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26.01.2023 | Schwerpunkt

Mechanoenergetische Defekte bei Herzinsuffizienz

verfasst von: Prof. Dr. Christoph Maack

Erschienen in: Herz | Ausgabe 2/2023

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Zusammenfassung

Die Herzinsuffizienz ist gekennzeichnet durch Defekte der elektromechanischen Kopplung, energetisches Defizit und oxidativen Stress. Die Bereitstellung von Energie für die kardiale Kontraktion und Relaxation erfolgt in Mitochondrien, deren Funktion eng durch die elektromechanische Kopplung in Herzmuskelzellen reguliert wird. Bei der Herzinsuffizienz mit reduzierter Ejektionsfraktion (HFrEF) beeinträchtigen Veränderungen des Ionenhaushalts in Herzmuskelzellen die mitochondriale Ca²⁺-Aufnahme und erzeugen so über mangelhafte Zitratzyklusaktivierung energetisches Defizit und oxidativen Stress. Neuere klinische Studien legen nahe, dass bei Herzinsuffizienz mit erhaltener Ejektionsfraktion (HFpEF) – im Gegensatz zu HFrEF – häufig eine Hyperkontraktilität vorliegt, die pathologisch erhöhte systemische und pulmonale Gefäßwiderstände zu kompensieren versucht. Diese Hyperkontraktilität erhöht den kardialen Energie- und Sauerstoffbedarf in Ruhe und reduziert die kontraktile, diastolische und koronare Reserve, wodurch keine adäquate Steigerung des Herzzeitvolumens unter Belastung erfolgen kann. Darüber hinaus verursacht die gesteigerte Kontraktilität langfristig maladaptive Remodelling-Prozesse, die u. a. auf oxidativen Stress und redoxsensible prohypertrophe Signalwege zurückzuführen sind. Da Übergewicht und Diabetes, insbesondere im Zusammenspiel mit hämodynamischer Belastung, wichtige Risikofaktoren für die Entwicklung einer HFpEF sind, könnten insbesondere metabolische Interventionen einen günstigen Einfluss auf die Entstehung und den Verlauf der HFpEF haben.

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Titel: Mechanoenergetische Defekte bei Herzinsuffizienz
verfasst von: Prof. Dr. Christoph Maack
Publikationsdatum: 26.01.2023
Verlag: Springer Medizin
Erschienen in: Herz / Ausgabe 2/2023
Print ISSN: 0340-9937
Elektronische ISSN: 1615-6692
DOI: https://doi.org/10.1007/s00059-022-05161-3

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Mechanoenergetische Defekte bei Herzinsuffizienz

Zusammenfassung

Neu im Fachgebiet Kardiologie

Schadet Ärger den Gefäßen?

Intervallfasten zur Regeneration des Herzmuskels?

Shunt-Therapie bei Herzinsuffizienz: Kein Anzug, der allen passt

Vorsicht, erhöhte Blutungsgefahr nach PCI!

Update Kardiologie

Springer Medizin

Zusammenfassung

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