Markers of fibrosis, inflammation, and remodeling pathways in heart failure

• Ventricular remodeling occurs progressively in patients with heart failure.
• Myocardial remodeling involves not only the myocytes, but also the non-myocyte cells and the extracellular matrix.
• Inflammation and the RAAS are pivotal in the development of cardiac remodeling.
• Troponins, galectin-3 and ST2 are the biomarkers of remodeling that are mentioned in the international guidelines.
• Novel biomarkers are under investigation to track the remodeling process.

Ventricular remodeling occurs progressively in untreated patients after large myocardial infarction and in those with cardiomyopathy. The pathologic changes of increased left ventricular (LV) volume and perturbation in the LV chamber geometry involve not only the myocytes, but also the non-myocyte cells and the extracellular matrix. Inflammation, fibrosis, neuro-hormonal activation, and ongoing myocardial damage are the mechanisms underlying remodeling. The detection of an ongoing remodeling process by means of biomarkers such as cytokines, troponins, neurohormones, metalloproteinases, galectin-3, ST-2 and others, may hold a clinical value and could, to some extent, drive the therapeutical strategy in patients after a myocardial infarction or with heart failure. For this reason, there is an increasing interest in the development of new biomarkers and a great number of laboratory tests have been recently proposed, whose clinical usefulness, however, is not fully established yet.