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A theoretical study of the effect of airway smooth muscle orientation on bronchoconstriction.

If airway smooth muscle shortened in vivo to the extent that it does in vitro, then maximal bronchoconstriction would result in complete closure of virtually all airways. The fact that this does not happen indicates the existence of inhibitory mechanisms preventing maximal muscle shortening. There are many factors potentially limiting shortening in vivo. In this study we investigated one of these factors, the orientation of the smooth muscle around the airway wall. The airway was modeled as a cylinder of given wall thickness around which the muscle was wound as a spiral. The longitudinal and circumferential elasticities of the airway were embodied in a 2 x 2 matrix of elastic coefficients. We investigated smooth muscle shortening under three conditions: 1) a longitudinally stiff airway, 2) a circumferentially stiff airway, and 3) a longitudinally and circumferentially compressible airway. In case 1, for a given degree of smooth muscle shortening, airway resistance increased markedly with increasing pitch of the smooth muscle spiral. On the other hand, the muscle tension required to elicit a given change in resistance also increased markedly with pitch. In case 2, the effect with increasing pitch was reversed. In case 3, resistance first increased and then decreased as spiral pitch increased. Similarly, the muscle tension required to elicit a given change in resistance first increased and then decreased with pitch. These results suggest that the orientation of the smooth muscle about the airway may be very important in determining airway responsiveness.

Airway Resistance↗

Abdominal wall hernia in autosomal dominant polycystic kidney disease.

BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is a common cause of renal impairment with a number of well recognized extrarenal associations. A high incidence of abdominal wall hernia was noted in patients with ADPKD. METHODS: A retrospective review of the notes of all patients with ADPKD on the South Wales renal replacement therapy database was performed. These patients were compared with age- and sex-matched patients with renal failure but without ADPKD and with general surgical patients. RESULTS: The prevalence of hernia in patients with ADPKD was 38 of 85 (45 per cent) compared with seven of 85 (8 per cent) for other forms of renal failure and three of 85 (4 per cent) for general surgical controls (P < 0.001). There were significantly greater numbers of inguinal (P < 0.001), incisional (P = 0.019) and paraumbilical (P = 0.007) hernias in patients with ADPKD compared with the other two groups. CONCLUSION: These results show a significantly greater incidence of hernia, which could be an additional manifestation of the underlying defect in extracellular matrix production identified in patients with ADPKD.

Adult↗

A continuous damage random thresholds model for simulating the fracture behavior of nacre.

This study investigates the fracture properties of nacre using a discrete lattice model based on continuous damage random threshold fuse network. The discrete lattice topology of the model is based on nacre's unique brick and mortar microarchitecture. The mechanical behavior of each of the bonds in the discrete lattice model is governed by the characteristic modular damage evolution of the organic matrix and the mineral bridges between the aragonite platelets. The numerical results obtained using this simple discrete lattice model are in very good agreement with the previously obtained experimental results, such as nacre's stiffness, tensile strength, and work of fracture. The analysis indicates that nacre's superior toughness is a direct consequence of ductility (maximum shear strain) of the organic matrix in terms of repeated unfolding of protein molecules, and its fracture strength is a result of its ordered brick and mortar architecture with significant overlap of the platelets, and shear strength of the organic matrix.

Biocompatible Materials↗

Mechanisms and dynamics of mechanical strengthening in ligament-equivalent fibroblast-populated collagen matrices.

We have measured the dynamics of extracellular matrix consolidation and strengthening by human dermal fibroblasts in hydrated collagen gels. Constraining matrix consolidation between two porous polyethylene posts held rigidly apart set up the mechanical stress which led to the formation of uniaxially oriented fibroblast-populated collagen matrices with a histology resembling a ligament. We measured the mechanical stiffness and tensile strength of these ligament equivalents (LEs) as a function of age at biweekly intervals up to 12 weeks in culture using a mechanical spectrometer customized for performing experiments under physiologic conditions. The LE load-strain curve changed as a function of LE age, increasing in stiffness and exhibiting less plastic-like behavior. At 12 weeks, LEs had acquired up to 30 times the breaking strength of 1-week-old LEs. Matrix strengthening occurred primarily through the formation of BAPN-sensitive, lysyl oxidase catalyzed crosslinks. Sulfated glycosaminoglycan (GAG) content increased monotonically with LE age, reaching levels that are characteristic of ligaments. Cells in the LEs actively incorporated [3H]proline and [35S]sulfate into the extracellular matrix. Over the first three weeks, DNA content increased rapidly but thereafter remained constant. This data represent the first documentation of strengthening kinetics for cell-assembled biopolymer gels and the results suggest that this LE tissue may be a valuable model for studying the cellular processes responsible for tissue growth, repair, and remodeling.

