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Myocardial hypertrophy and its role in heart failure with preserved ejection fraction
- Source :
- Journal of Applied Physiology. 119:1233-1242
- Publication Year :
- 2015
- Publisher :
- American Physiological Society, 2015.
-
Abstract
- Left ventricular hypertrophy (LVH) is the most common myocardial structural abnormality associated with heart failure with preserved ejection fraction (HFpEF). LVH is driven by neurohumoral activation, increased mechanical load, and cytokines associated with arterial hypertension, chronic kidney disease, diabetes, and other comorbidities. Here we discuss the experimental and clinical evidence that links LVH to diastolic dysfunction and qualifies LVH as one diagnostic marker for HFpEF. Mechanisms leading to diastolic dysfunction in LVH are incompletely understood, but may include extracellular matrix changes, vascular dysfunction, as well as altered cardiomyocyte mechano-elastical properties. Beating cardiomyocytes from HFpEF patients have not yet been studied, but we and others have shown increased Ca2+ turnover and impaired relaxation in cardiomyocytes from hypertrophied hearts. Structural myocardial remodeling can lead to heterogeneity in regional myocardial contractile function, which contributes to diastolic dysfunction in HFpEF. In the clinical setting of patients with compound comorbidities, diastolic dysfunction may occur independently of LVH. This may be one explanation why current approaches to reduce LVH have not been effective to improve symptoms and prognosis in HFpEF. Exercise training, on the other hand, in clinical trials improved exercise tolerance and diastolic function, but did not reduce LVH. Thus current clinical evidence does not support regression of LVH as a surrogate marker for (short-term) improvement of HFpEF.
- Subjects :
- medicine.medical_specialty
Physiology
Diastole
Left ventricular hypertrophy
Article
Physiology (medical)
Internal medicine
Diabetes mellitus
Animals
Humans
Medicine
Calcium Signaling
cardiovascular diseases
Heart Failure
business.industry
Surrogate endpoint
Myocardium
Stroke Volume
medicine.disease
Improved exercise tolerance
Myocardial hypertrophy
Cardiology
Hypertrophy, Left Ventricular
business
Heart failure with preserved ejection fraction
Kidney disease
Subjects
Details
- ISSN :
- 15221601 and 87507587
- Volume :
- 119
- Database :
- OpenAIRE
- Journal :
- Journal of Applied Physiology
- Accession number :
- edsair.doi.dedup.....72364a96be7a93dd68f1bd146c6789da