Cardiac remodeling-concepts and clinical implications: A consensus paper from an International Forum on Cardiac Remodeling

Jay N Cohn, Roberto Ferrari, Norman Sharpe

Research output: Contribution to journalArticle

1542 Citations (Scopus)

Abstract

Cardiac remodeling is generally accepted as a determinant of the clinical course of heart failure (HF). Defined as genome expression resulting in molecular, cellular and interstitial changes and manifested clinically as changes in size, shape and function of the heart resulting from cardiac load or injury, cardiac remodeling is influenced by hemodynamic load, neurohormonal activation and other factors still under investigation. Although patients with major remodeling demonstrate progressive worsening of cardiac function, slowing or reversing remodeling has only recently become a goal of HF therapy. Mechanisms other than remodeling can also influence the course of heart disease, and disease progression may occur in other ways in the absence of cardiac remodeling. Left ventricular end-diastolic and end-systolic volume and ejection fraction data provide support for the beneficial effects of therapeutic agents such as angiotensin-converting enzyme (ACE) inhibitors and beta-adrenergic blocking agents on the remodeling process. These agents also provide benefits in terms of morbidity and mortality. Although measurement of ejection fraction can reliably guide initiation of treatment in HF, opinions differ regarding the value of ejection fraction data in guiding ongoing theraphy. The role of echocardiography or radionuclide imaging in the management and monitoring of HF is as yet unclear. To fully appreciate the potential benefits of HF therapies, clinicians should understand the relationship between remodeling and HF progression. Their patients may then, in turn, acquire an improved understanding of their disease and the treatments they are given. (C) 2000 by the American College of Cardiology.

Original languageEnglish (US)
Pages (from-to)569-582
Number of pages14
JournalJournal of the American College of Cardiology
Volume35
Issue number3
DOIs
StatePublished - Mar 1 2000

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Heart Failure
Adrenergic beta-Antagonists
Therapeutic Uses
Therapeutics
Angiotensin-Converting Enzyme Inhibitors
Radionuclide Imaging
Echocardiography
Disease Progression
Heart Diseases
Hemodynamics
Genome
Morbidity
Mortality
Wounds and Injuries

Cite this

Cardiac remodeling-concepts and clinical implications : A consensus paper from an International Forum on Cardiac Remodeling. / Cohn, Jay N; Ferrari, Roberto; Sharpe, Norman.

In: Journal of the American College of Cardiology, Vol. 35, No. 3, 01.03.2000, p. 569-582.

Research output: Contribution to journalArticle

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