Cardiac remodelling - Part 1: From cells and tissues to circulating biomarkers. A review from the Study Group on Biomarkers of the Heart Failure Association of the European Society of Cardiology
Arantxa González 1 2, A Mark Richards 3 4, Rudolf A de Boer 5, Thomas Thum 6 7, Henrike Arfsten 8 9, Martin Hülsmann 8, Inês Falcao-Pires 10, Javier Díez 1 2 11, Roger S Y Foo 3, Mark Y Chan 3, Alberto Aimo 12 13, Chukwuemeka G Anene-Nzelu 3 14, Magdy Abdelhamid 15, Stamatis Adamopoulos 16, Stefan D Anker 17 18, Yuri Belenkov 19, Tuvia Ben Gal 20, Alain Cohen-Solal 21, Michael Böhm 22, Ovidiu Chioncel 23, Victoria Delgado 24, Michele Emdin 12 13, Ewa A Jankowska 18, Finn Gustafsson 25, Loreena Hill 26, Tiny Jaarsma 27, James L Januzzi 28, Pardeep S Jhund 29, Yuri Lopatin 30, Lars H Lund 31, Marco Metra 32, Davor Milicic 33, Brenda Moura 34 35, Christian Mueller 36, Wilfried Mullens 37, Julio Núñez 2 38, Massimo F Piepoli 39, Amina Rakisheva 40, Arsen D Ristić 41 42, Patrick Rossignol 43, Gianluigi Savarese 31, Carlo G Tocchetti 44, Sophie Van Linthout 9 45, Maurizio Volterrani 46, Petar Seferovic 42 47, Giuseppe Rosano 48, Andrew J S Coats 49, Antoni Bayés-Genís 2 24 50
Cardiac remodelling refers to changes in left ventricular structure and function over time, with a progressive deterioration that may lead to heart failure (HF) development (adverse remodelling) or vice versa a recovery (reverse remodelling) in response to HF treatment.
Adverse remodelling predicts a worse outcome, whilst reverse remodelling predicts a better prognosis. The geometry, systolic and diastolic function and electric activity of the left ventricle are affected, as well as the left atrium and on the long term even right heart chambers.
At a cellular and molecular level, remodelling involves all components of cardiac tissue: cardiomyocytes, fibroblasts, endothelial cells and leucocytes. The molecular, cellular and histological signatures of remodelling may differ according to the cause and severity of cardiac damage, and clearly to the global trend toward worsening or recovery.
These processes cannot be routinely evaluated through endomyocardial biopsies, but may be reflected by circulating levels of several biomarkers. Different classes of biomarkers (e.g. proteins, non-coding RNAs, metabolites and/or epigenetic modifications) and several biomarkers of each class might inform on some aspects on HF development, progression and long-term outcomes, but most have failed to enter clinical practice.
This may be due to the biological complexity of remodelling, so that no single biomarker could provide great insight on remodelling when assessed alone. Another possible reason is a still incomplete understanding of the role of biomarkers in the pathophysiology of cardiac remodelling. Such role will be investigated in the first part of this review paper on biomarkers of cardiac remodelling.
Keywords: Biomarkers; Cells; Remodeling; Tissue.
© 2022 European Society of Cardiology.