New therapeutic strategies for heart failure: left ventricular remodeling as a target.

Structural remodeling of the left ventricle involves myocyte growth and matrix changes that result in chamber enlargement, contractile dysfunction and dyssynchrony. Clinical and experimental data document that these structural changes correlate with progressive worsening of the syndrome of heart failure, that the changes are preventable and reversible, and that a favorable clinical therapeutic response is associated with regression of remodeling. The growing evidence that structural remodeling represents the disease of heart failure has now fueled mechanical as well as pharmacologic approaches to inhibiting the remodeling.