Molecular pathways underlying cardiac remodeling during pathophysiological stimulation.
Molecular pathways underlying cardiac remodeling during pathophysiological stimulation.
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DOI：
10.1161/circulationaha.110.942268
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发表时间：
2010-12-21
期刊：
影响因子：
37.8
通讯作者：
Molkentin JD
中科院分区：
文献类型：
--
作者：
Kehat I;Molkentin JD
心脏重塑涉及分子、细胞和间质的变化，临床上表现为损伤或应激刺激后心脏的大小、形状和功能的变化。[1]尽管最初创造心脏重塑一词是为了描述心肌梗死后发生的显著变化，[2，3]但很明显，其他类型的损伤，如压力超负荷（主动脉瓣狭窄、高血压）、炎症性疾病（心肌炎）、特发性扩张型心肌病和容量超负荷（瓣膜返流），也会发生类似的过程。虽然这些疾病的病因不同，但它们都有共同的分子、生化和细胞事件，共同改变心肌的形状。心肌肥厚是一种常见的心脏重塑类型，当心脏经历升高的工作负荷时发生。当面临增加的工作负荷或损伤时，心脏和单个肌细胞增大，作为减少室壁和间隔应力的手段。当心脏肥大发生在运动或怀孕后的健康个体中时，它被归类为“生理性”，并且与心脏损伤无关。相比之下，由压力或容量超负荷或心肌梗死后引起的肥大通常被称为"病理性"。然而，这个名字可能具有误导性，因为病理性肥大也可能涉及一个代偿和适应阶段，该阶段往往会减少室壁应力并维持输出，尽管最终这些积极方面会消失，心室功能下降，通常导致心力衰竭。
Cardiac remodeling involves molecular, cellular, and in-terstitial changes that manifest clinically as changes in size, shape, and function of the heart after injury or stress stimulation. 1 Although the term cardiac remodeling was initially coined to describe the prominent changes that occur after myocardial infarction, 2, 3 it is clear that similar processes transpire after other types of injury such as with pressure overload (aortic valve stenosis, hypertension), inflammatory disease (myocarditis), idiopathic dilated cardiomyopathy, and volume overload (valvular regurgitation). Although the causes of these diseases are different, they share molecular, biochemical, and cellular events to collectively change the shape of the myocardium.Cardiac hypertrophy is a common type of cardiac remodeling that occurs when the heart experiences elevated workload. The heart and individual myocytes enlarge as a means of reducing ventricular wall and septal stress when faced with increased workload or injury. Cardiac hypertrophy is classified as “physiological” when it occurs in healthy individuals after exercise or pregnancy and is not associated with cardiac damage. In contrast, hypertrophy that results from pressure or volume overload or after myocardial infarction is usually referred to as “pathological.” This name may be misleading, however, because pathological hypertrophy may also involve a compensatory and adaptive phase that tends to reduce wall stress and maintain output, although ultimately these positive aspects are lost and ventricular function declines, often leading to heart failure.