[Biology of myocardial adaptation to mechanical overload]

Chronic mechanical cardiac overload induces several adaptational processes, such as that provided by the Starling's law, which, allow the heart to function normally during a given period of time. Compensatory hypertrophy is, from a myocardial point of view, characterized by two main adaptational factors: hypertrophy due to a stimulation of protein synthesis and the slowing of the shortening velocity. This drop in contractility has undoubtedly been demonstrated in some experimental models, it is due to an isoenzymatic shift of myosin which is responsible for a depressed myosin ATPase activity. It has been clearly shown that this improves the efficiency of contraction, since for a given tension, the hypertrophied fiber produces less heat. Such a change does in fact exist in human heart but seems to have a limited physiological significance and in, any case, cannot explained the striking decrease in contractility which characterizes the final step of heart failure.