Cardiac Remodelling in the Era of the Recommended Four Pillars Heart Failure Medical Therapy

Figures

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  Figure 1. Cardiac remodelling pathophysiology. Heart failure is due to different causes such as cardiomyopathy, coronary artery disease, pressure/volume overload disorders, inflammatory/infective processes and infiltrative disorders. Pathological processes involving cardiomyocytes, the extracellular matrix, the endothelial function and inflammation are responsible for mechanism of cardiac remodelling. GDF‐15, growth differentiation factor‐15; ICAM, intercellular adhesion molecule 1; IL, interleukin; NO, nitric oxide; PICP, carboxy‐terminal propeptide of procollagen type I; RAA, renin‐angiotensin‐aldosterone axis; ROS, reactive oxygen species; TNF‐α, tumour necrosis factor‐α; VCAM, vascular cell adhesion molecule 1.

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  Figure 2. Four pillars heart failure medical therapy and cardiac reverse remodelling. ACE‐I/ARB/ARNI, beta‐blockers, MRA and SGLT2i promote cardiac reverse remodelling. The reverse remodelling is explained by different pharmacological effects including antioxidant properties, anti‐inflammatory effect, reduction of myocardial fibrosis and sympathetic activation, increase of mitochondrial and endothelial function. These processes eventually lead to reduction of myocardial volumes, mass and filling pressure, increase of LVEF and GLS, improvement of LA and RV structure and function. ACEI/ARB/ARNI, angiotensin‐converting enzyme inhibitors/angiotensin receptors II blockers/angiotensin receptor blocker‐neprilysin inhibitors; cGMP, cyclic guanosine monophosphate; GLS, global longitudinal strain; LA, left atrial; LV, left ventricle; LVEF, left ventricle ejection fraction; MRA, mineralocorticoid receptor antagonists; PA, pulmonary artery; RV, right ventricle; SGLT2i, sodium‐glucose transport protein 2 inhibitors.