cAMP plays crucial roles in cardiac remodeling and the progression of heart failure. Recently, we found that expression of cAMP hydrolyzing phosphodiesterase 3A (PDE3A) was significantly reduced in human failing hearts, accompanied by up-regulation of inducible cAMP early repressor (ICER) expression. Angiotensin II (Ang II) and the -adrenergic receptor agonist isoproterenol (ISO) also induced persistent PDE3A down-regulation and concomitant ICER up-regulation in vitro, which is important in Ang II-and ISO-induced cardiomyocyte apoptosis. We hypothesized that interactions between PDE3A and ICER may constitute an autoregulatory positive feedback loop (PDE3A-ICER feedback loop), and this loop would cause persistent PDE3A down-regulation and ICER up-regulation. Here, we demonstrate that ICER induction repressed PDE3A gene transcription. PDE3A down-regulation activated cAMP͞PKA signaling, leading to ICER up-regulation via PKAdependent stabilization of ICER. With respect to Ang II, the initiation of the PDE3A-ICER feedback loop depends on activation of Ang II type 1 receptor (AT1R), classical PKC(s), and CREB (cAMP response element binding protein). We further show that the PDE3A-ICER feedback loop is essential for Ang II-induced cardiomyocyte apoptosis. ISO and PDE3 inhibitors also induced the PDE3A-ICER feedback loop and subsequent cardiomyocyte apoptosis, highlighting the importance of this PDE3A-ICER feedback loop and cAMP signaling in cardiomyocyte apoptosis. Our findings may provide a therapeutic paradigm to prevent cardiomyocyte apoptosis and the progression of heart failure by inhibiting the PDE3A-ICER feedback loop.angiotension II ͉ -andrenergic receptor ͉ PKC ͉ heart failure C ardiac remodeling including dysregulated myocyte apoptosis contributes to the development and progression of myocardial remodeling and the transition from cardiac hypertrophy to chronic heart failure (1-3). Stimulation of the renin-angiotensin and -adrenergic receptor (-AR) systems are broadly involved in contraction, growth control, and cell death (3, 4). Both systems are subject to counterregulatory balances under normal physiological circumstances, which are overridden by chronic activation in heart failure. For example, chronic exposure to angiotensin II (Ang II) and ISO promote cardiac dysfunction resulting from cardiac remodeling including hypertrophy and apoptosis (4-7). Many clinical trials have indicated that angiotensinconverting enzyme inhibitors and -AR blockers significantly improve the survival rates of heart failure patients by decreasing cardiac remodeling (8). However, the exact mechanisms of myocyte apoptosis, especially those mediated by angiotensin II, remain unclear.cAMP signaling plays important roles in both physiologic and pathologic regulation of cardiac performance (9). cAMP is one of the most well characterized signaling molecules in -AR signaling, but its contribution to Ang II signaling in cardiomyocytes is not fully understood. Clinical and experimental studies indicate that acute stimulation of -AR...