Ventricular remodeling

Changes in the size, shape, structure, and function of the heart after injury to the ventricles

Ventricular remodeling

A diagram of a myocardiocyte, the primary cell type involved in ventricular remodeling.

Ventricular remodeling refers to the changes in size, shape, structure, and function of the heart's ventricles following cardiac injury, such as a myocardial infarction (heart attack). This process can lead to heart failure if the remodeling is maladaptive.

Pathophysiology

Ventricular remodeling involves complex interactions between cardiomyocytes, the extracellular matrix, and various signaling pathways. After a myocardial infarction, the loss of cardiomyocytes triggers an inflammatory response, leading to scar formation and changes in the extracellular matrix. This can result in dilation and thinning of the ventricular walls, altering the heart's geometry and impairing its function.

Cellular and molecular mechanisms

The remodeling process is driven by several molecular mechanisms, including the activation of neurohormonal systems such as the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system. These systems promote fibrosis, hypertrophy, and apoptosis of cardiomyocytes, contributing to the structural changes in the heart.

Clinical implications

Ventricular remodeling can lead to heart failure with reduced ejection fraction (HFrEF) due to the heart's decreased ability to pump blood effectively. It is associated with increased morbidity and mortality. Early intervention with medications such as ACE inhibitors, beta-blockers, and aldosterone antagonists can help mitigate the remodeling process and improve outcomes.

Diagnosis

Ventricular remodeling is typically assessed using imaging techniques such as echocardiography, magnetic resonance imaging (MRI), or computed tomography (CT) scans. These modalities allow for the evaluation of changes in ventricular size, wall thickness, and function.

Treatment

The management of ventricular remodeling focuses on addressing the underlying causes and preventing further cardiac damage. Pharmacological treatments, lifestyle modifications, and in some cases, surgical interventions such as coronary artery bypass grafting (CABG) or ventricular assist devices (VADs) may be employed.

Related pages

• Heart failure
• Myocardial infarction
• Cardiomyopathy