Abstract-The dystrophin-glycoprotein complex is a large complex of membrane-associated proteins linking the cytoskeleton to the extracellular matrix in muscle. Transmembrane heterodimeric (␣) integrins serve also as cellular adhesion molecules and mechanotransducers. In the animal model for Duchenne muscular dystrophy, the mdx mouse, loss of dystrophin causes more severe abnormalities in skeletal than in cardiac muscle. We hypothesized that ablation of cardiac myocyte integrins in the mdx background would lead to a severe cardiomyopathic phenotype. Mdx mice were crossed to ones with cardiac myocyte-specific deletion of 1 integrin (1KO) to generate 1KOmdx. Unstressed 1KOmdx mice were viable and had normal cardiac function; however, high mortality was seen in peri-and postpartum females by 6 months of age, when severe myocardial necrosis and fibrosis and extensive dystrophic calcification was seen. Decreased ventricular function and blunted adrenergic responsiveness was found in the 1KOmdx mice compared with control (Lox/Lox, no Cre), 1KO, and mdx. Similarly, adult 1KOmdx males were more prone to isoproterenol-induced heart failure and death compared with control groups. Given the extensive calcification, we analyzed transcript levels of genes linked to fibrosis and calcification and found matrix ␥-carboxyglutamic acid protein, decorin, periostin, and the osteoblast transcription factor Runx2/Cbfa1 significantly increased in 1KOmdx cardiac muscle. Our data show that combined deficiency of dystrophin and integrins in murine cardiac myocytes results in more severe cardiomyopathic changes in the stressed myocardium than reduction of either dystrophin or integrins alone and predisposes to myocardial calcification. Key Words: Integrin Ⅲ muscular dystrophy Ⅲ dystrophin Ⅲ heart failure Ⅲ calcification T he cardiac myocyte cytoskeleton and contractile apparatus are tethered to the sarcolemma at specialized regions termed costameres, which are aligned with the Z-disk. 1 Costameres are important for lateral force transmission from the sarcomere to the extracellular matrix (ECM) and from 1 myocyte to the next. 2 Three different cytoskeleton networks comprise the costamere: the dystrophin glycoprotein complex (DGC), the integrins, and the spectrinbased cytoskeleton.The DGC is composed of several membrane-spanning and associated proteins and is enriched in, but not restricted to, costameric regions. 2,3 In muscle, the DGC includes dystrophin, sarcoglycans (␣, , ␥, ␦, , and ), dystroglycans (␣ and ), ␣-dystrobrevin, syntrophins (␣1, 1 and 2), sarcospan, and NO synthase. Dystrophin is a 427-kDa protein that constitutes a core component of the DGC. Mutations in the human dystrophin gene lead to Duchenne muscular dystrophy (DMD), Becker muscular dystrophy, and X-linked dilated cardiomyopathy. 4 In mice, an X-linked recessive mutation in the dystrophin gene (mdx) results in loss of dystrophin expression, destabilization of the DGC, and muscular dystrophy. Whereas cardiomyopathy may occur early in the life of patie...