Drug Prescription Analysis at Hospital Discharge for Heart Failure Patients at the Institute of Cardiology of Abidjan

Introduction: Understanding improvement of pathophysiology of heart failure has allowed therapeutic progress over the past two decades in the pathology management. Our patients should benefit from these new drugs that improve survival. Objective: To analyze the treatment of hospital discharge according to ESC (European Society of Cardiology) Guidelines. Methods: We carried out a retrospective and descriptive study which included completed survey of patients hospitalized for heart failure in Medicine Department of cardiology Institut of Abidjan between January 1st 2011 to December 31st 2012. We analyzed the drugs prescription during hospital discharge by using the register of hospitalization. Results: 92.9% of the 532 files retained were included. Patients had a mean age of 54.4 ± 16.4 years old. 36.3% of the cases had a heart failure history with an average of 5.7 ± 3.2 days of hospital stay. At the hospital discharge, patients had for prescription: a diuretic specially Furosemide (100%), angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blockers (ARB) (63.7%), a beta-blocker (17.9%) and a mineralocorticoids receptor antagonist (MRA) (51.2%). Diuretic, IEC or ARB and the MRA were prescribed systematically. Beta-blockers were lower prescribed to patients who showed no more signs of congestion. Conclusion: Our prescribing practices were adapted to the guidelines for heart failure management. However, the gaps will be corrected through sensitization and training.

Modalities of Prescription of Regular Physical Activity by Cardiologists in the Management of Hypertensive Patients at the Institute of Cardiology of Abidjan

Introduction-Objective: The clinical management of hypertension is well codified. It is based on drug and non-drug therapies, including regular physical activity. The aim was to evaluate the knowledge of physicians on the importance of regular physical activity (RPA) in the care of hypertensive patients at the Institute of Cardiology of Abidjan (ICA). Material and Methods: That was a prospective and descriptive study carried out from July 20, 2019 to September 7, 2019 at the Outpatient Department of the ICA. Our study population consisted of 32 physicians from the Outpatient Department of the ICA. To achieve our goal, we developed a questionnaire for the physicians, which included seventeen items related to the socio-occupational characteristics, to the level of knowledge of hypertension, to the attitudes and the practices in the management of hypertension, and to the factors limiting the accessibility to the practice of a physical activity. Results: The majority of the health professionals in our study were men (62.50%). Among 32 physicians, 56.25% were cardiologists and 75% had a seniority in position of 1 to 4 years. 81.25% of the physicians responded that the hypertensive patients could not only benefit from non-drug means. The suggestion of a complementary physical activity (jogging and brisk walking) to the hypertension treatment was found 137.5 times. Jogging and brisk walking were the main types of physical activity which were suggested to patients. All the physicians responded 3 times per week when they were asked about the frequency of activities proposed for the clinical management of patients with hypertension. Regarding the medical prescription on the type, frequency, and duration of RPA to patients, there was some discrepancy, although the majority of healthcare professionals recommended brisk walking and jogging. Their responses for a 60-minute physical activity were prevalent in 37.5% of cases. Regular physical activity ranked third in the management of the hypertensive patients. Nevertheless, all respondents proposed drug treatment associated with hygienic-dietary measures. 93.75% of health workers initially considered the physical condition of patients before they prepared them for the physical activity. The respondents regularly regarded the physical condition of the patient to evaluate the practice or not of an RPA at a frequency of 24 times in 57.89% of the cases. 93.75% of them confirmed that there was a positive relationship between the practice of the RPA and the improvement of the patient’s clinical state. Conclusion: The knowledge of physical activity and its benefits on the organism remains a problem for its application even though the health professionals know its positive impact on the prevention and the treatment of hypertension.

Cardiologic side effects of psychotropic drugs

Psychotropic drugs can produce cardiovascular side effects associated with a degree of cardiotoxicity.The coexistence of a heart disease complicates the management of mental illness,can contribute to a reduced quality of life and a worse illness course.The co-occurrence of psychiatric disorders in cardiac patients might affect the clinical outcome and morbidity.Moreover,the complex underlying mechanism that links these two conditions remains unclear.This paper discusses the known cardiovascular complications of psychotropic drugs and analyzes the important implications of antidepressive treatment in patients with previous cardiac history.

