New concepts regarding events that lead to end-stage heart disease.

Cardiac dysfunction is a progressive process that eventuates in end-stage heart failure. This progression involves dilatation and hypertrophy of the left ventricle, characterized as left ventricular remodeling. This remodeling results in a falling left ventricular ejection fraction, worsening heart failure, and increased risk of lethal ventricular arrhythmias. Increased aortic impedance due to vasoconstriction, neurohormonal stimulation, and bioenergetic abnormalities all may contribute to the remodeling process. Therapeutic efforts aimed at halting this progressive process, especially if initiated early in the course of the disease, are most likely to exert a favorable effect.