The yin and yang of adaptive and maladaptive processes in heart failure

The heart is continuously faced with a dynamic workload and is able to respond by modifying its size and shape. In response to acute hemodynamic loads (e.g. short term increases in blood pressure) or conditions that place a physiologic load on the heart (e.g. exercise, pregnancy), the heart is able to adapt and maintain cardiac function. However, a sustained pathological stress such as chronic pressure overload or myocardial infarction, leads to a maladaptive form of heart growth and the heart ultimately fails. Here we discuss the features of adaptive and maladaptive heart growth, the dysregulation of processes involved with the transition to heart failure (e.g. angiogenesis, autophagy), and the regulation of signaling pathways and genes in different cardiac cells (e.g. myocytes, fibroblasts, vascular and inflammatory cells). Finally, we discuss novel therapeutic approaches for heart failure which target adaptive processes in the heart.