Assessment of ventricular remodeling in heart failure clinical trials.

Adverse remodeling involves a complicated process of structural and functional changes in the left ventricle (LV). LV remodeling is progressive and, if left unchecked, culminates in heart failure that portends a poor prognosis. Clinical trials in heart failure have employed various techniques to assess ventricular remodeling while focusing on therapeutic-specific strategies to halt or reverse remodeling. These strategies include (1) those designed to reduce wall stress by limiting LV dilatation and reducing LV loading conditions (nitrates and epicardial restraint), (2) those designed to block neurohormonal activation, including angiotensin converting enzyme inhibitors, angiotensin receptor blockers, β-adrenergic receptor blockers, and aldosterone receptor blockers, (3) ionotropic agents/cardiac glycosides, and (4) cardiac resynchronization therapy. Strategies in development include mechanical assist devices and myocardial regeneration. To date, trials have demonstrated a linkage between indices of remodeling and clinical outcomes measures. Indices of remodeling have facilitated identification of targets for novel pharmaceutical agents and new device therapies.