Cardiac hypertrophy, defined as an increase in mass of the heart, is a complex process driven by simultaneous changes in hemodynamics, mechanical stimuli, and hormonal inputs. It occurs not only during pre- and post-natal development but also in adults in response to exercise, pregnancy, and a range of cardiovascular diseases. One of the most exciting recent developments in the field of cardiac biomechanics is the advent of computational models that are able to accurately predict patterns of heart growth in many of these settings, particularly in cases where changes in mechanical loading of the heart play an import role. These emerging models may soon be capable of making patient-specific growth predictions that can be used to guide clinical interventions. Here, we review the history and current state of cardiac growth models and highlight three main limitations of current approaches with regard to future clinical application: their inability to predict the regression of heart growth after removal of a mechanical overload, inability to account for evolving hemodynamics, and inability to incorporate known growth effects of drugs and hormones on heart growth. Next, we outline growth mechanics approaches used in other fields of biomechanics and highlight some potential lessons for cardiac growth modeling. Finally, we propose a multiscale modeling approach for future studies that blends tissue-level growth models with cell-level signaling models to incorporate the effects of hormones in the context of pregnancy-induced heart growth.

心脏肥大，定义为心脏质量的增加，是一个复杂的过程，由血液动力学、机械刺激和激素输入的同时变化驱动。它不仅发生在产前和产后发育期间，而且还发生在成年人对运动、怀孕和一系列心血管疾病的反应中。心脏生物力学领域最令人兴奋的最新发展之一是计算模型的出现，这些模型能够准确预测在许多这些环境中心脏的生长模式，特别是在心脏机械负荷变化发挥重要作用的情况下. 这些新兴模型可能很快就能做出可用于指导临床干预的特定于患者的生长预测。这里，我们回顾了心脏生长模型的历史和现状，并强调了当前方法在未来临床应用方面的三个主要局限性：它们无法预测去除机械过载后心脏生长的回归，无法解释不断变化的血流动力学，以及无法结合已知的药物和激素对心脏生长的生长影响。接下来，我们概述了在其他生物力学领域中使用的生长力学方法，并重点介绍了心脏生长建模的一些潜在经验。最后，我们为未来的研究提出了一种多尺度建模方法，该方法将组织水平的生长模型与细胞水平的信号模型相结合，以在妊娠诱导的心脏生长的背景下纳入激素的影响。