Using nondenaturing polyacrylamide gel electrophoresis, we have identified two distinct myosin isoenzymes in human atrial tissue that correspond to the V1 and V3 isomyosins found in rat ventricular tissue. Normal left and right atrial appendages have approximately 50% V3. When the left atrium was exposed to hemodynamic overload secondary to mitral stenosis, the percent V3 increased to 77 + 10% (n = 10); exposure to hemodynamic overload secondary to mitral regurgitation caused an increase to 70 14% (n = 6). Changes in the isoenzyme pattern were seen in the right atria of patients with mitral stenosis and markedly elevated pulmonary arterial pressures compared with control subjects and patients with mitral stenosis without severe pulmonary hypertension. Several clinical variables were examined to determine which factors might influence isoenzyme expression. Age, sex, the presence of atrial fibrillation, and pulmonary capillary wedge pressure did not predict the isoenzyme pattern. However, patients with mitral valvular disease and only slightly enlarged left atria tended to have a higher percent V3 than those with massively enlarged atria. These data confirm that human atrial tissue, like rat ventricular tissue, can alter its isomyosin composition in response to a hemodynamic load. The data further suggest that the isoenzyme shift is an early adaptation to the imposed load. Circulation 74, No. 3, 477-483, 1986. EXPERIMENTAL STUDIES in many mammalian species have demonstrated that the biochemical constituents of the myocardium, especially the heavy chains of myosin, influence the mechanical performance of cardiac muscle1' 2 and that changes in expression of the various isomyosins mediate myocardial adaptations to imposed loads and/or hormonal stimuli.3'4 This is particularly apparent in rodents and other small animals. Several investigators have shown, for example, that the imposition of hypertension or aortic stenosis on rat ventricle shifts the normally V1 predominant isomyosin to V3, which is associated with reduced ATPase activity and with depressed mechanical properties. Conversely, the superimposition of physical training or hyperthyroidism increases the percentage of V1, the associated ATPase activities, and the velocity of contraction of the intact muscle.3 5-In human ventricular tissue, which is composed almost exclusively of an isomyosin homodimer with a From