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Permanent Ligation of the Left Anterior Descending Coronary Artery in Mice: A Model of Post-myocardial Infarction Remodelling and Heart Failure
Published on: December 2, 2014
Left atrial remodelling contributes to the progression of asymptomatic left ventricular systolic dysfunction to
George Karayannis1, George Kitsios, Haralambos Kotidis
1Department of Cardiology, University of Thessaly Medical School, Larissa University Hospital, P.O. Box 1425, 411 10 Larissa, Greece.
Insights
Left atrial remodeling, including dilation and systolic dysfunction, is a key factor in the progression from asymptomatic left ventricular dysfunction to symptomatic systolic heart failure (HF). This process contributes to pulmonary congestion and neurohormonal activation characteristic of symptomatic HF.
Area of Science:
- Cardiology
- Physiology
- Pathophysiology
Background:
- Systolic heart failure (HF) progresses from asymptomatic left ventricular (LV) dysfunction to symptomatic disease.
- LV remodeling and neurohormonal activation accompany symptomatic HF progression.
- Mechanisms of symptom development in HF remain unclear, potentially independent of hemodynamics.
Purpose of the Study:
- To review evidence supporting the role of left atrial remodeling in the progression to symptomatic systolic HF.
- To elucidate the contribution of left atrial dysfunction to HF symptom development.
Main Methods:
- Narrative review of experimental and clinical evidence.
- Analysis of the mechanical, endocrine, and regulatory functions of the left atrium.
- Examination of the relationship between left atrial remodeling and HF progression.
Main Results:
- Left atrial dilation and systolic dysfunction (remodeling) are identified as contributors to symptomatic HF.
- Left atrial remodeling precedes and facilitates pulmonary congestion and neurohormonal activation.
- Left atrial remodeling is a prerequisite for the development of symptomatic systolic HF.
Conclusions:
- Left atrial remodeling plays a critical role in the transition from asymptomatic LV dysfunction to symptomatic systolic HF.
- Understanding left atrial remodeling offers insights into HF pathophysiology and potential therapeutic targets.
- The left atrium's functions are integral to the development and manifestation of chronic symptomatic systolic HF.
Abstract:
Systolic heart failure (HF) is a progressive disorder that often begins with asymptomatic left ventricular (LV) systolic dysfunction and culminates in symptoms from fluid overload and poor end-organ perfusion. The progression to symptomatic HF is accompanied by marked activation of neurohormonal and cytokine systems, as well as a series of adaptive LV anatomical and functional changes, collectively referred to as LV remodelling. However, the mechanisms underlying symptom appearance have not been delineated and the weight of experimental and clinical evidence suggests that the development of symptomatic HF occurs independently of the haemodynamic status of the patient. The left atrium is a muscular chamber strategically located between the left ventricle and the pulmonary circulation with important mechanical function (modulation of LV filling), which is closely coupled with its endocrine (atrial natriuretic peptide synthesis and secretion) and regulatory (contribution to the control of sympathetic activity and vasopressin release) functions. In this narrative review we provide evidence supporting the concept that left atrial dilation and systolic dysfunction (left atrial remodelling) contributes to the progression of asymptomatic LV dysfunction to chronic symptomatic systolic HF as it is a prerequisite for the development of the pulmonary congestion and marked neuronhormoral activity that characterize the symptomatic state.
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