Intercellular Communication in Heart Failure: Crosstalk Among Cardiomyocytes, Fibroblasts, Endothelial Cells, and Macrophages

Chronic heart failure (CHF) is a complex disease syndrome closely linked to the interactions among various cell types. These cells establish dynamic communication networks via mediators such as inflammatory factors, cytokines, and exosomes, which collectively drive the progression of key pathological processes including chronic inflammation, myocardial fibrosis, microcirculatory dysfunction, and myocardial contractile dysfunction. A deeper understanding of these intercellular “conversations” not only provides theoretical insights into the pathogenic pathways of heart failure but also lays the foundation for the development of targeted interventions and multi-target therapeutic strategies. This review focuses on the interactions among critical mediators in CHF, including cardiomyocytes, fibroblasts, endothelial cells, and macrophages, exploring their regulatory mechanisms and biological roles throughout the progression of chronic heart failure, with the aim of offering new perspectives for clinical treatment strategies.