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Ventricular remodeling and the renin angiotensin aldosterone system
1Division of Cardiology, Department of Medicine, New England Medical Center, Boston, MA 02111.
Insights
The renin-angiotensin-aldosterone system drives ventricular remodeling in systolic dysfunction. Blocking this system, particularly with ACE inhibitors and aldosterone blockers, improves heart failure outcomes.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Ventricular remodeling is a slow process linked to poor prognosis in left ventricular systolic dysfunction.
- The renin-angiotensin-aldosterone system plays a key role in the development of ventricular remodeling.
- Heart failure is a syndrome closely related to ventricular remodeling.
Purpose of the Study:
- To review the role of the renin-angiotensin-aldosterone system in ventricular remodeling.
- To discuss the impact of ACE inhibitors and angiotensin II type I receptor blockers on remodeling.
- To highlight the role of aldosterone in interstitial remodeling and its blockade.
Main Methods:
- Review of clinical and experimental data.
- Analysis of studies on ACE inhibitors and angiotensin II type I receptor antagonists.
- Examination of aldosterone's role in interstitial remodeling.
Main Results:
- ACE inhibitors improve ventricular remodeling and heart failure.
- Angiotensin II type I receptor blockade shows favorable effects on remodeling.
- Aldosterone blockade improves clinical outcomes by targeting interstitial remodeling.
Conclusions:
- The renin-angiotensin-aldosterone system is central to ventricular remodeling in systolic dysfunction.
- Pharmacological blockade of this system, including aldosterone, offers therapeutic benefits.
- Further research is needed to fully elucidate mechanisms and develop more effective treatments.
Abstract:
Ventricular remodeling in patients with left ventricular systolic dysfunction is an indolent process that is associated with a poor prognosis. Clinical and experimental data support the central role played by the renin-angiotensin-aldosterone system in the pathophysiology of remodeling. ACE inhibitors improve the natural history of ventricular remodeling and the syndrome of heart failure. Experimental and preliminary clinical data suggest that angiotensin II type I receptor blockade also impacts favorably on remodeling. Some experimental studies suggest a possible synergistic effect when combining ACE inhibitors and angiotensin II type I receptor antagonists. Aldosterone, the regulation of which, in part, is independent of angiotensin II, is a direct mediator of the interstitial component of remodeling, and its blockade has been found to improve clinical outcomes. Future research will more precisely define the mechanism for ventricular remodeling and will yield more effective means of achieving a clinically relevant impact on this process. (c)2000 by CHF, Inc.