Table 1.
Level |
Parameters | Healthy heart | Dilated heart |
---|---|---|---|
Organ | Morphology | Left ventricle slightly larger than the right ventricle | Enlarged and weakened left ventricle [13] |
Diameter between 39 and 59 mm [12] | Diameter larger than 69 mm [12] | ||
Function | Full ejection fraction around 100 mL per beat [30] | Ejection fraction reduced of 45% [6] | |
Not enough oxygen provided | |||
Remodeling | Reversible remodeling with endurance [15] or pregnancy | Irreversible remodeling: increased ECM deposition, fibrosis, inflammation [15] | |
Tissue | Stiffness | From 7 kPa to 15 kPa [31] | Increased due to fibrosis and collagen deposition [32] |
Decreased elasticity [33] | |||
Inflammation | Inflammation is due to infection, oxidative stress or hypertension [18,34] | Robust proinflammatory response following cellular damages [18] | |
Recruitment of immune cells | |||
ECM | Fibers of collagen I and III (ratio 7:1) [35] | Overproduction of fibronectin and collagen [14] (especially I and VI [33]) Fibrosis occupy 20% of the volume [36] | |
Proteoglycans | Loss of CM alignment | ||
Anisotropy to allow CM alignment | |||
Capillary density | 2439 ± 59 capillaries per mm [2,37] | 1245 ± 345 capillaries per mm2 | |
Increased intercapillary distance [38] | |||
Shorter and smaller coronary arteries [22] | |||
Cell composition | Cardiomyocytes (18%), endothelial cells (24%) and mesenchymal cells (58%) [19] CM fill 75% of the volume [20] |
Loss of 10% of CM [36] Decreased cell density |
|
Cardiomyocytes (CM) | Sarcomeric passive tension | Ratio 30/70 between the two isoforms of titin | Reduced ratio 50/50 when titin is mutated [39] |
Faster relaxation kinetics [25] | |||
Myofibrils stiffness decreased by 26% [23] | |||
Contractile function | ECM stiffness for best force contraction generation [26] | Decreased force capacity depending on the mutation [23] | |
Ionic exchanges | Calcium concentration is high during systole and low during diastole (from 1 μM to 100 nM) [40] | Increased calcium sensitivity, enhances the contraction rate [23] Tissue acidification alters electrical conduction [29] | |
Cell metabolism | Adult cells consume fatty acids [41] | Metabolism switch to glucose consumption [27,42] | |
Cell density & morphology | 108 cells/cm3 | Loss of cardiomyocytes [17] Visible remodeling scars [43] Cell hypertrophy around 2 fold [36] |
|
High length/width ratio (7:1) |