Determinants of remodeling in systolic heart failure John Harding and Thomas Cappola

Cardiac remodeling is a broad term that describes the change in size, shape, and function of the left ventricle (LV) that occurs in response to pathologic stress. The LV exhibits two classic patterns of remodeling, depending on the nature and duration of stress (Figure 4.1). Concentric remodeling, characterized by an increase in LV wall thickness and mass in the absence of chamber dilation, occurs in the early phases of pressure overload. Eccentric remodeling, characterized by chamber dilation and a decline in function, occurs in response to myocardial infarction, volume load, aortic or mitral regurgitation, and idiopathic dilated cardiomyopathy. There is substantial evidence in animal models that concentric remodeling often progresses to an eccentric phenotype in the situation of continued pathologic stress, but data in human subjects are less consistent.1,2 Once initiated, remodeling progresses over time and ultimately results in symptomatic heart failure (Figure 4.2).