ROS can contribute to hypertrophy by direct interaction with cellular proteins and subsequent changes in cellular contraction and/or induction of apoptosis, or by activation of NFκB-mediated gene transcription. Calcineurin in turn dephosphorylates NFAT transcription factor, leading to its nuclear translocation, where it activates gene transcription. Elevated calcium ion levels downstream of GPCRs, either through activation of voltage-gated calcium channels or from intracellular stores, is sensed by calmodulin, which activates calcineurin. HCM in adults is characterised by unexplained LV wall thickness ≥15 mm, septal/posterior wall thickness ratio >1.3 in normotensive patients or septal/posterior wall thickness ratio >1.Diagrammatic representation of main intracellular signaling pathways regulating cardiac hypertrophy.
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