Age Factors↗

In vivo evaluation of demineralized bone matrix as a bone graft substitute for posterior spinal fusion.

STUDY DESIGN: Posterior lumbar spinal fusion segments were evaluated in 9 adult mongrel dogs 6, 12, and 26 weeks after implantation. Four sites on each animal received implants consisting of demineralized bone matrix alone, demineralized bone matrix with allograft bone, allograft bone alone, and autograft bone. Each unilateral fusion spanned one motion segment with one intervening vertebral level left undisturbed using T13-L7. The fusions were evaluated radiographically, mechanically, and histologically. OBJECTIVE: The purpose of this study was to determine the efficacy of demineralized bone matrix as a bone graft substitute for stable posterior spinal fusion. SUMMARY OF BACKGROUND DATA: Posterior spinal fusion is a procedure commonly performed for spinal stabilization. Increasing the incidence and speed of stable spinal fusion is a primary goal in spinal surgery. Concerns have developed regarding the graft material used to induce bone healing at the fusion site. The advent of osteoinductive materials, such as demineralized bone matrix, may eliminate the need to harvest autograft bone and may circumvent the immunologic response and lower osteogenic potential associated with allograft bone. METHODS: The quality of fusion and new bone formation was evaluated radiographically using plain films, computed tomography, and magnetic resonance imaging. After the dogs were killed, each fusion segment was evaluated mechanically in torsion to determine stiffness and histologically to determine qualitative parameters of new bone formation and remodeling. RESULTS: Radiographic studies showed that autograft bone sites achieved stable fusion by 26 weeks after surgery. Conversely, the demineralized bone matrix alone and with allograft bone demonstrated some new bone formation at 6 and 12 weeks, but did not achieve fusion by 26 weeks. The fusion sites of allograft bone alone showed minimal new bone formation at all time periods. Mechanically, the autograft fusion sites demonstrated torsional stability that was significantly greater than that of all other fusion sites at all time periods. The remaining fusion sites showed equivalent torsional stiffness at all time periods. Histologic analysis confirmed the radiographic and mechanical findings. CONCLUSIONS: The results indicate that demineralized bone matrix alone or with allograft bone is ineffective in achieving stable posterior spinal fusions.

Animals↗

On the implications of interpreting the stability index: a spine example.

Quantifying the stability of the spinal column offers a perspective on the effectiveness of the motor control strategy to ensure a stable spine--and minimize the risk of injury from experiencing an unstable event. There are essentially three energy based methods of calculating a stability index for the lumbar spine. All three methods involve mathematical manipulation of an 18 x 18 Hessian matrix. The purpose of this paper was to consider the mathematical implications for the three methods of determining a single stability index, and examine the effects of biological factors such as muscle activation in each of these methods. The first approach computes the Hessian's determinant and is thought to represent a more global or "average" perspective on stability. A second approach computes the smallest eigenvalue of the Hessian matrix to determine the weakest link of the spine. The final method determines an average critical stiffness difference for the spine and is intended to effectively determines how far a human spine is from instability, and allows comparison between tasks. This study shows that the same interpretation of stability is achieved via all three computational approaches--they agree as to whether the spine is stable or not. However they appear to differ in their sensitivity to the effect of muscle activation patterns.

Elasticity↗

Factors influencing arterial stiffness in systolic hypertension in the elderly: role of sodium and the renin-angiotensin system.

The mechanism(s) of systolic hypertension in the elderly imply structural and functional alterations of the large artery wall. Clinical and experimental studies have shown that, in the long term, the renin-angiotensin system may act on the geometry and stiffness of the large artery wall independently of blood pressure level through alterations of the extracellular matrix of vascular smooth muscle cells. In humans, gene polymorphisms related to angiotensin type I receptors, sodium, or alterations of endothelial function may modulate the age-related increase in pulse pressure and aortic rigidity, the two main predictors of cardiovascular risk in the elderly. Based on this approach to the renin-angiotensin system, it is suggested that antihypertensive drugs may be developed that attenuate the increase of aortic rigidity with age, acting on the hormonal environment as well as the secretory properties of vascular smooth muscle cells.

