Although rapid growth of the heart during early postnatal development
ceases with maturation of the organism, the potential for cardiomyocyt
e growth is not lost and may be observed even in senescent hearts. Rap
id developmental heart growth is accompanied by a proportional growth
of capillaries but not always of larger vessels, and thus coronary vas
cular resistance gradually increases. Growth of adult hearts can be en
hanced by thyroid hormones, catecholamines and the renin-angiotensin s
ystem hormones, but these do not always stimulate growth of coronary v
essels. Likewise, chronic exposure to hypoxia leads to growth, mainly
of the right ventricle and its vessels but without vascular growth els
ewhere in the heart. On the other hand, ischaemia is a potent stimulus
for the release of various growth factors involved in the development
of collateral circulation. Heart hypertrophy develops in response to
training, pressure or volume overload. Training usually leads to growt
h of larger coronary vessels but little growth of capillaries, except
in young animals. However, growth of the capillary bed, but not the re
sistance vasculature capacity, can be induced by either increased coro
nary blood flow, bradycardia (electrically or pharmacologically induce
d) or increased inotropism, all of which are involved in the training
stimulus. Thus, what actually promotes growth of larger vessels as opp
osed to capillaries in training is unclear. Pressure overload hypertro
phy is mediated by both the renin-angiotensin system and the response
of cardiomyocytes to stretch; both lead to activation of early oncogen
es (c-fos, c-jun, c-myc) and angiotensin II activates several protein
kinases involved in cell growth. In this condition, growth of larger v
essels is inadequate, although some capillary growth may occur. Volume
overload leads to cardiomyocyte hypertrophy and hyperplasia and some
increase in vascular supply. Deficits in capillary supply in pressure
or volume overload hypertrophy can be reversed by chronic administrati
on of ACE inhibitors, dipyridamole, the bradycardic drug alinidine or
pacing-induced bradycardia respectively, but in neither case is traini
ng effective. Mechanical and humoral factors are involved in growth of
cardiomyocytes and vessels. For cardiomyocytes, stretch is most impor
tant, activating oncogenes, protein kinases and possibly the inositol
phosphate pathway, but not ion channels, with regulation by the balanc
e of angiotensin II, TGF-beta 1 and IGF-1, but not FGFs. For vessels,
growth is stimulated by stretch and shear stress, possibly with involv
ement of VEGF. Increased shear stress disrupts the glycocalyx on the l
uminal side of vessels and releases plasminogen activator and metallop
roteinases which disrupt the basement membrane and enable endothelial
cell migration and proliferation. It also causes rearrangement of the
endothelial cytoskeleton and transmission of mechanical signals to the
abluminal side disturbing extracellular matrix and causing distortion
of capillary basement membrane. Stretch acting from the abluminal sid
e has a similar effect resulting also in basement membrane disruption
and endothelial cell proliferation.