ABSTRACT
Abstract Cardiac remodeling is defined as a group of molecular, cellular and interstitial changes that manifest clinically as changes in size, mass, geometry and function of the heart after injury. The process results in poor prognosis because of its association with ventricular dysfunction and malignant arrhythmias. Here, we discuss the concepts and clinical implications of cardiac remodeling, and the pathophysiological role of different factors, including cell death, energy metabolism, oxidative stress, inflammation, collagen, contractile proteins, calcium transport, geometry and neurohormonal activation. Finally, the article describes the pharmacological treatment of cardiac remodeling, which can be divided into three different stages of strategies: consolidated, promising and potential strategies.
Resumo A remodelação cardíaca é definida como um conjunto de mudanças moleculares, celulares e intersticiais cardíacas, que se manifestam clinicamente por alterações no tamanho, massa, geometria e função do coração, em resposta à determinada agressão. Esse processo resulta em mal prognóstico, pois está associado com a progressão da disfunção ventricular e arritmias malignas. Nessa revisão, são discutidos os conceitos e as implicações clínicas da remodelação, além do papel fisiopatológico de diferentes fatores, incluindo morte celular, metabolismo energético, estresse oxidativo, inflamação, colágeno, proteínas contráteis, transporte de cálcio, geometria e ativação neurohormonal. Finalmente, o artigo apresenta o tratamento farmacológico, que pode ser dividido em três estágios: estratégias consolidadas, promissoras e potenciais.
Subject(s)
Humans , Ventricular Dysfunction/drug therapy , Ventricular Dysfunction/physiopathology , Ventricular Remodeling/physiology , Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Arrhythmias, Cardiac/drug therapy , Arrhythmias, Cardiac/metabolism , Arrhythmias, Cardiac/physiopathology , Calcium/metabolism , Collagen/metabolism , Myocardial Infarction/drug therapy , Myocardial Infarction/metabolism , Myocardial Infarction/physiopathology , Oxidative Stress , Ventricular Dysfunction/metabolismABSTRACT
Antecedentes: El sistema renina angiotensina (SRA) es bastante complejo pues a la vía clásica, vasoconstrictora e hipertrofiante, se suma una vía paralela vasodilatadora y antiproliferativa cuyo componente principal es la ECA-2. Objetivo y Métodos: Determinar los cambios en la actividad de ECA y ECA-2 y niveles de angiotensinas (Ang) en el remodelamiento y disfunción ventricular temprano y tardío post infarto al miocardio (IAM) experimental. Se usaron ratas Sprague Dawley 200 +/- 10 g peso, las cuales se sometieron a ligadura de la arteria coronaria izquierda. Como controles se usaron ratas sham (S). La función ventricular se determinó por ecocardiografía transtoráxica bidimiensional después de 1 y 8 semanas de la cirugía, al igual que las actividades enzimáticas de ECA y de ECA-2 (fluorimetría) circulantes y en ventrículo izquierdo (VI), y los niveles circulantes de Ang I, II, (1-7) y (1-9) (HPLC y RIA). Conclusión: La progresión del remodelamiento miocárdico post infarto se asocia a un aumento de la actividad enzimática de ECA, y a una disminución de la actividad enzimática de ECA-2. Estos cambios favorecen la vasocontricción arterial, la fibrosis miocárdica y la hipertrofia ventricular patológica.
Background: The physiology of the renin angiotensin system (RAS) is complex: the vasodilator and anti proliferative effects of ACE-2 are added to the vasoconstrictor and hypertrophy induced effects of traditional ACE. Aim and methods: To determine the changes in ACE and ACE-2 along with angiotensin levels in relation to left ventricular remodeling and dysfunction, early an late after experimental myocardial infarction (MI). Sprague-Daley rats with weight 200 +/- 10 g were submitted to left coronary artery legation. Left ventricular function was estimated by transthoracic bidimensional echocardiography, one and 8 weeks after surgery. Activities of ACE and ACE-2 were determined y photometry both in plasma and in the left ventricle: angiotensin I and II (1-7 and 1-9) were measure by HPLC and RIA. Conclusion: Evolving myocardial remodeling after myocardial infarction is associated to increased levels of ACE and decreased levels of ACE-2. These changes would lead to arterial vasoconstriction, myocardial fibrosis and pathologic left ventricular hypertrophy.