https://caltcm.memberclicks.net/assets/documents/acc_aha_chf_2013_guidelines.pdf

2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines

Acute kidney injury (AKI) is a complex disorder for which currently there is no accepted definition. Having a uniform standard for diagnosing and classifying AKI would enhance our ability to manage these patients. Future clinical and translational research in AKI will require collaborative networks of investigators drawn from various disciplines, dissemination of information via multidisciplinary joint conferences and publications, and improved translation of knowledge from pre-clinical research. We describe an initiative to develop uniform standards for defining and classifying AKI and to establish a forum for multidisciplinary interaction to improve care for patients with or at risk for AKI. Members representing key societies in critical care and nephrology along with additional experts in adult and pediatric AKI participated in a two day conference in Amsterdam, The Netherlands, in September 2005 and were assigned to one of three workgroups. Each group's discussions formed the basis for draft recommendations that were later refined and improved during discussion with the larger group. Dissenting opinions were also noted. The final draft recommendations were circulated to all participants and subsequently agreed upon as the consensus recommendations for this report. Participating societies endorsed the recommendations and agreed to help disseminate the results. The term AKI is proposed to represent the entire spectrum of acute renal failure. Diagnostic criteria for AKI are proposed based on acute alterations in serum creatinine or urine output. A staging system for AKI which reflects quantitative changes in serum creatinine and urine output has been developed. We describe the formation of a multidisciplinary collaborative network focused on AKI. We have proposed uniform standards for diagnosing and classifying AKI which will need to be validated in future studies. The Acute Kidney Injury Network offers a mechanism for proceeding with efforts to improve patient outcomes.

Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury

Matrix metalloproteinases (MMPs), also designated matrixins, hydrolyze components of the extracellular matrix. These proteinases play a central role in many biological processes, such as embryogenesis, normal tissue remodeling, wound healing, and angiogenesis, and in diseases such as atheroma, arthritis, cancer, and tissue ulceration. Currently 23 MMP genes have been identified in humans, and most are multidomain proteins. This review describes the members of the matrixin family and discusses substrate specificity, domain structure and function, the activation of proMMPs, the regulation of matrixin activity by tissue inhibitors of metalloproteinases, and their pathophysiological implication.

Matrix metalloproteinases and tissue inhibitors of metalloproteinases: structure, function, and biochemistry.

https://www.medpagetoday.com/upload/2014/3/3/02536-1.pdf

2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease

Matrix metalloproteinases (MMPs), also called matrixins, function in the extracellular environment of cells and degrade both matrix and non-matrix proteins. They play central roles in morphogenesis, wound healing, tissue repair and remodelling in response to injury, e.g. after myocardial infarction, and in progression of diseases such as atheroma, arthritis, cancer and chronic tissue ulcers. They are multi-domain proteins and their activities are regulated by tissue inhibitors of metalloproteinases (TIMPs). This review introduces the members of the MMP family and discusses their domain structure and function, proenyme activation, the mechanism of inhibition by TIMPs and their significance in physiology and pathology.

Structure and function of matrix metalloproteinases and TIMPs

Changes in the Interstitial Matrix During Myocardial Remodeling

Cardiac Resynchronization Therapy (CRT) is a widely used, device-based therapy for patients with left ventricle (LV) failure. Unfortunately, many patients do not benefit from CRT, so there is potential value in identifying this group of non-responders before CRT implementation. Past studies suggest that predicting CRT response will require diverse variables, including demographic, biomarker, and LV function data. Accordingly, the objective of this study was to integrate diverse variable types into a machine learning algorithm for predicting individual patient responses to CRT.We built an ensemble classification algorithm using previously acquired data from the SMART-AV CRT clinical trial (n = 794 patients). We used five-fold stratified cross-validation on 80% of the patients (n = 635) to train the model with variables collected at 0 months (before initiating CRT), and the remaining 20% of the patients (n = 159) were used as a hold-out test set for model validation. To improve model interpretability, we quantified feature importance values using SHapley Additive exPlanations (SHAP) analysis and used Local Interpretable Model-agnostic Explanations (LIME) to explain patient-specific predictions.Our classification algorithm incorporated 26 patient demographic and medical history variables, 12 biomarker variables, and 18 LV functional variables, which yielded correct prediction of CRT response in 71% of patients. Additional patient stratification to identify the subgroups with the highest or lowest likelihood of response showed 96% accuracy with 22 correct predictions out of 23 patients in the highest and lowest responder groups.Computationally integrating general patient characteristics, comorbidities, therapy history, circulating biomarkers, and LV function data available before CRT intervention can improve the prediction of individual patient responses. 

