Left ventricular remodeling in heart failure: current concepts in clinical significance and assessment.
Reads0
Chats0
TLDR
The findings substantiate the importance of ventricular remodeling as central in the pathophysiology of advancing heart failure and support the role of measures of LV remodeling in the clinical investigation of novel heart failure treatments.Abstract:
Ventricular remodeling, first described in animal models of left ventricular (LV) stress and injury, occurs progressively in untreated patients after large myocardial infarction and in those with dilated forms of cardiomyopathy. The gross pathologic changes of increased LV volume and perturbation in the normal elliptical LV chamber configuration is driven, on a histologic level, by myocyte hypertrophy and apoptosis and by increased interstitial collagen. Each of the techniques used for tracking this process—echocardiography, radionuclide ventriculography, and cardiac magnetic resonance—carries advantages and disadvantages. Numerous investigations have demonstrated the value of LV volume measurement at a single time-point and over time in predicting clinical outcomes in patients with heart failure and in those after myocardial infarction. The structural pattern of LV remodeling and evidence of scarring on cardiac magnetic resonance have additional prognostic value. Beyond the impact of abnormal cardiac structure on cardiovascular events, the relationship between LV remodeling and clinical outcomes is likely linked through common local and systemic factors driving vascular as well as myocardial pathology. As demonstrated by a recent meta-analysis of heart failure trials, LV volume stands out among surrogate markers as strongly correlating with the impact of a particular drug or device therapy on patient survival. These findings substantiate the importance of ventricular remodeling as central in the pathophysiology of advancing heart failure and support the role of measures of LV remodeling in the clinical investigation of novel heart failure treatments.read more
Citations
More filters
Journal ArticleDOI
Association of Change in N-Terminal Pro-B-Type Natriuretic Peptide Following Initiation of Sacubitril-Valsartan Treatment With Cardiac Structure and Function in Patients With Heart Failure With Reduced Ejection Fraction.
James L. Januzzi,Margaret F. Prescott,Javed Butler,G. Michael Felker,Alan S. Maisel,Kevin McCague,Alexander Camacho,Ileana L. Piña,Ricardo Rocha,Amil M. Shah,Kristin M Williamson,Scott D. Solomon +11 more
TL;DR: This exploratory study of patients with heart failure and reduced ejection fraction treated with sacubitril-valsartan found a correlation between changes in log2-NT-proBNP concentrations and left ventricular (LV) EF,LV end-diastolic volume index (LVEDVI), LV end-systolic volumeIndex (LVESVI), left atrial volume index(LAVI), and ratio of early transmitral Doppler velocity/early diastolic
OtherDOI
Pathophysiology of Heart Failure.
Edit Tanai,Stefan Frantz +1 more
TL;DR: This summary of the pathophysiology of heart failure tries to give a compact overview of basic mechanisms and of the novel unfolding, progressive theory ofHeart failure to contribute to a more comprehensive knowledge of the disease.
Journal ArticleDOI
Empagliflozin Ameliorates Adverse Left Ventricular Remodeling in Nondiabetic Heart Failure by Enhancing Myocardial Energetics.
Carlos G. Santos-Gallego,Carlos G. Santos-Gallego,Juan Antonio Requena-Ibanez,Rodolfo San Antonio,Kiyotake Ishikawa,Shin Watanabe,Belén Picatoste,Eduardo Flores,Alvaro Garcia-Ropero,Javier Sanz,Roger J. Hajjar,Valentin Fuster,Juan J. Badimon,Juan J. Badimon +13 more
TL;DR: Empagliflozin ameliorates adverse cardiac remodeling and heart failure in a nondiabetic porcine model by switching myocardial fuel metabolism away from glucose toward ketone bodies (KB), which improves myocardIAL energy production.
Journal ArticleDOI
Proliferation and Recruitment Contribute to Myocardial Macrophage Expansion in Chronic Heart Failure
Hendrik B. Sager,Maarten Hulsmans,Kory J. Lavine,Marina B Beltrami Moreira,Timo Heidt,Gabriel Courties,Yuan Sun,Yoshiko Iwamoto,Benoit Tricot,Omar F. Khan,James E. Dahlman,Anna Borodovsky,Kevin Fitzgerald,Daniel G. Anderson,Ralph Weissleder,Peter Libby,Filip K. Swirski,Matthias Nahrendorf +17 more
TL;DR: The number, origin, phenotype, and function of remote cardiac macrophages residing in the nonischemic myocardium in mice with chronic heart failure after coronary ligation are investigated, suggesting that myocardial failure is influenced by an altered myeloid cell repertoire.
Journal ArticleDOI
Randomized Trial of Empagliflozin in Nondiabetic Patients With Heart Failure and Reduced Ejection Fraction.
