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J Geriatr Cardiol. 2015 Jan;12(1):76-82. doi: 10.11909/j.issn.1671-5411.2015.01.009.

The role of extracellular matrix in age-related conduction disorders: a forgotten player?

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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.
Unit of Cardiovascular Surgery, Center for Integrated Research, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome 00128, Italy.
Cardiac Surgery Centre Cardiologique du Nord de Saint-Denis, 36 Rue des Moulins Gémeaux, Saint-Denis, Paris 93200, France.


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.


Ageing; Arrhythmia; Cardiac; Conduction system; Extracellular matrix

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