*Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, Quebec, Canada, H1T 1C8.
Clin Sci (Lond). 2014 Jul;127(2):65-76. doi: 10.1042/CS20130296.
The lungs are the primary organs affected in LHD (left heart disease). Increased left atrial pressure leads to pulmonary alveolar-capillary stress failure, resulting in cycles of alveolar wall injury and repair. The reparative process causes the proliferation of MYFs (myofibroblasts) with fibrosis and extracellular matrix deposition, resulting in thickening of the alveolar wall. Although the resultant reduction in vascular permeability is initially protective against pulmonary oedema, the process becomes maladaptive causing a restrictive lung syndrome with impaired gas exchange. This pathological process may also contribute to PH (pulmonary hypertension) due to LHD. Few clinical trials have specifically evaluated lung structural remodelling and the effect of related therapies in LHD. Currently approved treatment for chronic HF (heart failure) may have direct beneficial effects on lung structural remodelling. In the future, novel therapies specifically targeting the remodelling processes may potentially be utilized. In the present review, we summarize data supporting the clinical importance and pathophysiological mechanisms of lung structural remodelling in LHD and propose that this pathophysiological process should be explored further in pre-clinical studies and future therapeutic trials.
左心疾病（LHD）主要影响肺部。左心房压力增加导致肺肺泡毛细血管应激衰竭，导致肺泡壁损伤和修复的循环。修复过程导致 MYFs（肌成纤维细胞）的增殖、纤维化和细胞外基质沉积，导致肺泡壁增厚。尽管血管通透性的降低最初对肺水肿有保护作用，但这一过程会变得适应不良，导致气体交换受损的限制性肺病综合征。由于左心疾病，这一病理过程也可能导致肺动脉高压（PH）。很少有临床试验专门评估左心疾病中肺结构重塑及其相关治疗的效果。目前批准用于慢性心力衰竭（HF）的治疗可能对肺结构重塑有直接的有益作用。未来，可能会使用专门针对重塑过程的新型治疗方法。在本综述中，我们总结了支持左心疾病中肺结构重塑的临床重要性和病理生理机制的数据，并提出应在临床前研究和未来治疗试验中进一步探索这一病理生理过程。