Digitalis Medication in Treatment of Heart Failure

In Mexico, digitalis was known since the 16th century and was used to treat patients with bloating, and it was not until the 20th century that it began to be used as a medicine for heart failure. In conjunction with diuretics. Digitalis was later used in combination individualized with the new medications, for this purpose and research has shown that the combination of medications on an individualized basis is what is currently successfully available for the medical treatment of heart failure.

Atorvastatin, etanercept and the nephrogenic cardiac sympathetic remodeling in chronic renal failure rats

BACKGROUND Chronic renal failure(CRF) patients are predisposed to arrhythmias, while the detailed mechanisms are unclear. We hypothesized the chronic inflammatory state of CRF patients may lead to cardiac sympathetic remodeling, increasing the incidence of ventricular arrhythmia(VA) and sudden cardiac death. And explored the role of atorvastatin and etanercept in this process.METHODS A total of 48 rats were randomly divided into sham operation group(Sham group), CRF group, CRF + atorvastatin group(CRF + statin group), and CRF + etanercept group(CRF + rhTNFR-Fcgroup). Sympathetic nerve remodeling was assessed by immunofluorescence of growth-associated protein 43(GAP-43) and tyrosine hydroxylase positive area fraction. Electrophysiological testing was performed to assess the incidence of VA by assessing the ventricular effective refractory period and ventricular fibrillation threshold. The levels of tumor necrosis factor-alpha(TNF-α) and interleukin-1beta were determined by Western blotting and enzyme-linked immunosorbent assay.RESULTS Echocardiogram showed that compared with the Sham group, left ventricular end-systolic diameter and ventricular weight/body weight ratio were significantly higher in the CRF group. Hematoxylin-eosin and Masson staining indicated that myocardial fibers were broken, disordered, and fibrotic in the CRF group. Western blotting, enzyme-linked immunosorbent assay,immunofluorescence and electrophysiological examination suggested that compared with the Sham group, GAP-43 and TNF-α proteins were significantly upregulated, GAP-43 and tyrosine hydroxylase positive nerve fiber area was increased, and ventricular fibrillation threshold was significantly decreased in the CRF group. The above effects were inhibited in the CRF + statin group and the CRF + rhTNFR-Fcgroup.CONCLUSIONS In CRF rats, TNF-α was upregulated, cardiac sympathetic remodeling was more severe, and the nephrogenic cardiac sympathetic remodeling existed. Atorvastatin and etanercept could downregulate the expression of TNF-α or inhibit its activity, thus inhibited the above effects, and reduced the occurrence of VA and sudden cardiac death.

Occlusion with a Vascular Plug of a Congenital Circumflex Coronary Artery—Right Ventricle Fistula with Coronary Steal Phenomenon

Background: Coronary fistulas are abnormal communications with a worldwide prevalence of 0.002% in the general population. Aim: The aim of this study is to present a case of a congenital coronary artery fistula presented with coronary steal and describe this phenomenon. Methods: A systematic search was conducted to explore the relationship between the coronary steal phenomenon and coronary artery diseases using the PubMed database. Case Presentation: A seven-month-old female patient, was admitted to the hospital presenting diaphoresis on feeding and failure to thrive. Physical examination denotes continuous murmur in the fourth intercostal space left parasternal border (IV/VI) crescendo-decrescendo, wide and permanent unfolding of S2 (S1-A2-P2). An echocardiogram shows enlargement of right cavities, dilatation of the left coronary artery, circumflex artery connected to the right ventricle, and pulmonary artery systolic pressure of 45 mmHg. Tomography angiography demonstrated dilatation of the circumflex artery and a tortuous trajectory towards the posterior wall of the right ventricle, suggesting a coronary fistula. Results: The findings were corroborated by catheterization and a vascular plug (Amplatzer AVP II) was successfully placed. During follow-up complete obliteration was observed, with adequate weight gain and no associated symptoms. Conclusion: This case illustrates a distinctive clinical manifestation of congenital coronary artery fistula associated with the coronary steal phenomenon, establishing a new paradigm for the early diagnosis and management of this condition in the pediatric population.

Protein C deficiency with venous and arterial thromboembolic events

Protein C(PC)is a key component of the vitamin K-dependent coagulation pathway.It exerts anticoagulant effects by inactivating factors V and VIII.Acquired or inherited PC deficiency results in a prothrombotic state,with presentations varying from asymptomatic to venous thromboembolism.However,there has been an increasing number of reports linking PC deficiency to arterial thromboembolic events,such as myocardial infarction and ischemic stroke.This editorial focuses on the association between PC deficiency and thromboembolism,which may provide some insights for treatment strategy and scientific research.

