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Circulation. 2003;108:929-932
Published online before print August 18, 2003, doi: 10.1161/01.CIR.0000088782.99568.CA
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(Circulation. 2003;108:929.)
© 2003 American Heart Association, Inc.


Brief Rapid Communications

Regional Alterations in Protein Expression in the Dyssynchronous Failing Heart

David D. Spragg, MD*; Christophe Leclercq, MD*; Morteza Loghmani, BS; Owen P. Faris, BS; Richard S. Tunin, MS; Deborah DiSilvestre, MS; Elliot R. McVeigh, PhD; Gordon F. Tomaselli, MD; David A. Kass, MD

From the Division of Cardiology, Department of Medicine (D.S., C.L., M.L., R.T., D.D., G.T., D.A.K.), Johns Hopkins University, Baltimore, Md; and the National Heart, Lung and Blood Institute/Laboratory of Cardiac Energetics (O.F., E.M.), National Institutes of Health, Bethesda, Md.

Correspondence to David A. Kass, Halsted 500, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287. E-mail dkass{at}jhmi.edu

Received January 27, 2003; de novo received May 27, 2003; revision received July 14, 2003; accepted July 18, 2003.

Background— Left ventricular (LV) mechanical dyssynchrony induces regional heterogeneity of mechanical load and is an independent predictor of mortality and sudden death in heart failure (HF) patients. We tested whether dyssynchrony also induces localized disparities in the expression of proteins involved with mechanical stress, function, and arrhythmia susceptibility.

Methods and Results— Eleven dogs underwent tachycardia-induced HF pacing, either from the right atrium or high right ventricular free wall. Whereas global LV dysfunction was similar between groups, LV contractile coordination assessed by tagged MRI was markedly dyssynchronous with right ventricular pacing but synchronous with right atrial pacing. In dyssynchronous failing hearts, the lateral LV endocardium displayed a 2-fold increase in phosphorylated erk mitogen-activated protein kinase expression (with no change in phospho-p38 or phospho-jnk), a 30% decline in sarcoplasmic reticulum Ca2+-ATPase, an 80% reduction in phospholamban, and a 60% reduction in the gap junction protein connexin43, relative to neighboring myocardial segments. In contrast, hearts from both right atrial–paced HF dogs and an additional 4 noninstrumented control animals showed minimal regional variability in protein expression.

Conclusions— LV dyssynchrony in failing hearts generates myocardial protein dysregulation concentrated in the late-activated, high-stress lateral endocardium. Such molecular polarization within the LV creates transmural and transchamber expression gradients of calcium handling and gap junction proteins that may worsen chamber function and arrhythmia susceptibility.


Key Words: heart failure • pacing • molecular biology • sarcoplasmic reticulum




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