Because of increased mechanical stress and the presence of circulating and myocardial neurohormones and cytokines alter myocardial architecture.
Cellular responses include myocyte hypertrophy, dysfunction and death along with altered and increased extracellular matrix deposition, i.e. myocardial fibrosis.
Some of its manifestations can be reversed by near complete unloading of left ventricle by a left ventricle assist device which may improve function of the myocardium.