Cardiac remodeling-concepts and clinical implications: A consensus paper from an international forum on cardiac remodeling

Cardiac remodeling is generally accepted as a determinant of the clinical c ourse of heart failure (HF). Defined as genome expression resulting in mole cular, cellular and interstitial changes and manifested clinically as chang es in size,: shape and function of the heart resulting from cardiac load or injury, cardiac remodeling is influenced by hemodynamic load, neurohormona l activation and other factors still:under investigation. Although patients with major remodeling demonstrate progressive worsening o f cardiac function, slowing or reversing remodeling has only recently becom e a goal of HF therapy. Mechanisms other than remodeling can also influence the course of heart disease, and disease progression may occur in other wa ys in the absence:of cardiac remodeling. Left ventricular end-diastolic and end-systolic volume and ejection fractio n data provide support for the beneficial effects of therapeutic agents suc h as angiotensin-converting enzyme (ACE) inhibitors and beta-adrenergic blo cking agents on the remodeling process. These agents also provide benefits in terms of morbidity and mortality. Although measurement of ejection fract ion can reliably guide initiation of treatment in HF, opinions differ regar ding the value of ejection fraction data in guiding ongoing therapy. The ro le of echocardiography or radionuclide imaging in the management; and monit oring of HF is as yet unclear. To fully appreciate the potential benefits of HF therapies, clinicians shou ld understand the relationship between remodeling and HF-progression. Their patients may then, in turn, acquire an improved understanding of their dis ease and the treatments they are given. (C) 2000 by the American College of Cardiology.