalance, microinflammation and oxidative stress. CKD patients accumulate traditional and non-traditional CV risk factors. FGF23, MMPs and PlGF belong among these non-traditional biomarkers of CV risk. FGF23 is a phosphaturic hormone and inhibitor of calcitriol synthesis. It is associated with vascular calcifications. Matrix-metalloproteinases (e.g. MMP-2, MMP-9) are proteolytic, proinflammatory enzymes, contributing to myocardial remodelation. Placental growth factor (PlGF) is a proangiogenic cytokine that is associated with LV hypertrophy in animal model. Plasmatic FGF23, MMPs and PlGF are elevated in CKD. Aim: We aimed to describe dynamic changes between several novel biomarkers of CV risk (FGF23, MMP-2, MMP-9 and PlGF) in CKD stages 1-5, to describe their mutual correlations and possible association with traditional CV risk markers. We studied possible association of laboratory and echocardiographic parameters in patients with CKD stages 2-4. Methods: In a cross-sectional study we evaluated 80 patiens with CKD 1-5 and 44 healthy controls. In a prospective study we evaluated echocardiographic and laboratory parameters in 62 patients with CKD 2-4 for an average study period of 36±10...