Stress pathways and heart failure

Stress-related pathways can be linked to each of these four pieces of the dilated cardiomyopathy puzzle: biomechanical stimuli, cytoskeletal signaling, myocyte survival, and SR calcium cycling. While the 'cholesterol' of dilated cardiomyopathy has yet to be identified, genetic clustering suggests the likelihood that chronic increases in wall stress mediated via cytoskeletal pathways may lead to the concomitant activation of downstream effects on myocyte survival, apoptosis, hypertrophy, and calcium cycling that drive the progression of heart failure. If such is the case, it may become possible to reverse the process of dilated cardiomyopathy by relieving wall stress at the molecular level. Given the pace and quality of recent work from many laboratories, the solution to the puzzle of heart failure may be closer than previously imagined.