Venopulmonary ECMO Improved Hypoxemia and Supported the Right Ventricle in a Patient with Decompensated Eisenmenger Syndrome

Mechanical circulatory and/or respiratory assistance with extracorporeal membrane oxygenation (ECMO) has become a standard of care for patients with circulatory (venoarterial) and/or respiratory (venovenous) failure refractory to standard therapies. Adult patients with congenital heart disease are an increasingly recognized and growing population and include various groups, such as undiagnosed cases in childhood and palliated and/or corrected cases, which require subsequent care because of residual lesions, cardiac arrest/insufficiency, and arrhythmias, among other conditions. In addition, these patients are prone to developing pathologies that are typical of adulthood with a generally increased risk of morbidity and mortality because of their low reserves and organic damage associated with the underlying heart disease, which makes them candidates for ECMO. These patients represent an additional challenge in this therapy because malformations and the presence of a shunt can generally affect the usual cannulation methods and hemodynamic and oximetry monitoring. Thus, the configuration decision must be made on a case-by-case basis. Here, we present a cannulation method, venopulmonary artery ECMO, which provides hemodynamic and respiratory support, and may be ideal for patients with shunts and/or right ventricular dysfunction. To our knowledge, this is the first report of this configuration in patients with congenital heart diseases.

Fabry Disease: Update, Focusing on Heart Disease by Multimodal Imaging

Fabry disease (FD) is a rare X-linked lysosomal accumulation disorder caused by a deficiency in the enzyme alpha-galactosidase A (Gal A), resulting in excessive storage of glycosphingolipids, particularly globotriaosylceramide (Gb3). This leads to cellular dysfunction in various organs, with cardiovascular compromise being the major cause of morbidity and mortality. This study aimed to provide a comprehensive overview of FD focusing on its genetic, epidemiological, clinical, diagnostic, and therapeutic aspects. This study explored the genetic mutations associated with FD, its epidemiology, clinical phenotypes, cardiac manifestations, diagnostic approaches, and current treatment options. Background: FD is caused by mutations in GLA on the X chromosome, with over 1000 identified variants. Neonatal screening and specific studies have shown an increased incidence of FD. The clinical presentation varies between classic and late phenotypes, with cardiac involvement being a major concern, particularly in late-onset FD. Purpose: This study aimed to summarize the current knowledge on FD, emphasizing cardiac involvement, diagnostic modalities, and treatment options. Methods: A literature review of relevant studies on FD, including genetics, epidemiology, clinical presentation, diagnostic methods, and treatment options, was conducted. Results: Cardiac manifestations of FD included left ventricular hypertrophy (LVH), heart failure, arrhythmias, and sudden death. Diagnostic approaches such as electrocardiography, echocardiography, and cardiac magnetic resonance imaging play crucial roles in the early detection and monitoring of cardiac involvement. Enzyme replacement therapy (ERT) and emerging treatments have shown promise in managing FD, although challenges remain. Conclusions: FD remains a challenging condition in cardiology, with under-diagnosis being a concern. Early detection and specific therapy are essential to improve patient outcomes. Echocardiography and cardiac MRI are valuable tools for diagnosis and follow-up. Despite the advances in treatment, accessibility remains an issue. More research is needed to deepen our understanding of FD and to improve therapeutic strategies.

Mechanical Complications after Myocardial Infarction: A Comprehensive Review

Mechanical complications of myocardial infarction are potentially fatal events that can occur after an acute myocardial infarction. While the introduction of primary percutaneous reperfusion and fibrinolysis has reduced the incidence of these complications to less than 1%. These complications pose significant hemodynamic consequences and necessitate prompt diagnosis. Echocardiography, cardiac magnetic resonance imaging, and computed tomography are valuable tools for establishing an accurate and expedited diagnosis. Consequently, it is imperative to conduct further scientific research to enhance hemodynamic stabilization techniques such as intra-aortic balloon counterpulsation and extracorporeal membrane oxygenation, in addition to exploring new surgical procedures that can reduce mortality resulting from mechanical complications. This article aims to provide a comprehensive review of mechanical complications following myocardial infarction and their correlation with multi-imaging, facilitating a better understanding of these complications.

Hypertrophic cardiomyopathy and left ventricular non-compaction:Distinct diseases or variant phenotypes of a single condition?

