Myosin Modulation in Hypertrophic Cardiomyopathy and Systolic Heart Failure: Getting Inside the Engine

Abstract

The contractile apparatus responds rapidly, and reversibly, to fluctuating preload and afterload using molecular accelerators and brakes to control the engine at any particular gear. It is now possible to stimulate or suppress the engine directly with a novel class of myocardial therapeutics. This conceptual framework of clutch, gears, and accelerators or brakes should help clinicians understand and categorize future directions in sarcomeric therapies for systolic and diastolic dysfunction.