(Circulation. 2000;101:2981.)
© 2000 American Heart Association, Inc.
Clinical Cardiology: New Frontiers |
From the University of Pennsylvania Medical Center, Philadelphia, Pa (M.G.S.J.S.), and the Department of Medicine, University of Auckland, Auckland, New Zealand (N.S.).
Correspondence to Norman Sharpe, MD, FRACP, FACC, Department of Medicine, University of Auckland, 4th Floor, Auckland Hospital, Grafton, Private Bag 92-019, Auckland, New Zealand. E-mail n.sharpe@auckland.ac.nz
Key Words: myocardial infarction remodeling signal transduction structure pharmacology
Left ventricular remodeling is the process by
which ventricular size, shape, and function are regulated
by mechanical, neurohormonal, and genetic factors.1 2
Remodeling may be physiological and adaptive during
normal growth or pathological due to myocardial infarction,
cardiomyopathy, hypertension, or valvular
heart disease (Figure 1
). This
article will review postinfarction remodeling,
pathophysiological mechanisms, and therapeutic
intervention.
|
Pathophysiology
Postinfarction Left Ventricular Remodeling
The acute loss of myocardium results in an abrupt
increase in loading conditions that induces a unique pattern of
remodeling involving the infarcted border zone and remote noninfarcted
myocardium. Myocyte necrosis and the resultant increase in
load trigger a cascade of biochemical intracellular signaling processes
that initiates and subsequently modulates reparative changes, which
include dilatation, hypertrophy, and the formation of a
discrete collagen scar. Ventricular remodeling may continue
for weeks or months until the distending forces are counterbalanced by
the tensile strength of the collagen scar. This balance is determined
by the size, location, and transmurality of the infarct, the extent of
myocardial stunning, the patency of the infarct-related artery, and
local tropic factors.1 3
The myocardium consists of 3 integrated components:
myocytes, extracellular matrix, and the capillary microcirculation that
services the contractile unit assembly. Consideration of all 3
components provides important insights into the remodeling process and
a rationale for future therapeutic strategies. The
cardiomyocyte is terminally differentiated and develops
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W. M. Yarbrough, R. Mukherjee, G. P. Escobar, J. T. Mingoia, J. A. Sample, J. W. Hendrick, K. B. Dowdy, J. E. McLean, A. S. Lowry, T. P. O'Neill, et al. Selective Targeting and Timing of Matrix Metalloproteinase Inhibition in Post-Myocardial Infarction Remodeling Circulation, October 7, 2003; 108(14): 1753 - 1759. [Abstract] [Full Text] [PDF] |
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T. Tsuda, E. Gao, L. Evangelisti, D. Markova, X. Ma, and M.-L. Chu Post-ischemic myocardial fibrosis occurs independent of hemodynamic changes Cardiovasc Res, October 1, 2003; 59(4): 926 - 933. [Abstract] [Full Text] [PDF] |
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K. Christopher, T. F. Mueller, R. DeFina, Y. Liang, J. Zhang, R. Gentleman, and D. L. Perkins The graft response to transplantation: a gene expression profile analysis Physiol Genomics, September 29, 2003; 15(1): 52 - 64. [Abstract] [Full Text] [PDF] |
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T. J. Wang, D. Levy, E. J. Benjamin, and R. S. Vasan The Epidemiology of "Asymptomatic" Left Ventricular Systolic Dysfunction: Implications for Screening Ann Intern Med, June 3, 2003; 138(11): 907 - 916. [Abstract] [Full Text] [PDF] |
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M. Jessup and S. Brozena Heart Failure N. Engl. J. Med., May 15, 2003; 348(20): 2007 - 2018. [Full Text] [PDF] |
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P Garot, O Pascal, M Simon, J L Monin, E Teiger, J Garot, P Gueret, and J L Dubois-Rande Impact of microvascular integrity and local viability on left ventricular remodelling after reperfused acute myocardial infarction Heart, April 1, 2003; 89(4): 393 - 397. [Abstract] [Full Text] [PDF] |
