Department of Cardiac Surgery, Zieken Huis Oost-Limburg (ZOL) Campus, St. Jan 6 Schiepse Bos, Genk 3600, Belgium.
Tissue Engineering Laboratory, Center for Integrated Research, Università Campus Bio-Medico di Roma Via Alvaro del Portillo 200, Rome 00128, Italy.
J Geriatr Cardiol. 2015 Jan;12(1):76-82. doi: 10.11909/j.issn.1671-5411.2015.01.009.
Cardiovascular aging is a physiological process gradually leading to structural degeneration and functional loss of all the cardiac and vascular components. Conduction system is also deeply influenced by the aging process with relevant reflexes in the clinical side. Age-related arrhythmias carry significant morbidity and mortality and represent a clinical and economical burden. An important and unjustly unrecognized actor in the pathophysiology of aging is represented by the extracellular matrix (ECM) that not only structurally supports the heart determining its mechanical and functional properties, but also sends a biological signaling regulating cellular function and maintaining tissue homeostasis. At the biophysical level, cardiac ECM exhibits a peculiar degree of anisotropy, which is among the main determinants of the conductive properties of the specialized electrical conduction system. Age-associated alterations of cardiac ECM are therefore able to profoundly affect the function of the conduction system with striking impact on the patient clinical conditions. This review will focus on the ECM changes that occur during aging in the heart conduction system and on their translation to the clinical scenario. Potential diagnostic and therapeutical perspectives arising from the knowledge on ECM age-associated alterations are further discussed.
心血管衰老（Cardiovascular aging）是一个生理过程，它会导致心脏和血管所有组成部分的结构退化和功能丧失。传导系统（conduction system）也会受到衰老过程的深刻影响，在临床方面会产生相关反射。与年龄相关的心律失常（age-related arrhythmias）具有显著的发病率和死亡率，并构成了临床和经济负担。细胞外基质（extracellular matrix，ECM）在衰老的病理生理学中是一个重要但尚未得到充分认识的因素，它不仅在结构上支持心脏，决定其机械和功能特性，还能发出生物信号，调节细胞功能，维持组织内稳态。在生物物理水平上，心脏 ECM 表现出一种特殊程度的各向异性（anisotropy），这是决定专门电传导系统传导特性的主要因素之一。因此，与年龄相关的心脏 ECM 改变能够深刻影响传导系统的功能，对患者的临床状况产生显著影响。这篇综述将重点关注心脏传导系统在衰老过程中发生的 ECM 变化及其在临床情况下的转化。还进一步讨论了从 ECM 与年龄相关的改变中获得的潜在诊断和治疗观点。
