Name: murine echocardiography of left atrium, aorta, and pulmonary artery
Uploaded: 2017-02-20T15:00:00
Description: Watch this Scientific Journal Video about Murine Echocardiography of Left Atrium, Aorta, and Pulmonary Artery at JoVE.com

This work was supported by the Huffington Center on Aging at Baylor College of Medicine, Geriatrics, CVS DeBakey Heart Center at Houston Methodist Hospital and BCM, NIH RO-1 HL 13870 to ML Entman, as well as a Career Development Award # IK2BX002410 from the United States Department of Veterans Affairs (LMP), Biomedical Laboratory Research and Development Program.
We are immensely grateful to Mark Entman M.D. for sharing his wisdom and supporting this work.

All animals were cared for in accordance with the guidelines of the National Institutes of Health Guide for the Care and Use of Laboratory Animals at Baylor College of Medicine.
1. Set-up
<ol>
	<li>Turn on the echocardiographic system. Start the software by selecting &#34;Cardiac Measurements&#34; from the drop down menu displayed and click &#34;Initialize&#34;.</li>
	<li>To begin a new study click on the &#34;New&#34; button on the upper part of the screen and enter the demographic informat...

<ol>
	<li>Upadhya, B., Taffet, G. E., Ping, C., Kitzman, D. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Heart+failure+with+preserved+ejection+fraction+in+the+elderly:+scope+of+the+problem.">Heart failure with preserved ejection fraction in the elderly: scope of the problem.</a> Journal of Molecular and Cellular Cardiology. 83, 73-87 (2015).</li><li>Mclaughlin, V. V., Archer, S. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=ACCF+/+AHA+Expert+Consensus+Document+Expert+Consensus+Document+ACCF+/+AHA+2009+Expert+Consensus+Document+on+Pulmonary+Hypertension+A+Report+of+the+American+College+of+Cardiology+Foundation+Task+Force+on+Expert+Consensus+Documents+and+the+American+Heart+Association.">ACCF / AHA Expert Consensus Document Expert Consensus Document ACCF / AHA 2009 Expert Consensus Document on Pulmonary Hypertension A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association.</a> Circulation. , 2250-2294 (2009).</li><li>Cieslik, K. A., Taffet, G. E., Carlson, S., Hermosillo, J., Trial, J., Entman, M. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Immune-inflammatory+dysregulation+modulates+the+incidence+of+progressive+fibrosis+and+diastolic+stiffness+in+the+aging+heart.">Immune-inflammatory dysregulation modulates the incidence of progressive fibrosis and diastolic stiffness in the aging heart.</a> Journal of Molecular and Cellular Cardiology. 50 (1), 248-256 (2011).</li><li>Tate, C. A., Taffet, G. E., Hudson, E. K., Blaylock, S. L., McBride, R. P., Michael, L. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Enhanced+calcium+uptake+of+cardiac+sarcoplasmic+reticulum+in+exercise-trained+old+rats.">Enhanced calcium uptake of cardiac sarcoplasmic reticulum in exercise-trained old rats.</a> Am J Physiol Heart Circ Physiol. 258 (2), H431-H435 (1990).</li><li>Kitzman, D. W., Daniel, K. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diastolic+Heart+Failure+in+the+Elderly.">Diastolic Heart Failure in the Elderly.</a> Heart Failure Clinics. 3 (4), 437-453 (2007).</li><li>Sanderson, J. E., Rusconi, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=How+to+diagnose+diastolic+heart+failure+a+consensus+statement+on+the+diagnosis+of+heart+failure+with+normal+left+ventricular+ejection+fraction+by+the+Heart+Failure+and+Echocardiography+Associations+of+the+European+Society+of+Cardiology.">How to diagnose diastolic heart failure a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology.</a> Eur Heart J. , 2539-2550 (2007).</li><li>Medrano, G., Hermosillo-Rodriguez, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Left+Atrial+Volume+and+Pulmonary+Artery+Diameter+Are+Noninvasive+Measures+of+Age-Related+Diastolic+Dysfunction+in+Mice.">Left Atrial Volume and Pulmonary Artery Diameter Are Noninvasive Measures of Age-Related Diastolic Dysfunction in Mice.</a> The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. (16), 1-10 (2015).</li><li>Franco, F., Thomas, G. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Magnetic+Resonance+Imaging+and+Invasive+Evaluation+of+Development+of+Heart+Failure+in+Transgenic+Mice+With+Myocardial+Expression+of+Tumor+Necrosis+Factor-+.">Magnetic Resonance Imaging and Invasive Evaluation of Development of Heart Failure in Transgenic Mice With Myocardial Expression of Tumor Necrosis Factor- .</a> Circulation. 99, 448-454 (1999).</li><li>Jenkins, C., Bricknell, K., Marwick, T. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+real-time+three-dimensional+echocardiography+to+measure+left+atrial+volume:+Comparison+with+other+echocardiographic+techniques.">Use of real-time three-dimensional echocardiography to measure left atrial volume: Comparison with other echocardiographic techniques.</a> Journal of the American Society of Echocardiography. 18 (9), 991-997 (2005).</li><li>Ujino, K., Barnes, M. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Two-dimensional+echocardiographic+methods+for+assessment+of+left+atrial+volume.">Two-dimensional echocardiographic methods for assessment of left atrial volume.</a> The American journal of cardiology. 98 (9), 1185-1188 (2006).</li><li>Scalia, G. M., Scalia, I. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=ePLAR+-+The+echocardiographic+Pulmonary+to+Left+Atrial+Ratio+-+A+novel+non-invasive+parameter+to+differentiate+pre-capillary+and+post-capillary+pulmonary+hypertension.">ePLAR - The echocardiographic Pulmonary to Left Atrial Ratio - A novel non-invasive parameter to differentiate pre-capillary and post-capillary pulmonary hypertension.</a> International Journal of Cardiology. 212, 379-386 (2016).</li></ol>

There are three critical steps to successfully measure the LAV, Aorta and PA diameters. During the Set-up it is important to completely remove the fur on the chest; failure to do so will result in interference with image quality. During the Image Acquisition steps it is important to obtain each image with their corresponding probe and filter as the frames per second vary from probe to probe: that is 25 MHz and Cardiac Filter for the assessment of the LAV and 30 MHz and Abdominal Filter for assessment of the Aorta and PA ...

