[Myocardial hypertrophy and arterial hypertension]

Area of Science:

• Cardiology
• Pathophysiology
• Cardiac Remodeling

Context:

• Myocardial hypertrophy is an adaptive response to increased hemodynamic load in cardiac diseases.
• Hypertensive patients exhibit diastolic dysfunction preceding hypertrophy, potentially causing heart failure symptoms independently.
• Factors beyond hemodynamic load significantly influence the development of myocardial hypertrophy.

Purpose:

• To elucidate the mechanisms underlying myocardial hypertrophy and its relationship with diastolic and systolic dysfunction in cardiac diseases.
• To differentiate between adaptive and inadequate hypertrophy and their clinical manifestations.
• To explore the role of cellular and structural changes in the progression of heart failure.

Summary:

• Functional abnormalities, particularly diastolic dysfunction, can precede myocardial hypertrophy in hypertension, leading to heart failure symptoms.
• Systolic dysfunction develops later, associated with focal myocardial cell death, fibrosis, and structural changes leading to inadequate hypertrophy.
• Advanced inadequate hypertrophy involves significant morpho-functional abnormalities, including altered myocyte-mitochondria ratio, fibrosis, and impaired coronary reserve, resulting in irreversible systolic dysfunction.

Impact:

• Highlights that heart failure symptoms can occur without myocardial hypertrophy, emphasizing the role of diastolic dysfunction.
• Provides insights into the transition from adaptive to inadequate hypertrophy and its link to irreversible systolic dysfunction.
• Underscores the complex interplay of cellular, structural, and functional changes in the progression of cardiac disease and heart failure.