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W. M. Yarbrough, R. Mukherjee, T. A. Brinsa, K. B. Dowdy, A. A. Scott, G. P. Escobar, C. Joffs, D. G. Lucas, F. A. Crawford Jr, and F. G. Spinale Matrix metalloproteinase inhibition modifies left ventricular remodeling after myocardial infarction in pigs J. Thorac. Cardiovasc. Surg., March 1, 2003; 125(3): 602 - 610. [Abstract] [Full Text] [PDF] |
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Y. Oishi, R. Ozono, Y. Yano, Y. Teranishi, M. Akishita, M. Horiuchi, T. Oshima, and M. Kambe Cardioprotective Role of AT2 Receptor in Postinfarction Left Ventricular Remodeling Hypertension, March 1, 2003; 41(3): 814 - 818. [Abstract] [Full Text] [PDF] |
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R. Mukherjee, T. A. Brinsa, K. B. Dowdy, A. A. Scott, J. M. Baskin, A. M. Deschamps, A. S. Lowry, G. P. Escobar, D. G. Lucas, W. M. Yarbrough, et al. Myocardial Infarct Expansion and Matrix Metalloproteinase Inhibition Circulation, February 4, 2003; 107(4): 618 - 625. [Abstract] [Full Text] [PDF] |
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F. Rademakers, F. Van de Werf, L. Mortelmans, G. Marchal, and J. Bogaert Evolution of regional performance after an acute anterior myocardial infarction in humans using magnetic resonance tagging J. Physiol., February 1, 2003; 546(3): 777 - 787. [Abstract] [Full Text] [PDF] |
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H. El-Adawi, L. Deng, A. Tramontano, S. Smith, E. Mascareno, K. Ganguly, R. Castillo, and N. El-Sherif The functional role of the JAK-STAT pathway in post-infarction remodeling Cardiovasc Res, January 1, 2003; 57(1): 129 - 138. [Abstract] [Full Text] [PDF] |
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E. O. Weinberg, M. Shimpo, G. W. De Keulenaer, C. MacGillivray, S.-i. Tominaga, S. D. Solomon, J.-L. Rouleau, and R. T. Lee Expression and Regulation of ST2, an Interleukin-1 Receptor Family Member, in Cardiomyocytes and Myocardial Infarction Circulation, December 3, 2002; 106(23): 2961 - 2966. [Abstract] [Full Text] [PDF] |
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M. Saeed, N. Watzinger, G. A. Krombach, G. K. Lund, M. F. Wendland, M. Chujo, and C. B. Higgins Left Ventricular Remodeling after Infarction: Sequential MR Imaging with Oral Nicorandil Therapy in Rat Model Radiology, September 1, 2002; 224(3): 830 - 837. [Abstract] [Full Text] [PDF] |
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A. Deten, H. C. Volz, W. Briest, and H.-G. Zimmer Cardiac cytokine expression is upregulated in the acute phase after myocardial infarction. Experimental studies in rats Cardiovasc Res, August 1, 2002; 55(2): 329 - 340. [Abstract] [Full Text] [PDF] |
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N. Ohte, K. Kurokawa, A. Iida, H. Narita, S. Akita, K. Yajima, H. Miyabe, J. Hayano, and G. Kimura Myocardial Oxidative Metabolism in Remote Normal Regions in the Left Ventricles with Remodeling After Myocardial Infarction: Effect of {beta}-Adrenoceptor Blockers J. Nucl. Med., June 1, 2002; 43(6): 780 - 785. [Abstract] [Full Text] [PDF] |
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J. McMurray and M. A. Pfeffer New Therapeutic Options in Congestive Heart Failure: Part I Circulation, April 30, 2002; 105(17): 2099 - 2106. [Full Text] [PDF] |
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M. K. Pasque Mathematic modeling and cardiac surgery J. Thorac. Cardiovasc. Surg., April 1, 2002; 123(4): 617 - 620. [Full Text] [PDF] |
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N. Watzinger, G. K. Lund, C. B. Higgins, M. Chujo, and M. Saeed Noninvasive assessment of the effects of nicorandil on left ventricular volumes and function in reperfused myocardial infarction Cardiovasc Res, April 1, 2002; 54(1): 77 - 84. [Abstract] [Full Text] [PDF] |
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D. Fraccarollo, J. Bauersachs, M. Kellner, P. Galuppo, and G. Ertl Cardioprotection by long-term ETA receptor blockade and ACE inhibition in rats with congestive heart failure: mono- versus combination therapy Cardiovasc Res, April 1, 2002; 54(1): 85 - 94. [Abstract] [Full Text] [PDF] |
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