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					Role of aldosterone
  in ventricular remodeling


               By Group Ⅱ
Introduction : ventricular remodeling


   synthesis of aldosterone changes in CHF


  role of aldosterone in ventricular remodeling


conclusion
             Introduction
   Ventricular remodeling:
       Any structural change of the left ( or
    right ) in response to a change in loading
    conditions , including alterations in
    ventricular mass ,chamber size and
    shape.

                        crawford MH, cardiology.2004;325-326
Mariell Jessup, M.D., and Susan Brozena, M.D. Heart Failure,
N Engl J Med 2003;348:2007-18.
ventricular remodeling

   Activite of neuroendocrine


      Activite of cytokine


   Abnormal gene expression


              ……
The Renin–Angiotensin–Aldosterone System




              Karl T. ,Weber. Aldosterone in congestive heart failure,
              New Engl J Med, 2001; 345:1689-1697
Heart AS mRNA
Role of aldosterone in ventricular remodeling ?


              Experimental evidence




 Improve                               Inhibitor
aldosterone                           aldosterone
inhibitor

                      10 days later    placebo
      Sham-operated


                                                   10 weeks later
                                       placebo
      Left coronary 10 days later
      artery ligation
          (CHF)
                                      eplerenone
fibrosis
Result & Discussion
                       fibrosis
                      hypertropy


                         ACE
aldostenone
                      AT1 receptor


              Ang Ⅱ
ATPase
Serca2 ATPase
Result & discussion
Role of aldosterone in ventricular
remodeling

                       fibro
                       sis

  hypertrop
  y

              Serca2
              ATPase
System      possible explanation for role of aldosterone in CHF
Myocardial reduce interstitial fibrosis and interstital remodeling
           reduce left ventricular hypertrophy
Vascular    more tendency for thrombosis
            decrease endothelial function
            decrease baroreceptor function
Renal       increase urinary potassium and magnesium loss
             worse volume status with enhanced sodium loss
Conclusion
   Local synthesis of aldosterone improved after
    myocardial infarction or heart failure.
   Aldosterone induced a significant cardiac fibrosis
    and hypertrophy ,impaired the cardiac pump and
    decreased the activity of ATPase of heart.
    Therefore , it plays a important role in ventricular
    remodeling.
   To fully understand the mechanism of ventricular
    remodeling ,we will need to investigate the
    molecular networks of aldosterone.
Reference
   Daniela F,Palol G,et al . Additive amelioration of left ventricular remodeling and
    molecular alterations by combined aldosterone and angiotensin receptor blockade after
    myocardial infarction. Cardiovascular Research, 2005: 67 : 97– 105.
   Karl T. ,Weber. Aldosterone in congestive heart failure,N Engl J Med, 2001; 345:1689-97
   Mariell Jessup, M.D., and Susan Brozena, M.D. Heart Failure, N Engl J Med
    2003;348:2007-18.
   Micheline Monteiro de Resende , Katalin Kauser , José Geraldo Mill . Regulation of
    cardiac and renal mineralocorticoid receptor expression by captopril following
    myocardial infarction in rats. Life Sciences 2006 :78 :3066–3073
   KIRKWOOD F. ADAMS, JR. Pathophysiologic role of the renin-angiotensin-aldosterone
    and sympathetic nervous systems in heart failure. Am J Health-Syst Pharm.Vol
    2004 :61:4-13
   C.Heymes,A.Garnier. et cl. Aldosterone-synthase overexpression in heart: a tool to
    explore aldosterone’s effects. 2004:217:213-219
   Tony Karram, Anan Abbasi, Shlomo Keidar,et al. Effects of spironolactone and eprosartan
    on cardiac remodeling and angiotensin-converting enzyme isoforms in rats with
    experimental heart failure.2005:289:1351-1358

				
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posted:5/11/2013
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