/pdf/interpretable-machine-learning-predicts-cardiac-203qsq4l.pdf

Interpretable machine learning predicts cardiac resynchronization therapy responses from personalized biochemical and biomechanical features

Myocardial dysfunction with severe cardiac hypertrophy and congestive heart failure is associated with abnormalities in myocyte action potential morphology, and consequently, trans-sarcolemmal ionic currents. Determination of the primary ionic current or event which contributes to myocardial contractile dysfunction is an area of active research. This review article coalesces findings on ionic processes and systems which have direct relevance in the setting of hypertrophy and congestive heart failure. The consensus conclusion that can be drawn from human and animal studies of severe hypertrophy and/or congestive heart failure is that action potential prolongation is associated with alterations in the outward K+ currents and the inward Ca2−currents.

Alterations in Ionic Currents and Relation to Contractile Dysfunction with Severe Cardiac Hypertrophy and Failure

Background: Chronic stress is known to induce vascular inflammation causing endothelial and vascular smooth muscle dysfunction. Changes in the hypothalamic-pituitary-adrenal axis lead to increased sympathetic and decreased parasympathetic drive, causing the release of inflammatory cytokines in the vasculature, by mechanisms that are unclear. Hypothesis: We hypothesize that chronic unpredictable stress (CUS) increases reactive oxygen species and induces gasdermin pore formation and voltage-dependent anion channel (VDAC) oligomerization in the membrane of the mitochondria, which releases mitochondrial DNA (mtDNA) to the cytosol and induces TNF-α, IL-1β and IL-18 production through activation of the NLRP-3 inflammasome pathway. Methods: Adult male and female C57Bl6/J mice were exposed to 28 consecutive days of chronic unpredictable stress (CUS) or handling (CTL). Systolic blood pressure (SBP) was measured at the end of the stress period by tail cuff plethysmography. Vascular function using myographs was assessed on isolated mesenteric resistance arteries (MRAs), pudendal artery (PA) and aorta from male and female CUS and CTL mice. The arterial rings were kept in physiological salt solution at 37°C, constantly aerated with 95%O2/5%CO2. Concentration-response curves to phenylephrine (PE; 1nM-30μM) and acetylcholine (ACh; 1nM-30μM) were performed. Expression of gasderminD was measured in the MRA by western blot. Concentration-response curves were analyzed using non-linear regression analysis. Data are presented as mean ± S.E.M. Statistical significance set at p<0.05. Data were analyzed with GraphPad Prism 9.2.0. Results: SBP was increased by 12.1±4.9% in CUS mice. In CUS mice, compared to the CTL, the potency of ACh-induced relaxation was decreased in the MRA (pEC50 CUS 6.17±0.09 vs CTL 6.81±0.11; p=0.003) and PA (pEC50 CUS 6.65±0.07 vs CTL 6.31±0.09; p=0.008) but not in the aorta of male mice. In females, the potency to ACh was decreased only in the MRA (pEC50 CUS 5.94±0.30 vs CTL 6.98±0.15; p=0.041). There were no differences in the contractile responses to PE between controls and mice exposed to CUS in the MRA and PA of both males and females, while in the aorta of CUS males, there was a significant reduction in maximal response (EMAX CTL: 4.70±0.48 mN vs CUS 3.01± 0.23mN; p=0.007). The expression of gasderminD was increased in MRA of female mice only. Conclusion: Our results show that, in both sexes, CUS increased SBP and induced vascular dysfunction observed by impaired reactivity to ACh and PE, with increased expression of gasderminD in MRA of female mice only. These results suggest that the vascular adaptations to CUS are sex-dependent. This work was supported by NIH grants P20GM109091 (F.H.), R01HL130972-01A1 (F.G.S.), R01HL5949 (F.G.S.), RO1DK132948 (C.W. & F.P.) and R01 MH129798 (SKW); VA grants: VISN7 RDA (F.H.), Merit awards: BX000168-10A1 (F.G.S.), BX005320 (F.G.S.), and BX002604 (M.J.R.). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the abstract. This is the full abstract presented at the American Physiology Summit 2023 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.

