Post-ischaemic cardiac dilatation and remodelling: reperfusion injury of the interstitium.

Cardiac size and geometry have an important influence on clinical prognosis in heart disease. The cardiac interstitium would appear to play a major role in modulating muscle configuration after ischaemic insults. Ischaemic reperfusion injury of the heart should not be viewed as confined to the myocyte compartment. There are major events occurring in the interstitial compartment which could ultimately determine the long-term configuration and topography of the heart. Thus, permanent plastic changes in cardiac dimensions appear to evolve after initial alterations in the collagen matrix. The physiological, cellular, biochemical, and molecular considerations in the cardiac interstitium are quite different from those of the myocyte compartment. Accordingly, therapeutic interventions to modulate cardiac geometry and remodelling may differ.