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Heart failure - a challenge to our current concepts of excitation-contraction coupling

Ivar Sjaastad *†, J. Andrew Wasserstrom ‡ and Ole M. Sejersted *

Development of novel therapeutic strategies for congestive heart failure (CHF) seems to be hampered by insufficient knowledge of the molecular machinery of excitation-contraction (EC) coupling in both normal and failing hearts. Cardiac hypertrophy and failure represent a multitude of cardiac phenotypes, and available invasive and non-invasive techniques, briefly reviewed here, allow proper quantification of myocardial function in experimental models even in rats and mice. Both reduced fractional shortening and reduced velocity of contraction characterize myocardial failure. Only when myocardial function is depressed in vivo can meaningful studies be done in vitro of contractility and EC coupling. Also, we point out potential limitations with the whole cell patch clamp technique. Two main factors stand out as explanations for myocardial failure. First, a basic feature of CHF seems to be a reduced Ca²⁺ load of the sarcoplasmic reticulum (SR) mainly due to a low phosphorylation level of phospholamban. Second, there seems to be a defect of the trigger mechanism of Ca²⁺ release from the SR. We argue that this defect only becomes manifest in the presence of reduced Ca²⁺ reuptake capacity of the SR and that it may not be solely attributable to reduced gain of the Ca²⁺-induced Ca²⁺ release (CICR). We list several possible explanations for this defect that represent important avenues for future research.

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