Elevated Intraoperative Expression of Ventricular Myosin Light Chain Predicts Heart Failure after Valve Replacement Surgery

Authors

  • Qiang Feng
  • Guo-Fei Zhang
  • Liang Ma
  • Yi-Ming Ni

DOI:

https://doi.org/10.1532/HSF98.20111069

Abstract

Background: It can be difficult to predict which patients will survive and recover cardiac function after valve replacement surgery. We hypothesized that the expression levels of ventricular myosin light chain (MLCv) might reflect the severity of disease or the extent of irreversible myocardial damage and might be useful for predicting the postoperative course. Thus, the aim of this study was to explore the relationship between MLCv expression in specimens obtained during valve replacement surgery and the postoperative New York Heart Association (NYHA) class.

Methods: The levels of expression of the regulatory MLCv (MLC-2v) and MLC-1v in papillary muscle specimens from 80 patients who underwent valve replacement surgery for rheumatic valvular disease were evaluated by Western blot analysis.

Results: The patients were similar with regard to the intraoperative expression of MLC-1v, regardless of postoperative NYHA class. The preoperative NYHA class, the end-systolic left ventricular internal dimension, and the intraoperative expression of MLC-2v emerged as independent risks factors for a NYHA class status of III/IV at 6 months after surgery, with an area under the receiver operating characteristic curve of 0.862.

Conclusion: The intraoperative level of MLC-2v expression was predictive of the patients' NYHA class after valve replacement surgery. This result suggests that future studies evaluating the use of preoperative specimens (such as biopsy or peripheral blood samples) for measurement of MLC-2v levels could lead to a valuable preoperative tool for the assessment of candidates for valve replacement.

