Faculty Bibliography

The intrinsic myocardial adaptation to chronic beta-blockade was explored in normal male Wistar rats. Propranolol was administered by subcutaneous infusion using osmotic minipumps for 3-4 wk (P group). Heart rate fell by approximately 100 beats/min. A second group of animals was similarly treated but had their pumps removed several days before study (P-R group). Heart rate rose, but remained below base line. Study of isolated ventricular papillary muscle from P, P-R, and age-matched controls (C group) revealed prolonged contraction duration in P and P-R groups, but no change in shortening velocity. A greater shortening of time to peak tension and time to one-half relaxation in response to norepinephrine was demonstrated in P and P-R groups. Acute in vivo or in vitro administration of propranolol had no effect on base-line mechanical performance. No changes in the Ca2+, actin-activated Mg2+ myosin adenosine triphosphatase (ATPase) activity, or myosin isoenzyme distribution were found. Free thyroxine levels were decreased in P but not P-R groups. These findings indicate that chronic propranolol therapy in normal rats slows contraction and relaxation without altering contractility. The greater shortening of contraction duration in response to norepinephrine is partly offset by the prolongation of the base-line contraction.

In rats, chronic diabetes is associated with depressed cardiac myosin ATPase activity and a shift from the predominant V1 isoenzyme to V3, correlating with depressed contractility. Rabbit myocardium consists mostly of the V3 isoenzyme, and therefore a switch to even more V3 isoenzyme in diabetes might not be possible and therefore not explain the mechanical abnormalities observed. To explore this, rabbits were made diabetic with 140-150 mg/kg of alloxan, and their hearts were studied 3 days, 1 mo, 3 mo, and 6 mo later. Ca2+-myosin-ATPase activity was decreased in the diabetic rabbit at 1, 3, and 6 mo, correlating with increased percent V3. Actin-activated Mg2+-ATPase activity was not significantly decreased in diabetics, but myofibrillar ATPase activity was decreased in 6-mo diabetic animals. When 3- to 4-mo diabetic animals were administered insulin for 3-4 additional months, myosin-ATPase activity and isoenzyme distribution normalized. These results correlate well with mechanical changes in papillary muscle from these same hearts. They suggest that in rabbit, as in rat, changes in cardiac contractile function are at least partially mediated by changes in myosin isoenzyme composition and are reversible with insulin.

Diabetes mellitus causes a cardiomyopathy in human subjects, independent of atherosclerotic coronary artery disease. Ventricular papillary muscle function studies in chronically diabetic rats and rabbits have shown diminished contractility and a prolonged duration of contraction. In rats there was complete reversibility of these changes with insulin therapy. However, the effects of insulin on the myocardial mechanics of diabetic rabbits have not been studied. Therefore, rabbits diabetic for 3-4 mo (after alloxan injection) were treated with PZI insulin for 3-4 mo, and the mechanical performance of their right ventricular papillary muscles was compared with that of untreated diabetic animals and age-matched controls. Insulin therapy normalized serum glucose concentration. All abnormalities in papillary muscle function were completely reversed in insulin-treated animals. Norepinephrine (NE) dose responses were also evaluated in muscles from all groups. There were no differences in the positive inotropic effects of NE between groups. However, the data suggested, in diabetic animals a blunted response of peak relaxation rate to NE; this abnormality was reversed in muscles from treated animals. These findings indicate that previous work on diabetic rats can be extended to diabetic rabbits and suggest that chronic insulin therapy completely reverses the contractile alterations in hearts from these diabetic animals.

Diabetes mellitus may lead to congestive heart failure in humans, independent of atherosclerotic coronary artery disease. Previous studies have explored the myocardial effects of chronic diabetes in dogs and rats with somewhat divergent results. Therefore the current study examined papillary muscle function in rabbits made diabetic with 140-150 mg/kg intravenous alloxan compared with that of age-matched controls. The period of diabetes was 3 days (study 1), 1 mo (study 2), 3 mo (study 3), and 6 mo (study 4). The duration of isometric and isotonic contraction and relaxation were markedly prolonged in diabetes from studies 2, 3, and 4. Shortening velocity was diminished in diabetics from studies 1, 3, and 4. A blunted inotropic response to increasing stimulus frequency was observed in diabetics. Changes in resting tension were not consistently observed, suggesting that passive muscle stiffness is not altered. These findings indicate that previous work on diabetic rats can be extended to diabetic rabbits and suggest that chronic diabetes diminishes contractility and prolongs the duration of contraction in mammalian hearts.