Aged↗

Stop-pass behavior of acoustic waves in a 1D fractured system

This study examines the dispersion and the stop-pass band behavior of acoustic waves propagating across periodically spaced and non periodically spaced parallel fractures. Laboratory ultrasonic wave measurements performed on a stack of synthetic fractures (identical steel plates with roughened interfaces) and numerical propagator matrix simulations show spectra with distinct stop-pass band structures that develop with decreasing fracture stiffness. To understand the physics behind these observations, an exact dispersion equation for wave propagation through an infinite series of equally spaced fractures is derived using displacement-discontinuity boundary conditions to model the constitutive behavior of the fractures and Floquet's (Bloch's) theory for the periodic boundary conditions. Both the measured and numerically simulated stop-pass band structures show good agreement with the theoretical predictions. Furthermore, the theory reveals that the left boundary of the stop-bands contains information about the fracture stiffness, suggesting the possibility of determining the stiffness of the parallel fractures from seismic waves. This paper also discusses the effects of fractured systems with random distributions of fracture spacings and stiffnesses on the stop-pass band structures of seismic waves in fractured rock.

Journal Article↗

ATP reduces gel compaction in osteoblast-populated collagen gels.

Bone remodeling is a localized process, but regulated by systemic signals such as hormones, cytokines, and mechanical loading. The mechanism by which bone cells convert these systemic signals into local signals is not completely understood. It is broadly accepted that the "prestress" in cytoskeleton of cells affects the magnitude of cellular responses to mechanical stimuli. Prestress derives from stiff cytoskeletal proteins and their connections within the cell and from cell contractility upon attaching to matrix. In an in vitro model of three-dimensional gel compaction, the relative cellular prestress levels in the same matrix environment were determined by matrix compaction rate: a greater compaction rate resulted in a higher level of prestress. In the present study, the effects of ATP on the prestress of osteoblasts were studied using mouse MC3T3-E1 cells grown in three-dimensional bioartificial tissues (BATs). ATP (> or =100 microM) reduced the compaction rate of BATs in a dose-dependent manner. ADP, 2'-(or 3')-O-(4-benzoylbenzoyl) ATP, and UTP, but not alpha,beta-methylene ATP, also reduced the compaction rate but to a lesser extent. Pyridoxal-phosphate-6-azophenyl-2',4'-disulfonic acid tetrasodium did not block the effect of ATP on BAT compaction rate. These results indicate that both P2X and P2Y receptors are involved in ATP-induced reduction of BAT compaction rate. Steady fluid flow and RT-PCR results showed that ATP reduced cell attachment on type I collagen by downregulating the expression of integrin alpha(1). These results suggest a potential role for P2 receptors in matrix remodeling and repair and as a potential drug target in treatment of bone diseases.

Adenosine Triphosphate↗

Cardioreparation in hypertensive heart disease.

The normal myocardium is composed of a variety of cells. Cardiac myocytes, tethered within an extracellular matrix of fibrillar collagen, represent one third of all cells; noncardiomyocytes account for the remaining two thirds. Ventricular hypertrophy involves myocyte growth. Hypertensive heart disease (HHD) includes myocyte and nonmyocyte growth that leads to an adverse structural remodeling of the intramural coronary vasculature and matrix. In HHD, it is not the quantity of myocardium but rather its quality that accounts for increased risk of adverse cardiovascular events. Structural homogeneity of cardiac tissue is governed by a balanced equilibrium existing between stimulator and inhibitor signals that regulate cell growth, apoptosis, phenotype, and matrix turnover. Stimulators (eg, angiotensin II, aldosterone, and endothelins) are normally counterbalanced by inhibitors (eg, bradykinin, NO, and prostaglandins) in a paradigm of reciprocal regulation. To reduce the risk of heart failure and sudden cardiac death that accompanies HHD, its adverse structural remodeling must be targeted for pharmacologic intervention. Cardioprotective agents counteract the imbalance between stimulators and inhibitors. They include ACE and endopeptidase inhibitors and respective receptor antagonists. Cardioreparative agents reverse the growth-promoting state and regress existing abnormalities in coronary vascular and matrix structure. ACE inhibition has achieved this outcome with favorable impact on vasomotor reactivity and tissue stiffness. Today's management of hypertension should not simply focus on a reduction in blood pressure, it must also target the adverse structural remodeling that begets HHD.

