Cardiac Remodelling and Failure after Myocardial Infarction

Acute myocardial infarction, particularly when it produces large transmural infarcts, can initiate complex changes in the structural and functional architecture of both infarcted and non-infarcted regions of the left ventricle, known as ventricular remodelling; these changes can profoundly affect left ventricular function and, consequently, clinical outcome and prognosis. Ventricular remodelling is a dynamic process with regional and global effects on wall thickness and composition and on chamber size, shape and function; it can include infarct extension, infarct expansion, regional and global distortion and ventricular dilatation. A systematic strategy for the ‘primary’ prevention of cardiac remodelling should probably be applied as early as possible to all patients suffering acute myocardial infarction. A ‘secondary’ prevention strategy should focus on the early identification and treatment of subsets of patients with evidence of cardiac remodelling, because later treatments have already been shown to be beneficial. Cardiologists must choose the strategy most appropriate for each individual patient.