The role of angiotensin-converting enzyme inhibitors in reducing ventricular remodeling after myocardial infarction.

Ventricular remodeling is a pathologic change in the size and shape of the heart after myocardial infarction. Human and animal studies have described the mechanisms responsible for the thinning and enlargement that progresses for years beyond the initial infarction. As a result of elevations in preload and afterload, ventricular pressures increase, and changes occur in both the infarcted and uninfarcted regions of the ventricle, increasing overall heart size. Recent investigation has demonstrated that the initiation of angiotensin-converting enzyme (ACE) inhibitor drugs after myocardial infarction reduces both systolic and diastolic wall stresses, thereby averting changes in heart size. These findings are significant, as increases in heart size and ventricular volumes have proved to be powerful predictors of early mortality after myocardial infarction.