Hypertrophic cardiomyopathy(HCM)is a genetically determined myocardial disease characterized by an increased thickness of the left ventricle(LV)wall that cannot be solely attributed to abnormal loading conditions.HCM may present with an intraventricular or LV outflow tract obstruction,diastolic dysfunction,myocardial fibrosis and/or ventricular arrhythmias.Differentiating HCM from other diseases associated with LV hypertrophy,such as hypertension,aortic stenosis,or LV non-compaction(LVNC),can at times be challenging.LVNC is defined by excessive LV trabeculation and deep recesses between trabeculae,often accompanied by increased LV myocardial mass.Previous studies indicate that the LVNC phenotype may be observed in up to 5%of the general population;however,in most cases,it is a benign finding with no impact on clinical outcomes.Nevertheless,LVNC can occasionally lead to LV systolic dysfunction,manifesting as a phenotype of dilated or non-dilated left ventricular cardiomyopathy,with an increased risk of thrombus formation and arterial embolism.In extreme cases,where LVNC is associated with a very thickened LV wall,it can even mimic HCM.There is growing evidence of an overlap between HCM and LVNC,including similar genetic mutations and clinical presentations.This raises the question of whether HCM and LVNC represent different phenotypes of the same disease or are,in fact,two distinct entities.

Role of angiotensin receptor-neprilysin inhibitor in diabetic complications

Diabetes mellitus is a prevalent disorder with multi-system manifestations,causing a significant burden in terms of disability and deaths globally.Angio-tensin receptor-neprilysin inhibitor(ARNI)belongs to a class of medications for treating heart failure,with the benefits of reducing hospitalization rates and mortality.This review mainly focuses on the clinical and basic investigations related to ARNI and diabetic complications,discussing possible physiological and molecular mechanisms,with insights for future applications.

Prediction of cyanotic and acyanotic congenital heart disease using machine learning models

BACKGROUND Congenital heart disease is most commonly seen in neonates and it is a major cause of pediatric illness and childhood morbidity and mortality.AIM To identify and build the best predictive model for predicting cyanotic and acyanotic congenital heart disease in children during pregnancy and identify their potential risk factors.METHODS The data were collected from the Pediatric Cardiology Department at Chaudhry Pervaiz Elahi Institute of Cardiology Multan,Pakistan from December 2017 to October 2019.A sample of 3900 mothers whose children were diagnosed with identify the potential outliers.Different machine learning models were compared,and the best-fitted model was selected using the area under the curve,sensitivity,and specificity of the models.RESULTS Out of 3900 patients included,about 69.5%had acyanotic and 30.5%had cyanotic congenital heart disease.Males had more cases of acyanotic(53.6%)and cyanotic(54.5%)congenital heart disease as compared to females.The odds of having cyanotic was 1.28 times higher for children whose mothers used more fast food frequently during pregnancy.The artificial neural network model was selected as the best predictive model with an area under the curve of 0.9012,sensitivity of 65.76%,and specificity of 97.23%.CONCLUSION Children having a positive family history are at very high risk of having cyanotic and acyanotic congenital heart disease.Males are more at risk and their mothers need more care,good food,and physical activity during pregnancy.The best-fitted model for predicting cyanotic and acyanotic congenital heart disease is the artificial neural network.The results obtained and the best model identified will be useful for medical practitioners and public health scientists for an informed decision-making process about the earlier diagnosis and improve the health condition of children in Pakistan.

Use of intravascular imaging in managing coronary artery disease

For many years,coronary angiography has been considered "the gold standard" for evaluating patients with coronary artery disease. However,angiography only provides a planar two-dimensional silhouette of the lumen and is unsuitable for the precise assessment of atherosclerosis. With the introduction of intravascular imaging,direct visualization of the arterial wall is now feasible. Intravascular imaging modalities extend diagnostic information,thereby enabling more precise evaluation of plaque burden and vessel remodeling. Of all technologies,intravascular ultrasound(IVUS) is the most mature and widely used intravascular imaging technique. Optical coherence tomography(OCT) is an evolving technology that has the highest spatial resolution of existing imaging methods,and it is becoming increasingly widespread. These methods are useful tools for planning interventional strategies and optimizing stent deployment,particularly when stenting complex lesions. We strongly support the mandatory use of IVUS for left main percutaneous coronary intervention(PCI). In addition,it can be used to evaluate vascularresponses,including neointimal growth and strut apposition,during follow-ups. Adequately powered randomized trials are needed to support IVUS or OCT use in routine clinical practice and to answer whether OCT is superior to IVUS in reducing adverse events when used to guide PCI. The current perception and adoption of innovative interventional devices,such as bioabsorbable scaffolds,will increase the need for intravascular imaging in the future.