Chronic Unpredictable Stress Impairs Vascular Reactivity in Male and Female Mice

Background: Psychosocial stress, particularly chronic unpredictable stress (CUS) has been identified as a risk factor for cardiovascular disease, but the effects of CUS on left ventricle (LV) function, geometry and systemic hemodynamics remains unclear. Moreover, whether and to what degree CUS activates intracellular formation of the inflammasome, including the NOD-LRR pyrin containing protein 3 (NLRP3) remains unknown. Accordingly, the central hypothesis of this project was that in a murine model of CUS, shifts in LV geometry and systemic hemodynamics would occur and be associated with the induction of NLRP3. Methods and Results: Mice (C57BL/6, 10wks of age, equal sex, n=16) were subjected to CUS for 4 weeks which entailed daily random stressors including tilted cage, wet bedding, and overnight light. Referent age and sex matched non CUS mice served as controls (n=16). LV function was assessed by high fidelity ultrasound and blood pressure measurements by tail cuff for both referent control and CUS mice. The changes in ambient heart rate (HR), LV end-systolic volume (LVEDV), and systolic blood pressure (SBP) were expressed as a function of referent control. All results are reported as mean ± SEM. While LV ejection fraction was equivalent between CUS and control groups (70 ± 3 vs. 67 ± 3%, respectively, p=0.48), HR trended higher (4.5 ± 3.1%, p=0.08), LVEDV was lower (-11 ± 5%, p=0.03) and SBP was elevated (12.1 ± 4.9%, p=0.04) - all indicative of heightened sympathetic tone. LV myocardial NLRP3 (rtPCR) was increased (1.47 ± 0.22 fold change, p=0.04) with CUS as was IL-1β (1.43 ± 0.20 fold change, p=0.05), a downstream cytokine activated by NLRP3. Conclusion: CUS, in and of itself, shifts LV geometry, causes mild hypertension and induction of the myocardial inflammasome- all of which would exacerbate/contribute to cardiovascular disease. This work was supported in part by National Institutes of Health grant R01HL130972-01A1 (F.G.S.), R01HL5949 (F.G.S.), RO1DK132948 (C.W. & F.P.), R01 MH129798 (SKW) and P20GM109091 (F.H.) as well as a Merit Award from the Veterans Health Administration, BX000168-10A1 (F.G.S.), BX005320 (F.G.S.), BX002604 (M.J.R.), and VISN7 RDA (F.H.). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. This is the full abstract presented at the American Physiology Summit 2023 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.

Francis G. Spinale

Papers

Changes in the Interstitial Matrix During Myocardial Remodeling

Interpretable machine learning predicts cardiac resynchronization therapy responses from personalized biochemical and biomechanical features

Alterations in Ionic Currents and Relation to Contractile Dysfunction with Severe Cardiac Hypertrophy and Failure

Chronic Unpredictable Stress Impairs Vascular Reactivity in Male and Female Mice

Chronic unpredictable stress changes left ventricular geometry and activation of the inflammasome