Pathological hypertrophy and cardiac interstitium

Fibrosis and renin-angiotensin-aldosterone system

Karl Weber, C. G. Brilla

Research output: Contribution to journalReview article

1754 Citations (Scopus)

Abstract

Left ventricular hypertrophy (LVH) is the major risk factor associated with myocardial failure. An explanation for why a presumptive adaptation such as LVH would prove pathological has been elusive. Insights into the impairment in contractility of the hypertrophied myocardium have been sought in the biochemistry of cardiac myocyte contraction. Equally compelling is a consideration of abnormalities in myocardial structure that impair organ contractile function while preserving myocyte contractility. For example, in the LVH that accompanies hypertension, the extracellular space is frequently the site of an abnormal accumulation of fibrillar collagen. This reactive and progressive interstitial and perivascular fibrosis accounts for abnormal myocardial stiffness and ultimately ventricular dysfunction and is likely a result of cardiac fibroblast growth and enhanced collagen synthesis. The disproportionate involvement of this nonmyocyte cell, however, is not a uniform accompaniment to myocyte hypertrophy and LVH, suggesting that the growth of myocyte and nonmyocyte cells is independent of each other. This has now been demonstrated in in vivo studies of experimental hypertension in which the abnormal fibrous tissue response was found in the hypertensive, hypertrophied left ventricle as well as in the normotensive, nonhypertrophied right ventricle. These findings further suggest that a circulating substance that gained access to the common coronary circulation of the ventricles was involved. This hypothesis has been tested in various animal models in which plasma concentrations of angiotensin II and aldosterone were varied. Based on morphometric and morphological findings, it can be concluded that arterial hypertension (i.e., an elevation in coronary perfusion pressure) together with elevated circulating aldosterone are associated with cardiac fibroblast involvement and the resultant heterogeneity in tissue structure. Nonmyocyte cells of the cardiac interstitium represent an important determinant of pathological LVH. The mechanisms that invoke short- (e.g., collagen metabolism) and long-term (e.g., mitosis) responses of cardiac fibroblasts require further investigation and integration of in vitro with in vivo studies. The stage is set, however, to prevent pathological LVH resulting from myocardial fibrosis as well as to reverse it.

Original languageEnglish (US)
Pages (from-to)1849-1865
Number of pages17
JournalCirculation
Volume83
Issue number6
DOIs
StatePublished - Jan 1 1991
Externally publishedYes

Fingerprint

Cardiomegaly
Left Ventricular Hypertrophy
Renin-Angiotensin System
Fibrosis
Muscle Cells
Fibroblasts
Hypertension
Aldosterone
Heart Ventricles
Collagen
Fibrillar Collagens
Ventricular Dysfunction
Coronary Circulation
Extracellular Space
Growth
Mitosis
Cardiac Myocytes
Angiotensin II
Biochemistry
Hypertrophy

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Pathological hypertrophy and cardiac interstitium : Fibrosis and renin-angiotensin-aldosterone system. / Weber, Karl; Brilla, C. G.

In: Circulation, Vol. 83, No. 6, 01.01.1991, p. 1849-1865.

Research output: Contribution to journalReview article

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