Heart failure cardiac remodeling

Stellbrink C, Breithardt OA, Franke A, et al. Impact of cardiac resynchronization therapy using hemodynami-cally optimized pacing on left ventricular remodeling in patients with congestive heart failure and ventricular conduction disturbances, [see comment]. J. Am. Coll. Cardiol. 2001 38 1957-65. 

ACE-inhibitors are known to cause regression of left ventricular and vascular hypertrophy. This phenomenon is important in the long-term treatment of hypertension, where cardiac hypertrophy is known to be an important, virtually independent risk factor. Data that are beginning to emerge, which indicate that ACE-inhibitors may be beneficial as secondary prevention in postinfarct patients, especially if signs of heart failure occur. This favourable influence of the ACE-inhibitors may be the result of haemodynamic effects, a favourable effect on neuroendocrine mechanisms, and also a beneficial influence on the process of remodeling of the heart, secondary to a myocardial infarction. 

Chizzola, P.R., de Freitas, H.F.G., Marinho, N.V.S., Mansur, J.A., Meneghetti, J.C., and Bocchi, E.A. 2006. The effect of P-adrenergic receptor antagonism in cardiac sympathetic neuronal remodeling in patients with heart failure. Int. J. Cardiol. 106 29-34. 

Heart failure is a progressive disorder that begins with myo- cardial injury. In response to the injury, a number of compensatory responses are activated in an attempt to maintain adequate cardiac output, including the sympathetic nervous system, increased preload, vasoconstriction, and ventricular hypertrophy/remodeling. These compensatory mechanisms are responsible for the symptoms of heart failure and contribute to disease progression. 

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