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.
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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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Gajarsa, J.J., Kloner, R.A. Left ventricular remodeling in the post-infarction heart: a review of cellular, molecular mechanisms, and therapeutic modalities. Heart Fail Rev 16, 13–21 (2011). https://doi.org/10.1007/s10741-010-9181-7
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DOI: https://doi.org/10.1007/s10741-010-9181-7