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Regulation of Fibrosis After Myocardial Infarction: Implications for Ventricular Remodeling

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Cardiac Remodeling

Part of the book series: Advances in Biochemistry in Health and Disease ((ABHD,volume 5))

Abstract

Fibrosis plays a critical role in ventricular remodeling after myocardial infarction (MI). The normal physiologic response to tissue injury in mammals involves activation of the healing process that leads to repair of the injured area with a fibrotic scar over time. In the heart, healing of the damaged area of the left ventricular (LV) chamber after MI with a firm fibrous scar is essential for the chamber to continue to pump blood effectively into the tissues. Optimal healing and repair of the wounded heart with appropriate fibrosis is critical for restoration of chamber size, shape, integrity, and systolic function and survival with a favorable outcome. Dysregulated healing and repair mechanisms may lead to adverse remodeling and poor outcome. While reparative fibrosis in the infarct zone is desirable, reactive interstitial fibrosis in the non-infarct zone contributes to chamber stiffness and diastolic dysfunction. Evidence suggests that the regulation and temporal progression of fibrosis may differ in the two zones. In addition, fibrosis in the infarct and non-infarct zones may become dysregulated and contribute to mixed dilative and hypertrophic remodeling and mixed LV systolic and diastolic dysfunction. Besides reparative and reactive fibrosis in the infarcted LV, fibrosis that develops at remote sites such as the atrial and right ventricular chambers and the kidneys can influence outcome after MI. Understanding the differential mechanisms of fibrosis in the infarct, non-infarct, and remote zones may allow the development of new and improved therapeutic strategies for controlling fibrosis and improve outcome in survivors of MI.

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Acknowledgments

This work was supported in part by grant # IAP99003 from the Canadian Institutes of Health Research, Ottawa, Ontario. I thank Catherine Jugdutt and Bernadine Jugdutt for assistance with the manuscript preparation and the figures.

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  1. Division of Cardiology, Department of Medicine, University of Alberta, 2C2 Walter MacKenzie Health Sciences Centre, Edmonton, AB, Canada, T6G 2R7

    Bodh I. Jugdutt M.D., M.Sc., D.M.

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Correspondence to Bodh I. Jugdutt M.D., M.Sc., D.M. .

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  1. Walter MacKenzie Health Sciences Centre, Division of Cardiology, University of Alberta, 8440-112 Street, Edmonton, T6G 2B7, Alberta, Canada

    Bodh I. Jugdutt

  2. St. Boniface General Hospital Research C, Institute of Cardiovascular Sciences, Tache Avenue 351, Winnipeg, R2H 2A6, Manitoba, Canada

    Naranjan S. Dhalla

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© 2013 Springer Science+Business Media New York

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Jugdutt, B.I. (2013). Regulation of Fibrosis After Myocardial Infarction: Implications for Ventricular Remodeling. In: Jugdutt, B., Dhalla, N. (eds) Cardiac Remodeling. Advances in Biochemistry in Health and Disease, vol 5. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5930-9_29

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