Diabetes mellitus is associated with a specific cardiomyopathy. This is evident from the clinical-pathological work and the epidemiologic data from the Framingham study. Noninvasive studies of diabetics have shown alterations in systolic and diastolic function that may ultimately lead to clinical heart failure. The relationship of these cardiac changes to the type of diabetes, its duration, and its severity is not settled. However, a correlation between changes in heart function and other complications of diabetes has been demonstrated. Insufficient prospective data is available from noninvasive studies to establish the frequency of progression from subclinical cardiac dysfunction to overt congestive failure. The pathogenesis of this disorder is still uncertain. Pathological studies have shown changes in the intramural arteries, arterioles, and capillaries but their functional significance is uncertain. Experimental studies have shown interstitial changes leading to an apparently less compliant left ventricle in the diabetic dog and monkey. In the diabetic rat reversible changes were found in myocardial function, related to changes in contractile proteins and intracellular calcium metabolism. In both species, the response to anoxia or ischemia was altered in the presence of diabetes. However, irreversible depression of the contractile element was not found in most animal studies of isolated diabetes. In contrast, the combination of hypertension and diabetes leads to substantial cardiac damage and circulatory congestion, both in clinical and experimental investigations. Clearly much more work must be carried out to understand the pathogenesis, treatment, and ultimately the prevention of diabetic cardiomyopathy.

Diabetes mellitus causes congestive heart failure in humans, independent of atherosclerosis. The present study extends previous work on the reversibility, with insulin, of the alterations in myocardial function and contractile protein biochemistry observed in diabetic rats. The response of these alterations to different fixed doses of insulin was explored. Diabetic rats were given 0, 0.5, 1, 1.5, 2, or 2.5 U of insulin daily for 6 wk. Papillary muscle function, actomyosin ATPase, and myosin isoenzyme distribution showed progressive normalization with increasing insulin dose as blood glucose concentration returned to normal. Thus insulin therapy in diabetic rats on a normal diet produces continuous improvement in cardiac function and biochemistry as euglycemia is approached. This study also suggests that mild diabetes results in qualitatively identical, although quantitatively less pronounced, myocardial changes compared with those observed in severely diabetic rats.

Myocardial function, electrophysiologic characteristics, and structure were studied in rats with both renovascular hypertension and streptozotocin-induced diabetes (HD). Ventricular papillary muscles from untreated rats with HD showed a marked slowing of isometric and isotonic contractions. Peak developed tension and peak shortening were preserved, except in one animal with findings of congestive heart failure. Transmembrane action potentials increased fivefold in duration. Myocardial interstitial fibrosis was frequently observed. Physiologic parameters of rats with HD treated by left nephrectomy, captopril, and insulin were very similar to those of age-matched controls. The mortality rate of rats with HD was 43% over 5 to 6 months in the first study. In a second study, spontaneously dying rats with HD were compared with those deliberately killed. A 55% mortality was observed over 7 months. Myocardial structural damage and histologic evidence of congestive heart failure were more frequent in spontaneously dying rats with HD. Combined renovascular hypertension and diabetes in rats appears to be a new preparation of congestive cardiomyopathy.

Diabetes induced by streptozotocin in rats is associated with changes in the mechanical function of isolated ventricular papillary muscle. Relaxation is slowed and shortening velocity is depressed. The effects of ouabain (10(-7) to 2 x 10(-4)M) and changes in extracellular calcium ([Ca2+]0 = 0.6 to 12 mM) on the mechanical and electrical properties of normal and diabetic papillary muscles were studied. High doses of ouabain caused a rise in resting tension and a fall in developed tension in both diabetic and control muscles. However, these changes were strikingly greater in diabetic muscles which developed partial contractures at 10(-4)M. The altered response to ouabain was observed in chronically (5 to 7 weeks or 3 months) but not acutely (less than 1 week) diabetic animals. Similarly, the response to ouabain was restored to normal after chronic (5 weeks) therapy with insulin but not after acute (4 days) therapy. In both normal and diabetic muscles, the mechanical effects of increasing [Ca2+]0 from 2.4 to 12.0 mM were qualitatively similar to those seen with ouabain at 10(-5) to 10(-4)M. Electrophysiologic studies showed that under control conditions action potentials of diabetic muscles were significantly longer than those of normal muscles. Treatment with progressively higher concentrations of ouabain (10(-7) to 10(-4)M) and [Ca2+]0 (2.4 to 12.0 mM) caused shortening of both normal and diabetic action potentials, but the effects of these interventions were much greater in the diabetics. These results suggest that the response of diabetic muscles to ouabain is markedly different from normal and that this altered response may be due to impaired regulation of intracellular Ca2+ levels in diabetic myocardium.

The pathogenesis of the cardiomyopathy associated with diabetes mellitus is unknown. Among several suggested mechanisms, myocardial necrosis induced by endogenous catecholamines may play a role. Therefore, the sensitivity of the heart to the effect of varying doses of isoproterenol hydrochloride and norepinephrine bitartrate was examined in diabetic and control rats given streptozocin. The dose of isoproterenol hydrochloride ranged from 0.008 to 30 mg/kg of body weight. Norepinephrine bitartrate was given in doses from 0.2 to 1.0 mg/kg of body weight. Each dose was given twice, 24 hours apart. Animals were killed 48 hours after the first dose, and their hearts were examined pathologically. Diabetes did not significantly alter the pathological response of the heart to either drug. We conclude that the diabetic heart is not intrinsically hypersensitive to catecholamines.