Prediction of atrial fibrillation development and progression:current perspectives

Atrial fibrillation(AF) is the most common arrhythmia in clinical practice. Several conventional and novel predictors of AF development and progression(from paroxysmal to persistent and permanent types) have been reported. The most important predictor of AF progression is possibly the arrhythmia itself. The electrical, mechanical and structural remodeling determines the perpetuation of AF and the progression from paroxysmal to persistent and permanent forms. Common clinical scores such as the hypertension, age ≥ 75 years, transient ischemic attack or stroke, chronic obstructive pulmonary disease, and heart failure and the congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65-74 years, sex category scores as well as biomarkers related to inflammation may also add important information on this topic. There is now increasing evidence that even in patients with so-called lone or idiopathic AF, the arrhythmia is the manifestation of a structural atrial disease which has recently been defined and described as fibrotic atrial cardiomyopathy. Fibrosis results from a broad range of factors related to AF inducing pathologies such as cell stretch, neurohumoral activation, and oxidative stress. The extent of fibrosis as detected either by late gadolinium enhancement-magnetic resonance imaging or electroanatomic voltage mapping may guide the therapeutic approach based on the arrhythmia substrate. The knowledge of these risk factors may not only delay arrhythmia progression, but also reduce the arrhythmia burden in patients with first detected AF. The present review highlights on the conventional and novel risk factors of development and progression of AF.

Abnormal Calcium “Sparks” in Cardiomyocytes of Post-myocardial Infarction Heart

In ischemic hypertrophic myocardium, contractile dysfunction can be attributed to the decreased calcium induced calcium release （CICR） in cytoplasm. This study aimed to investigate the electrophysiological properties and the expression of L calcium channel subunits in post-MI myocardium. The ischemic heart remodeling model was established in SD rats. The expressions of calcium channel subunits were determined by realtime RT-PCR. Whole cell patch clamp was used to record the electrophysiological properties of L calcium channel. The results showed that the L calcium channel agonist Bayk 8644 induced the significantly decreased CICR in the rat cardiomyocyte 6 weeks after myocardial infarction （MI）. In the post-MI cardiomyocytes, the amplitude of ICaL decreased dramatically and the inactivation curve of the current shifted to more negative potential. At mRNA level, the expression of the calcium channel alpha1c, beta2c subunits decreased dramatically in the ventricle of post-MI rats. The expression of alpha2/delta subunit, however, remained constant. It is concluded that the abnormal expression of the L calcium channel subunits in post-MI cardiomyocytes contributes to the ICaL decrease at early stage of the ischemic remodeling in cardiomyocytes, which leads to the decreased CICR in the cell and contractile dysfunction of myocardium.

Expression of NADPH Oxidase and Production of Reactive Oxygen Species in Aorta in an Active Immunization Mouse Model with AT1-EC2 Peptide

The antibody against AT1-EC2 plays a role in some kinds of inflammatory vascular diseases including malignant hypertension,preeclampsia,and renal-allograft rejection,but the detailed mechanisms remain unclear.In order to investigate the changes of NADPH oxidase and reactive oxygen species in the aorta in a mouse model which can produce AT1-EC2 antibody by active immunization with AT1-EC2 peptide,15 mice were divided into three groups:control group,AT1-EC2-immunized group,and AT1-EC2-immunized and valsartan-treated group.In AT1-EC2-immunized group and AT1-EC2-immunized and valsartan-treated group,the mice were immunized by 50 μg peptide subcutaneously at multiple points for 4 times:0,5,10,and 15 days after the experiment.In AT1-EC2-immunized and valsartan-treated group,valsartan was given at a dose of 100 mg/kg every day for 20 days.After the experiment,the mice were sacrificed under anesthesia and the aortas were obtained and frozen in liquid nitrogen for the preparation of frozen section slides and other experiments.The titer of AT1-EC2 was assayed by using ELISA.The level of NOX1 mRNA in the aorta was determined by using RT-PCR.The expression of NOX1 was detected by using Western blotting.Confocal scanning microscopy was used to assay the α-actin and NOX1 expression in the aortic tissue.The O 2.production was detected in situ after DHE staining.The mice produced high level antibody against AT1-EC2 in AT1-EC2-immunized group and AT1-EC2-immunized and valsartan-treated group,and the level of NOX1 mRNA in the aortic tissues was 1.6±0.4 times higher and the NOX1 protein expression was higher in AT1-EC2-immunized group than in control group.There were no significant differences in the level of NOX1 mRNA and protein expression between control group and AT1-EC2-immunized and valsartan-treated group.The expression and co-localization of α-actin and NOX1 in AT1-EC2-immunized group increased significantly as compared with those in control group,and the O 2.production increased about 2.7 times as compared with control group.There were no significant differences between control group and AT1-EC2-immunized and valsartan-treated group.It is concluded that active immunization with AT1-EC2 can activate NOX1-ROS,and increase vascular inflammation,which can be inhibited by AT1 receptor blocker valsartan.This may partially explain the mechanism of the pathogenesis of inflammatory vascular diseases related to antibody against AT1-EC2.