Angiotensin Receptor Antagonists↗

The thixotropic effect of the synovial fluid in squeeze-film lubrication of the human hip joint.

The thixotropic (shear-thinning) effect of the synovial fluid in squeeze-film lubrication of the human hip joint is evaluated, taking into account filtration of the squeezed synovial film by biphasic articular cartilage. A porous, homogeneous, elastic cartilage matrix filled with the interstitial ideal fluid, with the intact superficial zone (of lower permeability and stiffness in compression) already disrupted or worn away, models an early stage of arthritis. Due to a high viscosity of the normal synovial fluid at very low shear rates, the squeezed synovial film at a fixed time after the application of a steady load is found to be much thicker in a small central part of the lubricated contact area. In the remaining part, the film is thin as it corresponds to the Newtonian fluid with the same high-shear-rate viscosity. Filtration is lower for the normal cartilage with the intact superficial zone due to its lower permeability and compression stiffness. But even in the fictitious case of zero filtration, calculations show that the effect of thixotropy on the increase of the minimum synovial film thickness would manifest itself as late as after several tens of seconds since the physiologic load application. At that time, this thickness would be as low as about 0.3 microm. It follows that thixotropy of the normal synovial fluid (and so much more of the inflammatory fluid) is irrelevant in squeeze-film lubrication of both the normal and arthritic human hip joints.

Arthritis, Rheumatoid↗

Future materials for foot surgery.

Important advances have been made in the development of biomaterials science and engineering for foot surgery over the past four decades. In this paper, implant materials have been separated into two general categories: temporary implants for bone fixation and permanent implants for joint replacement. As presented, however, currently available temporary implants for bone fixation are often left in place permanently whereas, in the long run, permanent implants for joint replacement cannot realistically be expected to last the lifetime of the average-aged patient, and thus are actually only temporary. The benefits and problems of each of these two implant classes were first presented to set the stage for a discussion of possible future directions in the development of new biomaterials that offer the promise of providing improvements for patient care. For bone fixation in foot surgery, the most promising future biomaterials are presented as fully bioabsorbable polymer matrix composites. These implant materials have the potential for development to provide the initial strength and stiffness of currently used metal alloys without concern regarding implant removal. With the development of these materials, clinicians and patients will no longer be forced to choose between the risks of implant retrieval and the risks of leaving the implant behind. Current obstacles that must be overcome before these future materials can be introduced for general clinical use are related to improvements in mechanical property durability and degradation product biocompatibility. For joint replacement, tissue engineered viable biomaterials for permanent articular cartilage replacement are presented as the most important of the future biomaterials. If truly permanent joint replacement materials are to be developed, the implants must be able to regenerate and sustain themselves to permanently retain their properties. Living and sustainable tissues are therefore essential if implant properties are to be permanently maintained, because all nonviable materials are subject to eventual irreversible structural breakdown, degradation, and fatigue. Again, many problems remain to be solved before these envisioned future materials can be brought to accepted clinical use. However, substantial advances have already been achieved and have demonstrated the feasibility of the development of these materials. Biomaterials science and engineering remains a very challenging and exciting field of research and development. As technology advances, the problems that are faced become more complex and, more than ever, now require interdisciplinary cooperation from molecular and cell biologists, biomaterials scientists and engineers, and clinicians. This is especially true in the relatively new field of tissue engineering.(ABSTRACT TRUNCATED AT 400 WORDS)

Biocompatible Materials↗

Mechanical properties of the collagen network in human articular cartilage as measured by osmotic stress technique.

