Myocardial infarction remodeling that progresses to heart failure: a signaling misunderstanding

Following myocardial infarction (MI), remodeling of the left ventricle (LV) involves a wound healing orchestra involving a variety of cell types. In order for wound healing to be optimal, appropriate communication must occur--these cells all need to come in at the right time, be activated at the right time in the right amount, and know when to exit at the right time. When this occurs, a new homeostasis is obtained within the infarct, such that infarct scar size and quality is sufficient to maintain LV size and shape. The ideal scenario does not always occur in reality. Often, miscommunication can occur between infarct and remote spaces, across the temporal wound healing spectrum, and across organs. When miscommunication occurs, adverse remodeling can progress to heart failure. This review discusses current knowledge gaps and recent development of the roles of inflammation and extracellular matrix in MI remodeling. In particular, the macrophage is one cell type that provides direct and indirect regulation ...