Left ventricular remodeling after myocardial infarction: does the cardiac renin-angiotensin system play a role?

Possible cardioprotective effects are one of the most intriguing aspects of the expanding spectrum of clinical indications for the use of converting-enzyme inhibitors. Among them, the prevention of postinfarction ventricular remodeling--a deleterious process leading to eccentric cardiac hypertrophy and, eventually, to congestive heart failure--has attracted particular interest and attention. This communication examines the possible role of the endogenous cardiac renin-angiotensin system in the pathophysiology of ventricular remodeling. Although much of the evidence is indirect, there are several lines of investigation that strongly support the causative participation of the cardiac renin-angiotensin system in ventricular remodeling.