Cardiac remodelling by fibrous tissue: role of local factors and circulating hormones

Following myocardial infarction (MI), extensive fibrosis appears at and remote to the MI and is associated with diastolic dysfunction. Both circulating and tissue hormones contribute to the adverse structural remodelling of the myocardium and thereby influence the progressive nature of heart failure. In this review, factors contributing to the appearance of fibrous tissue will be considered, with special emphasis on the role of peptides produced within the diseased myocardium and on the circulating hormones of the renin-angiotensin-aldosterone system.