Figure 2.

Transition from the compensatory to maladaptive stage in ventricular remodeling. (A) After myocardial stress or injury, ventricular myocardium is exposed to both (a) pathological changes and (b) cardioprotective responses. (B) Progression of ventricular remodeling may be presented as net effects of (a) pathological changes and (b) cardioprotective responses. Thus, ventricular dysfunction may be masked by initial compensatory cardioprotective responses (hypertrophy) despite activation of the multiple maladaptive signaling pathways induced by persistent abnormal myocardial stretch or biomechanical stretch. The net outcome between maladaptive and cardioprotective responses may determine the overall ventricular dysfunction and systemic perfusion. It is plausible that pathological alteration is already initiated in the early phase and that the maladaptive phase commences when compensatory responses fail to normalize wall stress (Figure 1).