See Article by Shah et al

Impaired cardiac function results in increased neurohormonal activity, a stress response initially mounted to augment cardiac output. However, chronic or excessive activity of the neurohormonal response contributes to progressive myocardial damage and the clinical manifestations of the heart failure (HF) syndrome.¹ This myocardial injury leads to a vicious cycle of organ remodeling, wherein the shape, thickness, volume of the ventricular cavity, and the functional state of the cells populating the stressed heart are adversely altered in a manner that further compromises cardiac performance.^1,2 Early work in animal models of myocardial infarction demonstrated the pathophysiologic significance of cardiac remodeling and a role for neurohormonal blockade in its prevention and reversal.² These findings were subsequently extended to humans with myocardial infarction–associated HF and cardiac dilation in the absence of HF, with the severity of remodeling serving as a poor prognostic indicator.^3,4 Current guideline-directed medical therapy for HF is associated with regression of ventricular dilation and improvement of ejection fraction in a subset of patients, a process called left ventricular reverse remodeling (LVRR). As LVRR has emerged as a strong predictor of improved outcomes in HF patients,^5,6 understanding the molecular determinants of LVRR in humans and developing improved molecular biomarkers that predict LVRR are of great clinical interest. In this issue of Circulation: Heart Failure, Shah et al⁷ implicate a panel of plasma microRNAs (miRNAs) as predictors of LVRR in a cohort of patients with HF with reduced ejection fraction, findings which may point to novel …

参见Shah等人的文章

心脏功能受损会导致神经激素活动增加，这种应激反应最初是为了增加心输出量而建立的。但是，神经激素反应的慢性或过度活动会导致进行性心肌损伤和心力衰竭（HF）综合征的临床表现。¹这种心肌损伤导致器官重塑的恶性循环，其中，以进一步损害心脏性能的方式，不利地改变了心脏的形状，厚度，心室容积和构成受压心脏的细胞的功能状态。^1，2心肌梗死动物模型的早期工作证明了心脏重塑的病理生理意义以及神经激素阻滞在其预防和逆转中的作用。²这些发现随后扩展至患有心肌梗死相关性心力衰竭且在无心力衰竭的情况下心脏扩张的人，重塑的严重程度可作为不良的预后指标。^3，4为HF电流准则定向药物治疗与心室扩张和在一部分患者改善射血分数的回归相关联，称为左的处理室逆重塑（LVRR）。正如LVRR已经成为改进结果的HF患者一个强有力的预测，^5，6了解人中LVRR的分子决定因素并开发预测LVRR的改良分子生物标记物具有重大的临床意义。在《循环：心力衰竭》一期中，Shah等[ ^7]暗示一组血浆微RNA（miRNA）作为射血分数降低的HF患者队列中LVRR的预测指标，这一发现可能表明是新颖的……