Left ventricular remodelling and dysfunction - Can the process be prevented?

Due to continuous remodelling myocardial dysfunction is a progressive condition. Even if the initial event is so mild that it causes no immediate cardiac dysfunction (e.g. a small myocardial infarction), the remodelling process is triggered. Although the remodelling process can be adaptive, the process becomes maladaptive when the stimuli are continuous and pathological. A similar remodelling process is seen in most primary myocardial disorders, suggesting common mechanisms for the development of heart failure. Although clinical heart failure may develop acutely, for example, after an acute myocardial infarction, the progressive changes in myocardial structure and deterioration of myocardial function can go on silently fur a very long time and overt heart failure may develop several years after an initial insult, even if then are no further events. In order to fundamentally improve prognosis in cardiac failure it is necessary to identify patients with an ongoing remodelling process and to effectively counteract this process as early as possible. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.