The present methodology teaches the investigator how to measure and use the LAV, Aorta diameter and PA diameter with 2D echocardiography in mice under isoflurane. Heart Failure with preserved Ejection Fraction (HFpEF) in elderly people affects up to 10% in those 80 years and older1 and results in significant morbidity and mortality. Significant mortality also occur from Pulmonary Hypertension (PH), an insidious disease process presenting with similar symptoms as HFpEF, in which elevated pulmonary artery pressures lead to exertional dyspnea, progressive right heart failure, and often death.2 The increasing prevalence of both HFpEF and PH signify the need for developing a method that allows for accurate evaluation and monitoring of interventions in murine models in a non-invasive, non-terminal approach.
Aging leads to a deterioration of diastolic function via alterations in ventricular-arterial stiffening, vascular dysfunction, inflammation3, impaired calcium regulation4, decreased &#946;-adrenergic responsiveness, and physical deconditioning producing slowed active relaxation and increased passive stiffness. Over time this leads to increased LV filling pressure and compensatory enlargement of the LA.5
Though other etiologies such as valvular dysfunction (mitral regurgitation or stenosis) and infiltrative processes cause elevations in pressure and volume in the LA1, the European Society of Cardiology supports the addition of LA size as a noninvasive reflection of LV function.6
Correlations between LA volume and invasive measures of diastolic function have been studied in mice. LA volume correlated with differences in function determined invasively within age groups for both 14- and 31-months-old mice. In the 14-months-old mice, LA volume correlated with three standard invasive measures of diastolic function &#8722;dP/dtmin (r2 = .5, p &#60;0.05), Tau (time constant of relaxation, (r2 = .6, p &#60;0.05), and left ventricular end diastolic pressure (r2 = .25, p &#60;0.05). For the 31 months-old mice, the correlations between LA volume and -dP/ dtmin (r2 = .92, p &#60;0.05) and LVEDP (r2 = .61, p &#60;0.05) were apparent though the relationship with Tau was less clear. Therefore, LA volume increased with diastolic impairment not only across groups but within age groups.7
Studies of cardiac function in murine models using catheter techniques to evaluate cardiac performance, although rigorous and reliable, are limited due to their incompatibility with repeated assessments.8 Alternatives to invasive measures such as MRI and 3D echocardiography may also be more accurate than 2D echocardiographic techniques, but they are more expensive; 2D echocardiography is considered adequate for LA volume evaluation. 9,10
Assessment of the LA volume and PA diameter with echocardiography allows the discrimination between models that produce primary increases in pulmonary artery resistance resulting in an increase in PA diameter with no change in LA pressure or LAV from those where the Pulmonary Artery and Left Atrium both enlarge as a result of elevated filling pressures on the left side of the heart. This approach was taken by Scalia et al. who showed that in people, the echocardiographic Pulmonary Artery to Left Atrial Ratio (ePLAR) is a parameter to accurately differentiate between patients with pre-pulmonary capillary hypertension and post-capillaryhypertension.11

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murine echocardiography of left atrium, aorta, and pulmonary artery

The present methodology teaches the investigator how to measure and use the LAV as a surrogate of chronic elevations in Left Ventricular diastolic pressure through echocardiography, as well as to obtain measurements of the Aorta and PA diameter in mice.
Mice older than 10 d of age can be analyzed using the present technique. The technique is composed of 3 main steps: set-up, image acquisition, and image analysis. The set-up step consists of getting the mouse anesthetized with 1% isoflurane, shaving it, and taping it in a supine position to a heated EKG board where the image acquisition will take place. The image acquisition step consists of learning to identify the cardiac structures and obtaining all the required images with its correspondent probe and axis in order to be able to calculate volumes and diameters. The image analysis step consists of measuring the previously acquired images with the aid of computer software.
Advantages of the proposed technique include a fast (15 min) procedure that would allow the researcher to evaluate interventions in a non-invasive, non-terminal approach and therefore follow the same mouse over time; each mouse can be used as its own control. This fact plus having the same operator perform all the acquisition and analysis for the entire experiment minimizes the limitation of operator-dependency. The present methodology is useful for mouse researchers in cardiovascular and pulmonary medicine.

Assessment of the LA volume and PA diameter with echocardiography allows the discrimination between models where increased pulmonary artery resistance results in increased PA diameter with no change in LAV from those where the Pulmonary Artery and Left Atrial enlargement are both a result of elevated filling pressures on the left side of the heart. Images displaying the differences in the two pathophysiologies are shown in Figure 4. Images of the LA and PA are from young,...

Watch this Scientific Journal Video about Murine Echocardiography of Left Atrium, Aorta, and Pulmonary Artery at JoVE.com

Murine Echocardiography of Left Atrium, Aorta, and Pulmonary Artery

The following protocol describes the methodology for the acquisition and analysis of echocardiographic images used to obtain the Left Atrial Volume (LAV), Aorta (Ao) diameter, and Pulmonary Artery (PA) diameter in mice. This technique is a non-invasive, non-terminal procedure that allows assessment of the cardiopulmonary function.

The present methodology teaches the investigator how to measure and use the LAV as a surrogate of chronic elevations in Left Ventricular diastolic ...

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