Single-cell dynamics reveal a stress-induced decision between cardiomyocyte hypertrophy and apoptosis

Cardiomyocyte hypertrophy and apoptosis underlie cardiomyopathies and heart failure. While previous studies have reported both hypertrophy and apoptosis at the population level, how individual cells commit to these distinct analog and digital fates is unclear. To elucidate how individual cells decide to grow and/or die, we developed a high-content microscopy approach to track single-cell cardiomyocyte dynamics. Even untreated cells exhibited substantial single-cell variability in growth and death. Uniform treatments of staurosporine or phenylephrine induced distinctive morphological programs resulting in apoptosis and hypertrophy, respectively, but only in cell subpopulations. Increasing concentrations of the {beta}-adrenergic receptor agonist isoproterenol caused a population-level biphasic induction of hypertrophy and then apoptosis, consistent with either apoptosis in the most hypertrophic cells (a grow-and-die model) or an early decision between hypertrophy and delayed apoptosis (a grow-or-die model). By tracking single-cell fates, we found that when stressed with either isoproterenol or phenylphrine, individual cells that hypertrophy are protected from later apoptosis. Further, caspase 3 inhibition shifted the single-cell probability from apoptosis to hypertrophy fates. Machine learning models found that a cells initial size and DNA content or condensation could predict a cells bias for hypertrophy or apoptosis. Together, these data support a grow-or-die conceptual model for cardiomyocyte decisions. This single-cell profiling method for tracking joint analog-digital cell decisions reveals that despite hypertrophy and apoptosis co-occurring at the population level, individual cardiomyocytes decide early whether to grow or die.