We have used an isotropic osmotic stress technique to assess the swelling pressures of human articular cartilage over a wide range of hydrations in order to determine from these measurements, for the first time, the tensile stress in the collagen network, Pc, as a function of hydration. Osmotic stress was applied by means of calibrated solutions of polyethylene glycol. Calculations of osmotic stress were based on the balance, at equilibrium, between the applied stress, the collagen stress, and the proteoglycan osmotic pressure, piPG, acting within the extrafibrillar matrix compartment. Pc vs hydration was determined for several normal human samples, both native and trypsin-treated, and for cartilage from one osteoarthritic (OA) joint. We found that for normal cartilage the collagen network does not become "limp" until the volume of cartilage has decreased by 20-25% of its initial value and that its contribution to the balance of forces in cartilage therefore must be taken into account over a much wider range of hydrations than was previously thought. For normal cartilage, the Pc vs hydration curves exhibit a steep increase with increasing hydration; trypsin treatment does not change their slope, showing that PG concentration does not influence the inherent stiffness of the collagen network. By contrast, the curves for OA specimens are considerably shallower and displaced to higher hydrations. Our findings thus highlight the role of the stiffness of the collagen network in limiting hydration in normal cartilage and ensuring a high PG concentration in the matrix, which is essential for effective load-bearing and is lost in OA.

Cartilage, Articular↗

Renin-angiotensin system and myocardial fibrosis in hypertension: regulation of the myocardial collagen matrix.

The cardiac interstitium is composed of non-myocyte cells embedded in a highly organized extracellular matrix containing a three-dimensional collagen network which serves to maintain the architecture of the myocardium and determines myocardial stiffness. In hypertensive heart disease, a heterogeneity in myocardial structure, created by the altered behaviour of cardiac fibroblasts responsible for collagen synthesis and degradation, can explain the appearance of diastolic and ultimately systolic dysfunction of the left ventricle. In vivo, circulating and myocardial renin-angiotensin systems (RAS) were found to be involved in the regulation of the structural remodelling of the cardiac interstitium. In vitro, in cultured adult rat cardiac fibroblasts, angiotensin II was shown to stimulate collagen synthesis and to inhibit collagenase activity, which is the key enzyme for collagen degradation. In the SHR-model of primary hypertension, left ventricular hypertrophy could be regressed and abnormal myocardial diastolic stiffness, due to interstitial fibrosis, could be restored to normal by inhibition of the myocardial RAS. These antifibrotic or cardioreparative effects of ACE inhibition that occurred irrespective of blood pressure normalization may be valuable in reversing left ventricular diastolic dysfunction in hypertensive heart disease.

Animals↗

Cardiac mast cell regulation of matrix metalloproteinase-related ventricular remodeling in chronic pressure or volume overload.

The chronic elevation in ventricular wall stress secondary to ventricular volume or pressure overload leads to structural remodeling of the muscular, vascular and extracellular matrix components of the myocardium. While initially a compensatory response, the progressive hypertrophy and ventricular dilatation induced by this condition ultimately have a detrimental effect on ventricular function, resulting in heart failure. Fibrillar collagen provides the skeletal framework which interconnects the cardiomyocytes, thereby maintaining ventricular shape and size and contributing to tissue stiffness. Accordingly, these myocardial collagen fibers must be disrupted for ventricular dilatation, sphericalization and wall thinning to occur. The presence of an abundant, latent matrix metalloproteinase (MMP) population which coexists with myocardial fibrillar collagen has been documented. Thus, the potential for collagen degradation to exceed synthesis exists should there be significant activation of this latent MMP system. Mast cells are known to store and release a variety of biologically active mediators including TNF-alpha and proteases such as tryptase and chymase, which can induce MMP activation. Increased cardiac mast cell density has been implicated in the pathophysiology of human end-stage cardiomyopathy and experimental myocardial infarction, hypertension and chronic volume overload secondary to mitral regurgitation and aorto-caval fistula. The potential role of cardiac mast cells in activating MMPs, which then results in fibrillar collagen degradation and adverse myocardial remodeling secondary to chronic volume and pressure overload will be the subject of this review.

Extracellular Matrix↗

A poroelastic continuum model of the cupula partition and the response dynamics of the vestibular semicircular canal.

