Cardiac Remodeling: Mechanism and Treatment
Barry Greenberg, MD, ed
569 pages. New York, NY: Taylor and Francis; 2006. $199.95. ISBN 0-8247-2387-2.
The appreciation that the myocardium changes shape and structure in response to disease has been appreciated for more than a century. The German anatomists including Krehl, Romberg, Aschoff, and Tawara debated the morphological changes occurring in the heart related to function at the end of the last century. The seminal work of Linzbach1 described the changes in myocyte size in response to aging and to hypertension, valvular heart disease, and heart failure. Because the cardiomyocyte is considered to be “terminally differentiated,” it must respond to disease by adapting to change by modifying its molecular and cellular characteristics. In addition to the changes in the cardiomyocyte itself, changes also take place in the interstitium, collagen, and coronary vasculature that surround it. Although it has been intuitive that remodeling is a progressive process, only in the last decade have we begun to understand the factors that initiate and perpetuate the process.
The immense progress that has been made in our understanding of the remodeling process in heart failure is extensively reviewed in this book. Its arrival is timely, occurring at a moment when the field is catching its breath and moving in new directions. It is particularly useful as an overview of the current understanding of remodeling from the perspective of both the basic scientist and the clinician.
The first section of the book discusses in depth the structural changes associated with remodeling that include excellent discussions of those that occur in the myocyte and the interstitium. These changes are related to the clinical problems in patients with heart failure. The excellent review by Martin Gerdes covers the cellular changes associated with hypertrophy and stretch. Stephan Hein and Jutta Schapper provide elegant illustrations of the functional and structural changes associated with hypertension. Jeffrey Borer and Karl Schuleri integrate the structural changes to the clinical changes into the phenotypical heart patient.
The second section reviews the factors that initiate ventricular remodeling and that lead to heart failure, including an extensive discussion by Barry Greenberg on the importance of the renin- angiotensin system on progressive remodeling and by Douglas Mann et al on the importance of inflammation. Experimental models of heart failure including genetically modified mice are also discussed in this section.
The third section reviews the clinical aspects of remodeling and the therapeutic interventions that modify remodeling. Here, the editor includes excellent sections on the assessment of clinical progression, in addition to discussions by Patten and Konstam on the role of inhibition of the renin-angiotensin system and by Ooi and Colucci on adrenergic blockade. The role of surgical intervention including coronary bypass surgery, valve replacement, and left ventricular assist devices are also reviewed. The final part of this section includes sections on gene transfer and myoblast transplantation.
In all, the editor has brought together many of the scientists and clinicians who have moved this subject forward in the last decade. By selecting these authors, the editor has coalesced the present state of our knowledge of ventricular remodeling. An added feature of the book is the very extensive bibliography that follows each of the 27 chapters. The book is a valuable resource to clinicians interested in heart failure should have a place in their library.
Dr Goldstein has served on a speakers bureau for and received honoraria from AstraZeneca.