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Circulation
Article . 2022 . Peer-reviewed
Data sources: Crossref
Circulation
Article . 2022
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Mechanisms of Sinoatrial Node Dysfunction in Heart Failure With Preserved Ejection Fraction

Authors: Thassio Mesquita; Rui Zhang; Jae Hyung Cho; Rui Zhang; Yen-Nien Lin; Lizbeth Sanchez; Joshua I. Goldhaber; +5 Authors

Mechanisms of Sinoatrial Node Dysfunction in Heart Failure With Preserved Ejection Fraction

Abstract

Background: The ability to increase heart rate during exercise and other stressors is a key homeostatic feature of the sinoatrial node (SAN). When the physiological heart rate response is blunted, chronotropic incompetence limits exercise capacity, a common problem in patients with heart failure with preserved ejection fraction (HFpEF). Despite its clinical relevance, the mechanisms of chronotropic incompetence remain unknown. Methods: Dahl salt-sensitive rats fed a high-salt diet and C57Bl6 mice fed a high-fat diet and an inhibitor of constitutive nitric oxide synthase (Nω-nitro-L-arginine methyl ester [L-NAME]; 2-hit) were used as models of HFpEF. Myocardial infarction was created to induce HF with reduced ejection fraction. Rats and mice fed with a normal diet or those that had a sham surgery served as respective controls. A comprehensive characterization of SAN function and chronotropic response was conducted by in vivo, ex vivo, and single-cell electrophysiologic studies. RNA sequencing of SAN was performed to identify transcriptomic changes. Computational modeling of biophysically-detailed human HFpEF SAN was created. Results: Rats with phenotypically-verified HFpEF exhibited limited chronotropic response associated with intrinsic SAN dysfunction, including impaired β-adrenergic responsiveness and an alternating leading pacemaker within the SAN. Prolonged SAN recovery time and reduced SAN sensitivity to isoproterenol were confirmed in the 2-hit mouse model. Adenosine challenge unmasked conduction blocks within the SAN, which were associated with structural remodeling. Chronotropic incompetence and SAN dysfunction were also found in rats with HF with reduced ejection fraction. Single-cell studies and transcriptomic profiling revealed HFpEF-related alterations in both the “membrane clock” (ion channels) and the “Ca 2+ clock” (spontaneous Ca 2+ release events). The physiologic impairments were reproduced in silico by empirically-constrained quantitative modeling of human SAN function. Conclusions: Chronotropic incompetence and SAN dysfunction were seen in both models of HF. We identified that intrinsic abnormalities of SAN structure and function underlie the chronotropic response in HFpEF.

Country
United States
Keywords

Heart Failure, sinoatrial node, cardiac, Clinical Sciences, heart failure, Stroke Volume, Cardiorespiratory Medicine and Haematology, Cardiovascular, Rats, Heart Disease, Cardiovascular System & Hematology, heart rate, Public Health and Health Services, 2.1 Biological and endogenous factors, Animals, Humans, Aetiology, arrhythmias, Nutrition, Sinoatrial Node

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    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
34
Top 10%
Top 10%
Top 1%
Green