Background-Gap junction resistivity, R j , has been proposed as a key determinant of conduction velocity (CV). However, studies in connexin-gene knockout mice demonstrated significant CV slowing only with near-complete connexin deletion, and these findings led to the concept of a significant redundancy of myocardial gap junctions. We challenged this prevailing concept and addressed the hypothesis that there is a continuous relationship between R j and CV, each independently measured in human and guinea-pig myocardium. Methods and Results-R j and CV were directly measured by oil-gap impedance and microelectrode techniques in human left ventricular myocardium from patients with hypertrophic cardiomyopathy and in guinea-pig atrial and ventricular myocardium before and during pharmacological uncoupling with 20-µmol/L carbenoxolone. There was a continuous relationship between R j and CV in human and guinea-pig myocardium, pre-and post-carbenoxolone (r 2 =0.946; P<0.01). In guinea-pig left ventricle, left atrium, and right atrium, carbenoxolone increased R j by 28±9%, 26±16%, and 25±14% and slowed CV by 17±3%, 23±8%, and 11±4% respectively (all P<0.05 versus control). As a clinically accessible measure of local microscopic myocardial conduction slowing in vivo in the intact human heart, carbenoxolone prolonged electrogram duration in the right atrium (39.7±4.2 to 42.3±4.3 ms; P=0.01) and right ventricle (48.1±2.5 to 53.3±5.3 ms; P<0.01). Conclusions-There is a continuous relationship between R j and CV that is consistent between cardiac chambers and across species, indicating that naturally occurring variations in cellular coupling can account for variations in CV, and that the concept that there is massive redundancy of coupling is not tenable. (Circ Arrhythm Electrophysiol. 2013;6:1208-1214.)
We tested the hypothesis that in left ventricular myocardial hypertrophy (LVH) the positive staircase effect is impaired and is related to a raised intracellular [Na+] ([Na+]i). Human myocardial specimens were obtained from patients undergoing mitral and aortic valve surgery, the latter group had LVH. LVH was induced in guinea-pigs by ascending aortic constriction. The extent of hypertrophy was quantified by measuring myocyte cross-section area, echocardiographic mass (in humans) and heart-to-body weight ratio (in guinea-pigs). The response to increasing stimulation frequency was expressed as the ratio of tension generated at 1.6 and 0.8 Hz (T1.6/0.8); ratios greater and less than 1.0 equate with positive and negative force/frequency relationships respectively. [Na+]i was measured using ion-selective microelectrodes. In human and guinea-pig myocardium T1.6/0.8 values decreased and [Na+]i increased with hypertrophy. For guinea-pig myocardium T1.6/0.8 decreased from 1.39 +/- 0.05 to 1.02 +/- 0.05 and [Na+]i increased from 7.3 +/- 1.4 to 12.1 +/- 1.3 mM in LVH. There was a close relationship between the reduction of T1.6/0.8 and increase of [Na+]i which was also observed when the [Na+]i was increased with strophanthidin in normal myocardium. The recovery of a raised [Na+]i after an acute acidosis was slowed in hypertrophied myocardium and stabilised at a higher level, suggesting that the membrane mechanisms that regulate [Na+]i are reset.
Lower urinary tract symptoms are frequency report in Parkinson's disease. Whether these are causally related to Parkinson's disease rather than the known effects of age on the urinary tract is unknown. In this study we compared urodynamic data from 1864 women and 357 men with no neurological disease with data from 34 women and 42 men with Parkinson's disease, 96 women and 75 men with cerebrovascular disease and 42 women and 16 men with dementia. We examined isometric and isotonic detrusor contractile function and urethral outflow. Bladder capacity was reduced in both men and women with Parkinson's disease in comparison with patients of similar to that measured in patients without neurological disease and we found no evidence of obstruction in patients with Parkinson's disease. Disease-specific changes were not identified in patients with cerebrovascular disease or dementia. These findings contradict previous reports suggesting specific changes in lower urinary tract function in association with Parkinson's disease.
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