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(Circulation. 2000;101:2981.)
© 2000 American Heart Association, Inc.


Clinical Cardiology: New Frontiers

Left Ventricular Remodeling After Myocardial Infarction

Pathophysiology and Therapy

Martin G. St. John Sutton, MBBS, FRCP; Norman Sharpe, MD, FRACP

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 1Down). This article will review postinfarction remodeling, pathophysiological mechanisms, and therapeutic intervention.



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Figure 1. Diagrammatic representation of the many factors involved in the pathophysiology of ventricular remodeling. ECM indicates extracellular matrix; RAAS, renin-angiotensin-aldosterone system; CO, cardiac output; SVR, systemic vascular resistance; LV, left ventricular; and AII, angiotensin II.

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 . . . [Full Text of this Article]




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Crit. Care Nurse, December 1, 2004; 24(6): 14 - 29.
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HeartHome page
Y Sato, T Kita, Y Takatsu, and T Kimura
Biochemical markers of myocyte injury in heart failure
Heart, October 1, 2004; 90(10): 1110 - 1113.
[Abstract] [Full Text] [PDF]


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HeartHome page
A D McGavigan, J Moncrieff, M M Lindsay, P R Maxwell, and F G Dunn
Time course of plasma markers of collagen turnover in patients with acute myocardial infarction
Heart, September 1, 2004; 90(9): 1053 - 1054.
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Am. J. Physiol. Heart Circ. Physiol.Home page
R. Ramani, M. Mathier, P. Wang, G. Gibson, S. Togel, J. Dawson, A. Bauer, S. Alber, S. C. Watkins, C. F. McTiernan, et al.
Inhibition of tumor necrosis factor receptor-1-mediated pathways has beneficial effects in a murine model of postischemic remodeling
Am J Physiol Heart Circ Physiol, September 1, 2004; 287(3): H1369 - H1377.
[Abstract] [Full Text] [PDF]


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Eur Heart J SupplHome page
L.G Melo, M Gnecchi, A.S Pachori, K Wang, and V.J Dzau
Gene- and cell-based therapies for cardiovascular diseases: current status and future directions
Eur. Heart J. Suppl., September 1, 2004; 6(suppl_E): E24 - E35.
[Abstract] [Full Text]


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J. Thorac. Cardiovasc. Surg.Home page
M. Cirillo, A. Amaducci, F. Brunelli, M. Dalla Tomba, P. Parrella, G. Tasca, G. Troise, and E. Quaini
Determinants of postinfarction remodeling affect outcome and left ventricular geometry after surgical treatment of ischemic cardiomyopathy
J. Thorac. Cardiovasc. Surg., June 1, 2004; 127(6): 1648 - 1656.
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Circ. Res.Home page
S. Janssens, P. Pokreisz, L. Schoonjans, M. Pellens, P. Vermeersch, M. Tjwa, P. Jans, M. Scherrer-Crosbie, M. H. Picard, Z. Szelid, et al.
Cardiomyocyte-Specific Overexpression of Nitric Oxide Synthase 3 Improves Left Ventricular Performance and Reduces Compensatory Hypertrophy After Myocardial Infarction
Circ. Res., May 14, 2004; 94(9): 1256 - 1262.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Heart Circ. Physiol.Home page
R. Mukherjee, A. M. Parkhurst, J. T. Mingoia, S. E. Sweterlitsch, J. S. Leiser, G. P. Escobar, F. G. Spinale, and J. P. Saul
Myocardial remodeling after discrete radiofrequency injury: effects of tissue inhibitor of matrix metalloproteinase-1 gene deletion
Am J Physiol Heart Circ Physiol, April 1, 2004; 286(4): H1242 - H1247.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
F. Eefting, B. Rensing, J. Wigman, W. J. Pannekoek, W. M. Liu, M. J. Cramer, D. J Lips, and P. A Doevendans
Role of apoptosis in reperfusion injury
Cardiovasc Res, February 15, 2004; 61(3): 414 - 426.
[Abstract] [Full Text] [PDF]


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Eur J Heart FailHome page
G. A. Whalley, G. D. Gamble, H. J. Walsh, S. P. Wright, S. Agewall, N. Sharpe, and R. N. Doughty
Effect of tissue harmonic imaging and contrast upon between observer and test-retest reproducibility of left ventricular ejection fraction measurement in patients with heart failure
Eur J Heart Fail, January 1, 2004; 6(1): 85 - 93.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Heart Circ. Physiol.Home page
R. E. Chapman and F. G. Spinale
Extracellular protease activation and unraveling of the myocardial interstitium: critical steps toward clinical applications
Am J Physiol Heart Circ Physiol, January 1, 2004; 286(1): H1 - H10.
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CirculationHome page
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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Cardiovasc ResHome page
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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Physiol. GenomicsHome page
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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ANN INTERN MEDHome page
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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NEJMHome page
M. Jessup and S. Brozena
Heart Failure
N. Engl. J. Med., May 15, 2003; 348(20): 2007 - 2018.
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HeartHome page
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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J. Thorac. Cardiovasc. Surg.Home page
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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HypertensionHome page
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.
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CirculationHome page
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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J. Physiol.Home page
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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Cardiovasc ResHome page
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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CirculationHome page
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.
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RadiologyHome page
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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Cardiovasc ResHome page
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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JNMHome page
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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CirculationHome page
J. McMurray and M. A. Pfeffer
New Therapeutic Options in Congestive Heart Failure: Part I
Circulation, April 30, 2002; 105(17): 2099 - 2106.
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J. Thorac. Cardiovasc. Surg.Home page
M. K. Pasque
Mathematic modeling and cardiac surgery
J. Thorac. Cardiovasc. Surg., April 1, 2002; 123(4): 617 - 620.
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Cardiovasc ResHome page
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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Cardiovasc ResHome page
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]