References

Bergler-Klein J. 2009. Natriuretic peptides in the management of aortic stenosis. Curr Cardiol Rep 11:85-93.nChen J, Kubalak SW, Minamisawa S, et al. 1998. Selective requirement of myosin light chain 2v in embryonic heart function. J Biol Chem 273:1252-6.nCunningham MW. 2000. Pathogenesis of group A streptococcal infections. Clin Microbiol Rev 13:470-511.nDavis JS, Hassanzadeh S, Winitsky S, et al. 2001. The overall pattern of cardiac contraction depends on a spatial gradient of myosin regulatory light chain phosphorylation. Cell 107:631-41.nDavis JS, Satorius CL, Epstein ND. 2002. Kinetic effects of myosin regulatory light chain phosphorylation on skeletal muscle contraction. Biophys J 83:359-70.nDella Corte A, Salerno G, Chiosi E, et al. 2008. Preoperative, postoperative and 1-year follow-up N-terminal pro-B-type natriuretic peptide levels in severe chronic aortic regurgitation: correlations with echocardiographic findings. Interact Cardiovasc Thorac Surg 7:419-24.nDias FA, Walker LA, Arteaga GM, et al. 2006. The effect of myosin regulatory light chain phosphorylation on the frequency-dependent regulation of cardiac function. J Mol Cell Cardiol 41:330-9.nFlores-Marín A, Gómez-Doblas JJ, Caballero-Borrego J, et al. 2010. Long-term predictors of mortality and functional recovery after aortic valve replacement for severe aortic stenosis with left ventricular dysfunction. Rev Esp Cardiol 63:36-45.nFrustaci A, Magnavita N, Chimenti C, Caldarulo M, Sabbioni E, Pietra R. 1999. Marked elevation of myocardial trace elements in idiopathic dilated cardiomyopathy compared with secondary cardiac dysfunction. J Am Coll Cardiol 33:1578-83.nGoto T, Takase H, Toriyama T, et al. 2003. Circulating concentrations of cardiac proteins indicate the severity of congestive heart failure. Heart 89:1303-7.nGreenberg MJ, Kazmierczak K, Szczesna-Cordary D, Moore JR. 2010. Cardiomyopathy-linked myosin regulatory light chain mutations disrupt myosin strain-dependent biochemistry. Proc Natl Acad Sci U S A 107:17403-8.nGuilherme L, Kalil J. 2010. Rheumatic fever and rheumatic heart disease: cellular mechanisms leading to autoimmune reactivity and disease. J Clin Immunol 30:17-23.nHernandez OM, Jones M, Guzman G, Szczesna-Cordary D. 2007. Myosin essential light chain in health and disease. Am J Physiol Heart Circ Physiol 292:H1643-54.nHoffmann PA, Metzger JM, Greaser ML, Moss RL. 1990. The effects of partial extraction of light chain 2 on Ca2+ sensitivities of isometric tension stiffness and velocity of shortening in skinned skeletal muscle fibers. J Gen Physiol 95:477-98.nJacques AM, Briceno N, Messer AE, et al. 2008. The molecular pheno-type of human cardiac myosin associated with hypertrophic obstructive cardiomyopathy. Cardiovasc Res 79:481-91.nKockskämper J, von Lewinski D, Khafaga M, et al. 2008. The slow force response to stretch in atrial and ventricular myocardium from human heart: functional relevance and subcellular mechanisms. Prog Biophys Mol Biol 97:250-67.nLee W, Hwang TH, Kimura A, et al. 2001. Different expressivity of a ventricular essential myosin light chain gene Ala57Gly mutation in familial hypertrophic cardiomyopathy. Am Heart J 141:184-9.nMargossian SS, White HD, Caulfield JB, Norton P, Taylor S, Slayter HS. 1992. Light chain 2 profile and activity of human ventricular myosin during dilated cardiomyopathy. Identification of a causal agent for impaired myocardial function. Circulation 85:1720-33.nMorano M, Zacharzowski U, Maier M, Lange PE, Alexi-Meskishvili V, Haase H. 1996. Regulation of human heart contractility by essential myosin light chain isoforms. J Clin Invest 98:467-73.nNussinovitch U, Shoenfeld Y. 2011. The clinical and diagnostic significance of anti-myosin autoantibodies in cardiac disease. Clin Rev Allergy Immunol. In press.nOlsson MC, Patel JR, Figzsimons DP, Walker JW, Moss RL. 2004. Basal myosin light chain phosphorylation is a determinant of Ca2+ sensitivity of force and activation dependence of the kinetics of myocardial force development. Am J Physiol Heart Circ Physiol 287:H2712-8.nRottbauer W, Wessels G, Dahme T, et al. 2006. Cardiac myosin light chain-2: a novel essential component of thick-myofilament assembly and contractility of the heart. Circ Res 99:323-31.nSato Y, Kita T, Takatsu Y, Kimura T. 2004. Biochemical markers of myocyte injury in heart failure. Heart 90:1110-3.nSeguchi O, Takashima S, Yamazaki S, et al. 2007. A cardiac myosin light chain kinase regulates sarcomere assembly in the vertebrate heart. J Clin Invest 117:2812-24.nSolaro RJ. 1992. Myosin and why hearts fail. Circulation 85:1945-7.nSütsch G, Brunner UT, von Schulthess C, et al. 1992. Hemodynamic performance and myosin light chain-1 expression of the hypertrophied left ventricle in aortic valve disease before and after valve replacement. Circ Res 70:1035-43.nTarantini G, Buja P, Scognamiglio R, et al. 2003. Aortic valve replacement in severe aortic stenosis with left ventricular dysfunction: determinants of cardiac mortality and ventricular function recovery. Eur J Cardiothorac Surg 24:879-85.nTrahair T, Yeoh T, Cartmill T, et al. 1993. Myosin light chain gene expression associated with disease states of the human heart. J Mol Cell Cardiol 25:577-85.nVaquette B, Corbineau H, Laurent M, et al. 2005. Valve replacement in patients with critical aortic stenosis and depressed left ventricular function: predictors of operative risk, left ventricular function recovery, and long term outcome. Heart 91:1324-9.nVillar AV, Llano M, Cobo M, et al. 2009. Gender differences of echocardiographic and gene expression patterns in human pressure overload left ventricular hypertrophy. J Mol Cell Cardiol 46:526-35.nWeber M, Hausen M, Arnold R, Nef H, Moellman H, Berkowitsch A. 2006. Prognostic value of N-terminal pro-B-type natriuretic peptide for conservatively and surgically treated patients with aortic valve stenosis. Heart 92:1639-44.n

Published

2011-12-13

How to Cite

Feng, Q., Zhang, G.-F., Ma, L., & Ni, Y.-M. (2011). Elevated Intraoperative Expression of Ventricular Myosin Light Chain Predicts Heart Failure after Valve Replacement Surgery. The Heart Surgery Forum, 14(6), E340-E348. https://doi.org/10.1532/HSF98.20111069

Issue

Section

Article