Heart Failure Reviews

, Volume 16, Issue 1, pp 13–21 | Cite as

Left ventricular remodeling in the post-infarction heart: a review of cellular, molecular mechanisms, and therapeutic modalities

Article

Abstract

As more patients survive myocardial infarctions, the incidence of heart failure increases. After an infarction, the human heart undergoes a series of structural changes, which are governed by cellular and molecular mechanisms in a pathological metamorphosis termed “remodeling.” This review will discuss the current developments in our understanding of these molecular and cellular events in remodeling and the various pharmacological, cellular and device therapies used to treat, and potentially retard, this condition. Specifically, this paper will examine the neurohormonal activity of the renin–angiotensin–aldosterone axis and its molecular effects on the heart. The emerging understanding of the extra-cellular matrix and the various active molecules within it, such as the matrix metalloproteinases, elicits new appreciation for their role in cardiac remodeling and as possible future therapeutic targets. Cell therapy with stem cells is another recent therapy with great potential in improving post-infarcted hearts. Lastly, the cellular and molecular effects of left ventricular assist devices on remodeling will be reviewed. Our increasing knowledge of the cellular and molecular mechanisms underlying cardiac remodeling enables us not only to better understand how our more successful therapies, like angiotensin-converting enzyme inhibitors, work, but also to explore new therapies of the future.

Keywords

Ventricular remodeling Post-infarction Pharmacological therapy Cellular therapy Molecular physiology 

Abbreviations

CAPRICORN

Carvedilol post infarction survival controlled evaluation trial

MERIT-HF

Metoprolol CR/XL Randomized Intervention trial in congestive heart failure trial

SAVE

Survival and ventricular enlargement trial

SOLVD

Survival in patients with reduced left ventricular ejection fraction and congestive heart failure-treatment trial

TRACE

Trandolapril Cardiac Evaluation trial

VALIANT

Valsartan in Acute myocardial infarction trial

RESOLVD

Randomized Evaluation Strategies of Left Ventricular Dysfunction

RALES

Randomized Aldactone Evaluation study

EPHESUS

Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival study

REPAIR-AMI

Re-infusion of Enriched Progenitor Cells and Infarct remodeling in Acute Myocardial Infarction trial

PREMIER

Prevention of Myocardial Infarction Early Remodeling

ESV

End systolic volume

EDV

End diastolic volume

EF

Ejection fraction

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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Division of Cardiology, Department of MedicineHarbor-UCLA Medical CenterTorranceUSA
  2. 2.Heart Institute, Good Samaritan Hospital, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA

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