Left ventricular remodeling in the post-infarction heart: a review of cellular, molecular mechanisms, and therapeutic modalities

Abstract

As more patients survive myocardial infarctions, the incidence of heart failure increases. After an infarction, the human heart undergoes a series of structural changes, which are governed by cellular and molecular mechanisms in a pathological metamorphosis termed "remodeling." This review will discuss the current developments in our understanding of these molecular and cellular events in remodeling and the various pharmacological, cellular and device therapies used to treat, and potentially retard, this condition. Specifically, this paper will examine the neurohormonal activity of the renin-angiotensin-aldosterone axis and its molecular effects on the heart. The emerging understanding of the extra-cellular matrix and the various active molecules within it, such as the matrix metalloproteinases, elicits new appreciation for their role in cardiac remodeling and as possible future therapeutic targets. Cell therapy with stem cells is another recent therapy with great potential in improving post-infarcted hearts. Lastly, the cellular and molecular effects of left ventricular assist devices on remodeling will be reviewed. Our increasing knowledge of the cellular and molecular mechanisms underlying cardiac remodeling enables us not only to better understand how our more successful therapies, like angiotensin-converting enzyme inhibitors, work, but also to explore new therapies of the future.

Retracted: Tanshinone IIA prevents left ventricular remodelling via the TLR4/MyD88/NF‐κB signalling pathway in rats with myocardial infarction

“…After an infarction, the heart undergoes a series of structural changes that are governed by cellular and molecular mechanisms in a pathological metamorphosis known as ventricular remodelling 4. Ventricular remodelling (VR) is a powerful prognostic factor is used after a patient has suffered from an infarction has been proved as a good target for intervention.…”

“…Ventricular remodelling (VR) is a powerful prognostic factor is used after a patient has suffered from an infarction has been proved as a good target for intervention. Shortly after the injury occurs, histopathological and structural changes occur in the left ventricular myocardium that leads to a decline in left ventricular performance, which can eventually manifest itself in diminished systolic function and reduced stroke volume 4. Moreover, left ventricular remodelling (LVR) in ischaemic cardiomyopathy has been determine as the main cause of heart failure and is an established prognostic factor for cardiovascular complications 5.…”

Heart Failure After Myocardial Infarction: Clinical Implications and Treatment

“…Neovascularization, paracrine effects on surrounding tissues, and regeneration of viable myocardium are some of the hypotheses concerning its mechanism. 34 There are 2 important trials that have used stem cells in HF after MI, the Re-infusion of Enriched Progenitor Cells and Infarct Remodeling in Acute Myocardial Infarction (REPAIR-AMI) trial and the BALANCE (Clinical Benefit and Long-Term Outcome After Intracoronary Autologous Bone Marrow Cell Transplantation in Patients With Acute Myocardial Infarction) study. 35,36 In the first trial, 204 patients were randomized to receive intracoronary bone marrow-derived stem cell transplantation 3 to 7 days after MI.…”

Az oxidatív stressz szerepe szívelégtelenségben

“…Ennek hátterében a RAAS-rendszer, a szimpatikus idegrendszer és az ezek következtében megváltozott intracelluláris jelátviteli mechanizmusok állnak [4].…”