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Ventricular remodeling after myocardial infarction. Experimental and clinical studies

  • Chapter
Angiotensin and the Heart

Summary

Changes of ischemic myocardium following coronary occlusion, including active and passive functions, and adaptive changes of non-ischemic surviving myocardium have been summarized under the term “left ventricular remodeling” post myocardial infarction. An increase in left ventricular volume may be a consequence, and associated with an adverse prognosis. Although left ventricular dilatation may increase stroke volume and, thus, be compensatory at first, in about one-fifth of patients it ultimately results in progressive dysfunction and heart failure. Major determinants of this process are time, infarct size, infarct location, global left ventricular function assessed 4 days after infarction by radionuclide ejection fraction and right heart catheter (stroke volume), and morphology of the infarct-associated coronary artery.

The surviving myocardium hypertrophies and may also dilate structurally. Depression of left ventricular ejection fraction chronically after the infarct is due to deterioration of wall motion of chamber segments initially classified normal by radionuclide analysis. Biochemical changes may also occur, including reduction of phosphocreatine, prolongation of time to peak Cai 2+, and changes in myosin isoforms. Systemic or local humoral factors may be involved in these changes, however, clear evidence is still lacking. Perfusion of surviving myocardium may be altered under various conditions due to morphologic and functional changes of coronary vasculature. Successful prevention of heart failure and death by angiotensin converting enzyme inhibitors in asymptomatic patients with left ventricular dysfunction post-myocardial infarction has supported the pathophysiologic concepts of remodeling.

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Authors and Affiliations

  1. Medizinische Klinik, der Universität Würzburg, Josef-Schneider-Straße 2, D-8700, Würzburg, Germany

    Prof. Dr. G. Ertl, P. Gaudron & K. Hu

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  1. Prof. Dr. G. Ertl
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  2. P. Gaudron
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  3. K. Hu
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Editors and Affiliations

  1. Institut für Pharmakologie, der Universitä Regensburg, Universitätsstraße 31, 8400, Regensburg, Germany

    H. Grobecker

  2. Abt. Pathophysiologie Zentrum Innere Medizin, Universitätsklinikum Essen, Hufelandstraße 55, 4300, Essen, Germany

    Gerd Heusch

  3. Abt. für Kardiologie, Pneumologie, Med. Klinik und Poliklinik B der Heinrich-Heine-Universität, Moorenstraße 5, 4000, Düsseldorf 1, Germany

    B. E. Strauer

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© 1993 Dr. Dietrich Steinkopff Verlag GmbH & Co. KG, Darmstadt

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Ertl, G., Gaudron, P., Hu, K. (1993). Ventricular remodeling after myocardial infarction. Experimental and clinical studies. In: Grobecker, H., Heusch, G., Strauer, B.E. (eds) Angiotensin and the Heart. Steinkopff. https://doi.org/10.1007/978-3-642-72497-8_9

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  • DOI: https://doi.org/10.1007/978-3-642-72497-8_9

  • Publisher Name: Steinkopff

  • Print ISBN: 978-3-7985-0936-8

  • Online ISBN: 978-3-642-72497-8

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