Review Articles
Cardiac remodeling—concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling

https://doi.org/10.1016/S0735-1097(99)00630-0Get rights and content
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Abstract

Cardiac remodeling is generally accepted as a determinant of the clinical course of heart failure (HF). Defined as genome expression resulting in molecular, cellular and interstitial changes and manifested clinically as changes in size, shape and function of the heart resulting from cardiac load or injury, cardiac remodeling is influenced by hemodynamic load, neurohormonal activation and other factors still under investigation.

Although patients with major remodeling demonstrate progressive worsening of cardiac function, slowing or reversing remodeling has only recently become a goal of HF therapy. Mechanisms other than remodeling can also influence the course of heart disease, and disease progression may occur in other ways in the absence of cardiac remodeling.

Left ventricular end-diastolic and end-systolic volume and ejection fraction data provide support for the beneficial effects of therapeutic agents such as angiotensin-converting enzyme (ACE) inhibitors and beta-adrenergic blocking agents on the remodeling process. These agents also provide benefits in terms of morbidity and mortality. Although measurement of ejection fraction can reliably guide initiation of treatment in HF, opinions differ regarding the value of ejection fraction data in guiding ongoing therapy. The role of echocardiography or radionuclide imaging in the management and monitoring of HF is as yet unclear.

To fully appreciate the potential benefits of HF therapies, clinicians should understand the relationship between remodeling and HF progression. Their patients may then, in turn, acquire an improved understanding of their disease and the treatments they are given.

Abbreviations

ACE
angiotensin-converting enzyme
AIRE
Acute Infarction Ramipril Evaluation Study
ANP
atrial natriuretic peptide
ANZ
Australia/New Zealand Collaborative Group
CIBIS II
Cardiac Insufficiency Bisoprolol Study
ECG
electrocardiogram
HF
heart failure
LV
left ventricular
MDC
Metropol Dilated Cardiomyopathy trial
MERIT-HF
Metoprolol CR/XL Randomized Intervention Trial in Heart Failure
MI
myocardial infarction
MRI
magnetic resonance imaging
NO
nitric oxide
RAS
renin angiotensin system
SAVE
Survival and Ventricular Enlargement Study
SNS
sympathetic nervous system
SOLVD
Studies of Left Ventricular Dysfunction
TBARS
thiobarbituric acid reactive substances
TNF
tumor necrosis factor
TRACE
Trandolapril Cardiac Evaluation Study
V-HeFT I and V-HeFT II
Vasodilator Heart Failure Trials

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This research was supported by an educational grant from SmithKline Beecham Pharmaceuticals, Philadelphia, Pennsylvania.