Alteration of excitation-contraction coupling in the failing human heart was deemed an
interesting subject for a dialogue between basic scientists and clinical researchers in
continuation of previous Gargellen Conferences concerned with the function of the normal and
failing human myocardium. In 1987 basic mechanisms and clinical implications of then new
insights into cardiac energetics was followed by a comprehensive review of inotropic
stimulation and myocardial energetics in 1989. Here we undertook a re-evaluation of the
principles of inotropic stimulation and of its potential therapeutic value based on new
observa tions from experiments with human myocardium. In 1992 the risk due to myocardial
phenotype change as a consequence of adaptation in heart failure was published. Here
alterations of subcellular structures and functions as a consequence of chronic heart failure
summarized as phenotype change could be described as an essential characteristic of the
failing human myocardium. This topic was discussed in greater depth in the volume Cellular and
Molecular Alterations in the Failing Human Heart considering both the sarcolemma and the
phosphodiesterases as well as excitation-contraction coupling and contractile proteins
extracellular matrix and mitrochondrial function.
