Figure 4. Mechanotransduction of low wall shear stress because of left heart failure in endothelial cells and smooth muscle cells results in pathologic vascular remodeling throughout the vessel wall.

Boxes within the cell signaling cascade are colored to match their corresponding box at the top of the figure (altered biomechanics, mechanotransduction, or vascular remodeling). ECM indicates extracellular matrix; eNOS, endothelial nitric oxide synthase; ET‐1, endothelin‐1; F‐Actin, anti‐filamentous actin; MMP, matrix metalloproteinase; NF‐κB, nuclear factor‐κB; PDGF, platelet‐derived growth factor; PECAM‐1, platelet endothelial cell adhesion molecule‐1; ROS, reactive oxygen species; SMC, smooth muscle cell; TGFβ, transforming growth factor beta; and VE cadherin, vascular endothelial cadherin.