Ventricular remodeling and its prevention in the treatment of heart failure.

Ventricular remodeling refers to changes in left ventricular (LV) geometry, mass, and volume in response to myocardial injury or alterations in load. The extent of LV dilatation or remodeling after myocardial infarction (MI) or in patients with heart failure is a strong predictor of both morbidity and mortality. Based on these observations, it is clear that LV remodeling is a maladaptive process. Two classes of drugs appear to inhibit LV remodeling. A large amount of data support the use of angiotensin-converting enzyme (ACE) inhibitors to improve survival and to prevent progressive remodeling. In addition, recent studies suggest that beta-adrenergic blockers have a beneficial effect on both survival and remodeling. These data support a causative role of the renin-angiotensin system and perhaps the sympathetic nervous system in this process. Thus, ACE inhibitors and possibly beta-blockers should be part of the pharmacologic regimen for the treatment of patients with LV dysfunction to prevent progressive LV remodeling.