MYOCYTE DEATH IN HEART-FAILURE

Decompensated eccentric ventricular hypertrophy characterizes the tran sition from compensated pressure or volume overload hypertrophy to myo cardial dysfunction and failure. Myocyte loss is the major etiologic f actor of wall thinning and chamber dilation and may condition the prog ression of the cardiac myopathy. Myocyte death can occur by apoptosis or necrosis, but the activation of the suicide program of myocytes exc eeds necrotic cell death in the pathologic heart of ischemic origin. W hether reactive fibrosis constitutes a primary event in the initiation of ventricular dysfunction or a secondary reaction to myocyte death i s an important unanswered question.