Bupha-Intr T, Oo YW, Wattanapermpool J. Increased myocardial stiffness with maintenance of length-dependent calcium activation by female sex hormones in diabetic rats. Am J Physiol Heart Circ Physiol 300: H1661-H1668, 2011. First published February 18, 2011 doi:10.1152/ajpheart.00411.2010.-A decrease in peak early diastolic filling velocity in postmenopausal women implies a sex hormonerelated diastolic dysfunction. The regulatory effect of female sex hormones on cardiac distensibility therefore was evaluated in ovariectomized rats by determining the sarcomere length-passive tension relationship of ventricular skinned fiber preparations. Diabetes also was induced in the rat to assess the protective significance of female sex hormones on diastolic function. While ovariectomy had no effect on myocardial stiffness, collagen content, or titin ratio, a significant increase in myocardial stiffness was observed in diabetic rat only when female sex hormones were intact. The increased stiffness in diabetic-sham rats was accompanied by an elevated collagen content resulting from increases in the levels of procollagen and Smad2. Surprisingly, the increased myocardial stiffness in diabetic-sham rats was accompanied by a shift toward a more compliant N2BA of cardiac titin isoforms. The pCa-active tension relationship was analyzed at fixed sarcomere lengths of 2.0 and 2.3 m to determine the magnitude of changes in myofilament Ca 2ϩ sensitivity between the two sarcomere lengths. Interestingly, high expression of N2BA titin was associated with a suppressed magnitude of changes in myofilament Ca 2ϩ sensitivity only in the diabetic-ovariectomized condition. Estrogen supplementation in diabetic-ovariectomized rats partially increased myocardial stiffness but completely reversed the change in myofilament Ca 2ϩ sensitivity. These results indicate a restrictive adaptation of myocardium governed by female sex hormones to maintain myofilament activity in compensation to the pathophysiological induction of cardiac dilatation by the diabetic condition. female sex hormones; diabetes; diastolic distension; titin; collagen THE REGULATORY ROLE OF FEMALE sex hormones on cardiac diastolic function has been indicated from reports showing a significant decrease in peak early diastolic velocity (E-wave) of the heart in postmenopausal women (1, 21). Of the two major factors affecting diastolic filling velocity, namely, relaxation and distension of myocardium, our previous studies in rats have demonstrated prolonged ventricular relaxation induced after chronic deprivation of ovarian sex hormones (8). A decrease in sarcoplasmic reticulum Ca 2ϩ uptake activity ultimately leads to a delayed decay of intracellular Ca 2ϩ level in cardiomyocytes of ovariectomized (OVX) rats, and Ca 2ϩ hypersensitivity of cardiac myofilament detected in such animals also impedes myocardial relaxation (7,8,41). A preventive effect of estrogen supplementation on all of these changes further supports the regulatory role of female sex hormones on ventricular relaxation (7,8)....