DOI: 10.25881/20728255_2022_17_3_4

Authors

Shevchenko Yu.L., Ulbashev D.S.

Pirogov National Medical and Surgical Center, Moscow

Abstract

The fibrosis is an important pathophysiological basis of heart failure. It is determined in cardiomyopathies of various genesis. According to the results of numerous experimental and clinical studies, the possibility of an isolated violation of the structure of the endomysium and perimysium, with a tendency to compaction and gradual mechanical compression of cardiomyocytes – immobilization, has been revealed. Moreover, this process gradually reaches such a degree of coarsening that the formed framework around individual cardiomyocytes and their bundles prevents first a full-fledged diastole, and later systole. This particular form is called “the immobilizing interstitial fibrosis of the heart”.

Conclusion. The immobilizing interstitial fibrosis of the heart is one of the main independent causes of heart failure not associated with atherosclerotic lesions of the coronary arteries. In advanced stages, such fibrosis can lead to coronary artery disease as a result of extravascular compression of arterioles. An isolated violation of the structure of the endomysium and perimysium, manifested by excessive collagen production of types I and III, increases myocardial stiffness and changes cardiodynamics. Antifibrosis strategies aimed at preventing unfavorable remodeling of the heart are becoming a promising approach in the prevention and treatment of heart failure and require further in-depth clinical studies.

Keywords: fibrosis, heart failure, connective tissue.

References

1. Berk BC, Fujiwara K, Lehoux S. ECM remodeling in hypertensive heart disease. J Clin Invest. 2007; 117: 568–575.

2. Creemers EE, Pinto YM. Molecular mechanisms that control interstitial fibrosis in the pressure-overloaded heart. Cardiovascular Research. 2011; 89: 265–272. doi:10.1093/cvr/cvq308.

3. Sabbah HN, Sharov VG, Lesch M, Goldstein S. Progression of heart failure: a role for interstitial fibrosis. Mol Cell Biochem. 1995; 147: 29–34.

4. Weber KT, Sun Y, Tyagi SC, Cleutjens JP. Collagen network of the myocardium: func- tion, structural remodeling and regulatory mechanisms. J Mol Cell Cardiol. 1994; 26: 279–292.

5. Bishop JE, Lindahl G. Regulation of cardiovascular collagen synthesis by mechanical load. Cardiovasc Res. 1999; 42: 27–44.

6. Silver MA, Pick R, Brilla CG, Jalil JE, Janicki JS, Weber KT. Reactive and reparative fibrillar collagen remodelling in the hypertrophied rat left ventricle: two experimental models of myocardial fibrosis. Cardiovasc Res. 1990; 24: 741–747.

7. Shevchenko YuL. The immobilizing interstitial fibrosis of the heart. Рart I. Bulletin of Pirogov National Medical & Surgical Center. 2022; 17(2): 4-10. (In Russ). doi:10.25881/20728255_2022_17_2_4.

8. Tkachenko SB, Beresten NF. Tkanevoe dopplerovskoe issledovanie miokarda. M.: Real Tajm, 2006. (In Russ).

9. Pavlyukova EN, Kuzhel DA, Matyushin GV, et al. Rotaciya, skruchivanie i raskruchivanie levogo zheludochka: fiziologicheskaya rol’ i znachenie v klinicheskoj praktike. Racional’naya farmakoterapiya v kardiologii. 2015; 11(1): 68-78. (In Russ).

For citation

Shevchenko Yu.L., Ulbashev D.S. The immobilizing interstitial fibrosis of the heart. Part 2. Bulletin of Pirogov National Medical & Surgical Center. 2022;17(3):4-10. (In Russ.) https://doi.org/10.25881/20728255_2022_17_3_4