[Left ventricular remodeling. A complex biological problem around three simple paradigms].

Left ventricular remodelling occurring after myocardial infarction is a complicated issue. This review aims to propose that the clinical background of cardiac remodelling, namely systolic and diastolic dysfunctions and arrhythmias is arranged around three, perhaps four, simple biological paradigms: (i) the deleterious aspects of the adaptational process to mechanical overload, (ii) fibrosis which does not belong to the adaptational process and is multifactorial, with two major etiologies, namely senescence and ischemia, (iii) cell death due to necrosis or apoptosis, the later is also multifactorial. (iv) A fourth additional parameter may be of importance, namely the phenotypic specific modifications of the cardiocytes which are directly provoked by either ischemia or certain hormones and which may modify, or even reverse the changes due to the adaptational process.