Cytopathological basis of heart failure--cardiomyocyte apoptosis, interstitial fibrosis and inflammatory cell response.

A characteristic feature of heart failure is progressive deterioration of the left ventricular function. The mechanisms responsible for progression of heart failure are not known, but may be related to progressive loss of cardiomyocytes due to apoptosis or programmed cell death. Apoptosis of cardiomyocytes can cause scattered loss of cardiomyocytes and, when sufficiently widespread, this might cause heart failure. Beside cardiomyocyte apoptosis, progressive accumulation of interstitial collagen fibres in the heart occurs in the failing heart that may lead to ventricular diastolic or systolic dysfunction. Pathological processes in the failing heart (cardiomyocyte apoptosis, changes in interstitial tissue of the heart) are accompanied by an inflammatory cell response. In this paper cardiomyocyte apoptosis, inflammatory cell response and changes in interstitial tissue of the heart are reviewed as potential factors responsible for progression of the left ventricular dysfunction in heart failure.