Physiological and Pathophysiological Prerequisites for the Reparative Potential of the Epicardium

Cardiovascular diseases, and in particular, myocardial infarction, occupy a dominant place in the structure of mortality and disability worldwide. Long–term complications of a heart attack — myocardial remodeling, chronic heart failure, rhythm disturbances, left ventricular aneurysms significantly reduce the quality of life of patients, increase the level of disability, and finally, lead to serious financial costs. An urgent area of medicine is the search for mechanisms of cardiac regeneration after a myocardial infarction. The assumption about the regenerative potential of the epicardium is based on studying its properties and characteristics. During embryogenesis, the epicardium produces a large number of multipotent progenitor cells of the epicardium, which subsequently undergo epithelial-­mesenchymal transformation. These cells migrate into the thickness of the myocardium and give rise to various cardiac cell types, including cardiomyocytes. The epicardium participates in the synthesis of paracrine factors that ensure the growth of coronary vessels, as well as the differentiation and development of the myocardium as a whole. The mechanisms of myocardial repair being developed are based on various ways to stimulate the activity of the epicardium along the embryonic pathway. The article structures the currently available information on the reparative potential of the epicardium — physiological aspects in embryogenesis, as well as its response to myocardial damage.