Ventricular remodeling and the renin angiotensin aldosterone system.
Ventricular remodeling in patients with left ventricular systolic dysfunction is an indolent process that is associated with a poor prognosis. Clinical and experimental data support the central role played by the renin-angiotensin-aldosterone system in the pathophysiology of remodeling. ACE inhibitors improve the natural history of ventricular remodeling and the syndrome of heart failure. Experimental and preliminary clinical data suggest that angiotensin II type I receptor blockade also impacts favorably on remodeling. Some experimental studies suggest a possible synergistic effect when combining ACE inhibitors and angiotensin II type I receptor antagonists. Aldosterone, the regulation of which, in part, is independent of angiotensin II, is a direct mediator of the interstitial component of remodeling, and its blockade has been found to improve clinical outcomes. Future research will more precisely define the mechanism for ventricular remodeling and will yield more effective means of achieving a clinically relevant impact on this process. (c)2000 by CHF, Inc.
Patten
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RD
Division of Cardiology, Department of Medicine, New England Medical Center, Boston, MA 02111.
Konstam
M A
MA