The role of lymphatic vessels in cardiac injury and repair

Abstract The cardiac lymphatic system plays a vital role in maintaining interstitial fluid balance, immune cell homeostasis, and overall cardiac health. Despite its importance, the involvement of cardiac lymphatics in heart disease has only recently garnered significant research attention. This review explores the structural, molecular, and functional characteristics of the cardiac lymphatic network and its role in cardiac injury and the subsequent repair process, including conditions such as myocardial infarction, ischemia-reperfusion injury, infective endocarditis, atherosclerosis, heart failure, and atrial fibrillation. Studies demonstrate that cardiac lymphatics facilitate the clearance of interstitial fluid, proteins, and immune cells, contributing to inflammation resolution and tissue repair. However, dysfunctions in the lymphatic system can exacerbate pathologic processes, leading to myocardial edema, fibrosis, and cardiac remodeling. Emerging evidence suggests that targeted modulation of lymphangiogenesis and lymphatic function may offer new therapeutic avenues for treating cardiovascular diseases. This review provides a comprehensive understanding of the cardiac lymphatic system’s contribution to cardiac injury and repair, aiming to lay the groundwork for future research and therapeutic development in this burgeoning field.