Medical and surgical therapy for cardiac remodeling.

Ventricular remodeling refers to changes in ventricular geometry, volume, mass, and myocellular structure in response to myocardial injury or alteration in loading conditions. Although initially adaptive as a consequence of the initial damage to the myocardium, progressive ventricular remodeling is ultimately a maladaptive process that is associated with significant cardiovascular morbidity and mortality. Treatment with an aim to halt or reverse remodeling with mainly two classes of medications, angiotensin-converting enzyme inhibitors and beta-adrenergic blockers, has been shown to improve the long-term outcome. The role of pharmacologic and surgical therapy in remodeling is evolving and may have an important impact on the development of new directions of therapy for heart failure, myocardial infarction, and hypertension.