Myocardial remodeling (REM) is a deleterious process characterized by gradual cardiac enlargement, cardiac dysfunction and typical molecular changes. It is a universal phenomenon, being caused by many pathological conditions [1, 2]. Of these, myocardial infarction is the more common.
What causes cardiac remodeling in heart failure?
This remodeling occurs due to mechanical stress on the heart muscle produced by the underlying disease process. In the early stages of a heart attack, some degree of remodeling can help the ventricle compensate for the damage that has occurred.
Is concentric remodeling heart failure?
Concentric remodeling is commonly conceptualized as an adaptive response to increased cardiac afterload caused by conditions such as hypertension and aortic stenosis. This adaptation is known to be finite in extent and eventually may lead to myocardial dysfunction and CHF.
What is reverse remodeling in heart failure?
Current therapeutic strategies for systolic heart failure aim to slow or halt the remodelling process. “Reverse remodelling” is a relatively new concept, where progressive LV dilatation and deterioration in contractile function are not simply arrested, but partially reversed.
How do ACE inhibitors prevent cardiac Remodelling?
ACE inhibitors are known to increase tissue bradykinin accumulation. Bradykinin has antigrowth effects and reduces vasomotor tone. Increased kinin activation resulting from ACE inhibition may attenuate structural remodelling in the infarcted heart.
What causes concentric Remodelling?
Concentric remodeling is the late stage response to LV hypertrophy; caused by either chronic pressure, volume overload or a MI (which is commonly associated with CAD, but can be due to longstanding hypertension, especially untreated).
How long does it take for cardiac remodeling?
Cardiac remodelling is a dynamic and ongoing process up to 24 months following acute myocardial infarction. Long-term LVEF deterioration is characterised by an increase in end-systolic volume and less wall thickening in the remote zones.
Is cardiac remodeling reversible?
Cardiac remodeling comprises changes in ventricular volume as well as the thickness and shape of the myocardial wall. With optimized treatment, such remodeling can be reversed, causing gradual improvement in cardiac function and consequently improved prognosis.
What happens in ventricular remodeling?
The term ventricular remodeling refers to alteration in ventricular architecture, with associated increased volume and altered chamber configuration, driven on a histologic level by a combination of pathologic myocyte hypertrophy, myocyte apoptosis, myofibroblast proliferation, and interstitial fibrosis (1, 2, 3).
Is heart failure concentric or eccentric?
4 The most common type of LV remodelling in heart failure with a reduced ejection fraction (HFrEF) is eccentric hypertrophy. However, a subset of HFrEF patients appear to have concentric hypertrophy.
Do beta blockers decrease cardiac remodeling?
Beta blockers improve function of the failing LV, prevent or reverse progressive LV dilation, chamber sphericity, and hypertrophy, and consequently have positive impact on cardiac remodeling.
What are differences between concentric and eccentric myocardial Hypertrophies?
Concentric hypertrophy is associated with increased left ventricular wall thickness whereas eccentric hypertrophy is characterized by dilatation of the left ventricular chamber; however, there occurs a general increase in the overall size of cardiomyocytes under both conditions.
What causes left ventricular remodeling?
In response to pathophysiological stimuli such as ischemia/reperfusion or excessive mechanical load, multiple molecular and cellular processes contribute to ventricular remodeling. These include cardiomyocyte loss through cell death pathways such as necrosis, apoptosis, or possibly excessive autophagy.
How do beta blockers prevent ventricular remodeling?
The general trend from a number of clinical studies indicates that whereas ACE-inhibitors seem to prevent progressive left ventricular dilatation, the third generation beta-blocker, carvedilol, may actually reverse the remodelling process by reducing left ventricular volumes and improving systolic function.
What is left ventricular remodeling?
Left ventricular remodeling is the process by which ventricular size, shape, and function are regulated by mechanical, neurohormonal, and genetic factors.
Do ARBs decrease cardiac remodeling?
Clinical studies have demonstrated that therapeutic agents such as angiotensin converting enzyme inhibitors (ACE-Is), Ang II receptor blockers (ARBs) and beta-blockers can modify the process of cardiac remodelling in addition to their other clinically relevant benefits in reducing morbidity and mortality in patients …
Why are ACE inhibitors given post MI?
Earlier studies indicated that ACE inhibitors reduce myocardial infarction size and improve ventricular remodeling, both of which have a beneficial effect on morbidity and mortality in postinfarction patients who have evidence of left ventricular dysfunction.
What is maladaptive cardiac remodeling?
Cardiac remodeling has been described as both an adaptive and a maladaptive process, with the adaptive component enabling the heart to maintain function in response to pressure or volume overloading in the acute phase of cardiac injury (78)(reviewed by Sabbah and Goldstein ).
How common is concentric remodeling?
Concentric remodeling was defined by the thickness of the septum or posterior wall divided by the left ventricular radius at end-diastole > or = 0.45. Results: Prevalence of concentric remodeling was 39.2%.
How can ventricular remodeling be prevented?
Angiotensin-Converting Enzyme Inhibitors, Angiotensin Receptor Blockers and Beta-Blockers have been proven effective in modulating the process of remodelling and in reducing the occurrence of adverse events.
Is cardiac Remodelling good?
Cardiac remodeling is defined as a group of molecular, cellular and interstitial changes that manifest clinically as changes in size, mass, geometry and function of the heart after injury. The process results in poor prognosis because of its association with ventricular dysfunction and malignant arrhythmias.
Which drug can help limit cardiac remodeling?
The neurohormonal antagonists that have been demonstrated to reduce mortality and morbidity in HF (angiotensin-converting enzyme inhibitors [ACE], beta-blockers, angiotensin receptor blockers, and aldosterone antagonists) are also able to inhibit or reverse remodeling.
Can ejection fraction be reversed?
Luckily, lifestyle changes and heart failure medicines can help improve your ejection fraction and even reduce symptoms. Your ejection fraction is the percentage of blood that gets squeezed out of the ventricle with each beat. A healthy ejection fraction is around 50 to 70 percent.
Does CHF cause hypertrophy?
Left ventricular hypertrophy is more common in people who have uncontrolled high blood pressure. But no matter what your blood pressure is, developing left ventricular hypertrophy puts you at higher risk of congestive heart failure and irregular heart rhythms.
Is concentric hypertrophy heart failure?
Given that concentric LV hypertrophy is associated with heart failure in the setting of a preserved LVEF,13 data demonstrating that concentric LV hypertrophy is a major risk factor for heart failure with a reduced LVEF are needed.