Remodeling and Fibrosis of the Cardiac Muscle in the Course of Obesity—Pathogenesis and Involvement of the Extracellular Matrix

Round 1

Reviewer 1 Report

Dear authors

I have reviewed the manuscript "Remodeling and fibrosis of the cardiac muscle in the course of obesity- Pathogenesis and involvement of the extracellular matrix " by Jagoda Kruszewska et al. Fibrosis in the myocardium is a very problematic condition which is usually irreversible and leads not only to diastolic dysfunction but also systolic deterioration. In this review the authors have focused on how obesity by itself stimulate fibrosis pathways and through which mechanisms: hemodynamic, endocrine- leptin, adiponectin, RAAs, sympathic nervous system etc. They also describe which ECM proteins that are affected which all make sense. The text is well structured, english good and they use adequate citations. I cannot find anything that should be changed in the text. I must congratulate you to the comprehensive overview of the field which covers the majority of the aspects/ mechanisms of how obesity contributes to cardiac fibrosis and heart failure. The text is well written and correctly cited. 

Reviewer 2 Report

With an increasingly aging population, obesity and its consequent cardiovascular diseases represent a major burden for the healthcare system. A relatively neglect aspect in the pathophysiology of obesity is the involvement of the extracellular matrix. This review nicely highlights the link between obesity, cardiovascular diseases, and remodelling of the extracellular matrix. First, it describes the clinical aspects of obesity and the effects of high body mass index on the cardiovascular system, then it summarises the status of the art on the myocardial extracellular matrix and the pathological changes It undergoes in obesity, in particular hypertension, myocardial infarction, heart failure and atrial fibrillation. This is a well written contribution to the field.