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Adverse Remodeling and Reverse Remodeling After Myocardial Infarction

  • Myocardial Disease (A Abbate, Section Editor)
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Abstract

Purpose of Review

The purpose of this review it to summarize the current literature on remodeling after myocardial infarction, inclusive of pathophysiological considerations, imaging modalities, treatment strategies, and future directions.

Recent Findings

As patients continue to live longer after myocardial infarction (MI), the prevalence of post-MI heart failure continues to rise. Changes in the left ventricle (LV) after MI involve complex interactions between cellular and extracellular components, under neurohormonal regulation. Treatments to prevent adverse LV remodeling and promote reverse remodeling in the post-MI setting include early revascularization, pharmacotherapy aimed at neurohormonal blockade, and device-based therapies that address ventricular dyssynchrony.

Summary

Despite varying definitions of adverse LV remodeling examined across multiple imaging modalities, the presence of an enlarged LV cavity and/or reduced ejection fraction is consistently associated with poor clinical outcomes. Advances in our knowledge of the neurohormonal regulation of adverse cardiac remodeling have been instrumental in generating therapies aimed at arresting adverse remodeling and promoting reserve remodeling. Further investigation into other specific mechanisms of adverse LV remodeling and pathways to disrupt these mechanisms is ongoing and may provide incremental benefit to current evidence-based therapies.

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Authors and Affiliations

  1. Department of Medicine, Duke University Medical Center, Durham, NC, USA

    Ankeet S. Bhatt

  2. Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA

    Andrew P. Ambrosy & Eric J. Velazquez

  3. Duke Clinical Research Institute, Durham, NC, USA

    Andrew P. Ambrosy & Eric J. Velazquez

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  1. Ankeet S. Bhatt
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  2. Andrew P. Ambrosy
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Correspondence to Andrew P. Ambrosy.

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Eric J. Velazquez reports grants from NHLBI, personal fees from Abiomed, grants from Alnylam Pharmaceuticals and Bay Laboratories, grants and personal fees from Amgen, personal fees from Expert Exchange, personal fees from Merck & Co., grants and personal fees from Novartis Pharmaceutical Corp, and grants from Pfizer.

Ankeet S. Bhatt and Andrew P. Ambrosy declare that they have no conflict of interest.

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Bhatt, A.S., Ambrosy, A.P. & Velazquez, E.J. Adverse Remodeling and Reverse Remodeling After Myocardial Infarction. Curr Cardiol Rep 19, 71 (2017). https://doi.org/10.1007/s11886-017-0876-4

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