Indian Journal of Clinical Anatomy and Physiology

Page: 107-117

Cardiac remodelling—structural, cellular, and molecular changes that reshape the heart after stress or injury—drives heart failure progression. In contrast, cardiac regeneration refers to the replacement of lost myocardium with new, functional tissue. Adult human hearts exhibit very low baseline cardiomyocyte renewal (<1% per year), insufficient to recover from large injuries, so post-infarction “healing” usually culminates in non-contractile scar and adverse remodelling. Recent advances across single-cell/spatial omics, comparative biology (zebrafish, neonatal mouse), mechanobiology (Hippo–YAP), immunology, biomaterials, engineered tissues, gene/mRNA delivery, and extracellular vesicles (EVs) are reshaping the translational landscape. Meanwhile, guideline-directed medical therapies (e.g., ARNI, SGLT2 inhibitors) and devices can induce reverse remodelling, improving volumes and function but without true remuscularization. This review synthesizes mechanistic insights and late-breaking evidence, outlines therapeutic strategies moving from paracrine repair to bona fide remuscularization, and highlights key hurdles for durable, arrhythmia-safe regeneration in humans.