Using mixture theory, an axisymmetric continuum model is presented describing the response dynamics of the vestibular semicircular canals to canal-centered head rotation in which the cupula partition is modeled as a poroelastic mixture of interpenetrating solid and fluid constituents. The solid matrix of the cupula is assumed to behave as a linear elastic material, whereas the fluid constituent is assumed to be Newtonian. A regular perturbation analysis of the fluid dynamics in the canal provides a dynamic boundary condition, which acts across the cupula partition. Numerical solution of the coupled system of momentum equations provides the spatio-temporal displacement fields for both the fluid and solid constituents of the cupula. Results indicate that at frequencies above 1 Hz, the fluid constituent is dynamically entrained by the solid matrix such that their motions are bound as if to exist as a single component. The resulting high-frequency response is consistent with the macromechanical response predicted by single-component viscoelastic models of the cupula. Below 1 Hz, the dynamic coupling between the fluid and solid constituents weakens and the transcupular differential pressure is sufficient to force fluid through the mixture with little deformation of the solid matrix. Results are sensitive to the precise value of the cupular permeability. One of the most important distinctions between the present analysis and previous impermeable models of the cupula arises at the micromechanical level in terms of the local fluid flow that is predicted to occur within the cupula and around the ciliary bundles and sensory hair cells. Another important result reveals that the permeation dynamics predicted below 1 Hz gives rise to the same low-frequency macromechanical response as would occur with an impermeable viscoelastic structure having a much greater stiffness. Current estimates of the mechanical stiffness of the cupula, based solely on afferent nerve data, may therefore overestimate the true value intrinsic to the solid matrix by as much as an order of magnitude.

Animals↗

Cell shape, cytoskeletal mechanics, and cell cycle control in angiogenesis.

Capillary endothelial cells can be switched between growth and differentiation by altering cell-extracellular matrix interactions and thereby, modulating cell shape. Studies were carried out to determine when cell shape exerts its growth-regulatory influence during cell cycle progression and to explore the role of cytoskeletal structure and mechanics in this control mechanism. When G0-synchronized cells were cultured in basic fibroblast growth factor (FGF)-containing defined medium on dishes coated with increasing densities of fibronectin or a synthetic integrin ligand (RGD-containing peptide), cell spreading, nuclear extension, and DNA synthesis all increased in parallel. To determine the minimum time cells must be adherent and spread on extracellular matrix (ECM) to gain entry into S phase, cells were removed with trypsin or induced to retract using cytochalasin D at different times after plating. Both approaches revealed that cells must remain extended for approximately 12-15 h and hence, most of G1, in order to enter S phase. After this restriction point was passed, normally 'anchorage-dependent' endothelial cells turned on DNA synthesis even when round and in suspension. The importance of actin-containing microfilaments in shape-dependent growth control was confirmed by culturing cells in the presence of cytochalasin D (25-1000 ng ml-1): dose-dependent inhibition of cell spreading, nuclear extension, and DNA synthesis resulted. In contrast, induction of microtubule disassembly using nocodazole had little effect on cell or nuclear spreading and only partially inhibited DNA synthesis. Interestingly, combination of nocodazole with a suboptimal dose of cytochalasin D (100 ng ml-1) resulted in potent inhibition of both spreading and growth, suggesting that microtubules are redundant structural elements which can provide critical load-bearing functions when microfilaments are partially compromised. Similar synergism between nocodazole and cytochalasin D was observed when cytoskeletal stiffness was measured directly in living cells using magnetic twisting cytometry. These results emphasize the importance of matrix-dependent changes in cell and nuclear shape as well as higher order structural interactions between different cytoskeletal filament systems for control of capillary cell growth during angiogenesis.

Actin Cytoskeleton↗

Collagen network remodelling and diastolic stiffness of the rat left ventricle with pressure overload hypertrophy.

This study had two objectives: (a) to determine the accumulation of collagen and its structural remodelling in the hypertrophied rat left ventricle after 4 and 8 weeks of abdominal aorta banding; and (b) to correlate these findings with the diastolic stress-strain relation of the intact myocardium. In comparison to age and sex matched controls, the collagen volume fraction of the hypertrophied myocardium after 4 and 8 weeks of aortic banding increased significantly from 3.5(SD1.0)% to 7.8(4.2)% and 6.2(2.0)% respectively. This accumulation of collagen, or fibrosis, occurred in the absence of myocyte necrosis. Scanning electron microscopy showed increased density and thickness of the collagen weave and tendons. At 4 weeks, light microscopy showed interstitial oedema and disrupted collagen fibrils. Left ventricular diastolic stress-strain relations of both pressure overload groups were significantly steeper than that of the control group. Thus the response of the interstitium to the hypertrophic process that accompanies abdominal aorta banding is a complex process that includes a structural remodelling of the fibrillar collagen matrix and the early appearance of interstitial oedema, each of which may contribute to a rise in the passive stiffness of the intact myocardium.

Animals↗