Experimental Study of Assessment on Ventricular Activation Origin and Contraction Sequence by Doppler Tissue Imaging

To evaluate the possibility and accuracy of Doppler tissue image (DTI) on assessment of normal and abnormal ventricular activation and contraction sequence, 9 open chest canine hearts were analyzed by acceleration mode, M mode, and spectrum mode DTI. Our results showed that: (1) Acceleration mode DTI could show the origin of activation and conduction sequence on line; (2) M mode DTI revealed that the activation in mid interventricular septum was earlier than that in mid left ventricular posterior wall at sinus activation; (3) Spectrum DTI showed the ventricular endocardium was activated earlier than the ventricular epicardium in all segments at sinus rhythm. The earliest site of activation of the normal ventricular wall was at middle interventricular septum; the latest site was at basal posterior wall; the contraction sequence was different at the different walls; (4) During abnormal ventricular activation, mid left ventricular posterior wall was activated earliest in accordance with the pacing sites. Abnormal ventricular activation was slower than sinus activation, and the contraction sequence varied at different sites of ventricular wall. It is concluded that DTI can be used to localize the origin of normal or abnormal myocardial activation and to assess the contraction sequence conveniently, accurately and non invasively.

Heart regeneration:Past,present and future

The heart has been considered a post-mitotic organ without regenerative capacity for most of the last century.We review the evidence that led to this hypothesis in the early 1900s and how it was progressively modified,culminating with the report that we renew 50% of our cardiomyocytes during our lifetime.The future of cardiac regenerative therapies is discussed,presenting the difficulties to overcome before repair of the diseased heart can come into clinical practice.

Phospholamban Antisense RNA Improves SR Ca^(2+)-ATPase Activity and Left Ventricular Function in STZ-induced Diabetic Rats

Objective To study the effect of phospholamban antisense RNA （asPLB） on sarcoplasmic reticulum Ca2＋-ATPase activity and cardiac function in rats with diabetes mellitus （DM） mediated by recombinant adeno-associated virus （rAAV） vector. Methods Six weeks after the induction of DM by streptozotocin injected intraperitoneally, the rats were divided into three groups, namely： DM-rAAV-asPLB group, DM-saline group and DM group （control group）. The rats in the DM-rAAV-asPLB group were intramyocardially injected with rAAV-asPLB, the rats in the DM-saline group were injected with saline, and those in the control group did not receive any treatment. Six weeks after gene transfer, the expressions of PLB protein and PLB phosphorylation were detected by Western-blot, while the activity of sarcoplasmic reticulum （SR） Ca2＋-ATPase and left ventricular function were measured. Results The PLB protein expression level was significantly higher whereas the PLB phosphorylation, SR Ca2＋-ATPase activity and left ventricular function were significantly lower in the DM-saline group than in the control group. No significant difference was found in PLB protein expression level, PLB phosphorylation or SR Ca2＋-ATPase activity between the DM-rAAV-asPLB group and the control group. The left ventricular function in the DM-rAAV-asPLB group was poorer than in the control group and was better than in the DM-saline group. Conclusion rAAV-asPLB can down-regulate PLB protein expression and up-regulate phosphorylation and SR Ca2＋-ATPase activity, thus contributing to the improvement of in vivo ventricutar function. PLB left