Carlos G. Santos-Gallego,Ariana P. Vargas-Delgado,Juan Antonio Requena-Ibanez,Alvaro Garcia-Ropero,Donna M. Mancini,Sean Pinney,Frank Macaluso,Samantha Sartori,Mercè Roqué,Fernando Sabatel-Perez,Anderly Rodriguez-Cordero,M. Urooj Zafar,Icilma V. Fergus,Farah Atallah-Lajam,Johanna Contreras,Cathleen Varley,Pedro R. Moreno,Vivian M. Abascal,Anuradha Lala,Ronald Tamler,Javier Sanz,Valentin Fuster,Juan J. Badimon,Empa-Tropism (Atru ) Investigators +23 more
TL;DR: Empagliflozin administration to non-diabetic HFrEF patients significantly improves LV volumes, LV mass, LV systolic function, functional capacity, and quality of life when compared with placebo.
References
More filters
Journal ArticleDOI
The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators.
Bertram Pitt,Faiez Zannad,Willem J. Remme,Robert J. Cody,Alain Castaigne,Alfonso Perez,Jolie Palensky,Janet Wittes +7 more
TL;DR: Blockade of aldosterone receptors by spironolactone, in addition to standard therapy, substantially reduces the risk of both morbidity and death among patients with severe heart failure.
Journal ArticleDOI
Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. results of the survival and ventricular enlargement trial
Marc A. Pfeffer,Eugene Braunwald,Lemuel A. Moyé,Lofty L. Basta,Edward J. Brown,Thomas E. Cuddy,Barry R. Davis,Edward M. Geltman,Steven Goldman,Greg C. Flaker,Marc Klein,Gervasio A. Lamas,Milton Packer,Jacques R. Rouleau,Jean L. Rouleau,John D. Rutherford,John H. Wertheimer,C. Morton Hawkins +17 more
TL;DR: In patients with asymptomatic left ventricular dysfunction after myocardial infarction, long-term administration of captopril was associated with an improvement in survival and reduced morbidity and mortality due to major cardiovascular events.
Journal ArticleDOI
The Effect of Spironolactone on Morbidity and Mortality in Patients with Severe Heart Failure
Bertram Pitt,Faiez Zannad,Willem J. Remme,Robert J. Cody,Alain Castaigne,Alfonso Perez,Jolie Palensky,Janet Wittes +7 more
Journal ArticleDOI
Eplerenone, a Selective Aldosterone Blocker, in Patients with Left Ventricular Dysfunction after Myocardial Infarction
Bertram Pitt,Willem J. Remme,Faiez Zannad,James D. Neaton,Felipe Martinez,Barbara Roniker,Richard Bittman,Steve Hurley,Jay H. Kleiman,Marjorie Gatlin +9 more
TL;DR: The addition of eplerenone to optimal medical therapy reduces morbidity and mortality among patients with acute myocardial infarction complicated by left ventricular dysfunction and heart failure.
Journal ArticleDOI
The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction.
Raymond J. Kim,Edwin Wu,Allen Rafael,Enn-Ling Chen,Michele Parker,Orlando P. Simonetti,Francis J. Klocke,Robert O. Bonow,Robert M. Judd +8 more
TL;DR: Reversible myocardial dysfunction can be identified by contrast-enhanced MRI before coronary revascularization and is strongly related to the degree of improvement in the global mean wall-motion score and the ejection fraction after Revascularization.
Related Papers (5)
2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
Clyde W. Yancy,Mariell Jessup,Biykem Bozkurt,Javed Butler,Donald E. Casey,Mark H. Drazner,Gregg C. Fonarow,Stephen A. Geraci,Tamara B. Horwich,James L. Januzzi,Maryl R. Johnson,Edward K. Kasper,Wayne C. Levy,Frederick A. Masoudi,Patrick E. McBride,John J.V. McMurray,Judith E. Mitchell,Pamela N. Peterson,Barbara Riegel,Flora Sam,Lynne W. Stevenson,W.H. Wilson Tang,Emily J. Tsai,Bruce L. Wilkoff +23 more
Ventricular remodeling after myocardial infarction. Experimental observations and clinical implications.
Marc A. Pfeffer,Eugene Braunwald +1 more
Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.
Roberto M. Lang,Luigi P. Badano,Victor Mor-Avi,Jonathan Afilalo,Anderson C. Armstrong,Laura Ernande,Frank A. Flachskampf,Elyse Foster,Steven A. Goldstein,Tatiana Kuznetsova,Patrizio Lancellotti,Denisa Muraru,Michael H. Picard,Ernst Rietzschel,Lawrence G. Rudski,Kirk T. Spencer,Wendy Tsang,Jens-Uwe Voigt +17 more