Myocardial proteases and matrix remodeling in inflammatory heart disease

Recently, it has been demonstrated that myocardial inflammation plays a pivotal role in the development and progression of congestive heart failure. The myocardial inflammatory reaction not only affects myocardial hypertrophy and apoptosis, but it has a major influence on the regulation of extracellular matrix turnover. The balance between collagen synthesis and degradation is of crucial relevance in maintaining the structural integrity of the heart. Therefore, the overwhelming inflammatory response, as seen in acute myocarditis or inflammatory cardiomyopathy, could lead to a breakdown of this tightly regulated system. This is an additional key factor in the development and progression of heart failure. This review summarizes the importance of myocardial inflammation in respect to extracellular matrix remodeling and its possible pathophysiological role in the development and progression of left ventricular dysfunction in inflammatory heart disease. (c) 2006 European Society of Cardiology. Published by Elsevier B.V.