[Post-infarct myocardial remodelling: from experimental data to the prevention of heart failure]

Structural and biochemical modifications of the myocardium (remodeling) occur after acute myocardial infarction. An important part of this process of myocardial remodeling takes place in the interstitial compartment which is composed mainly of fibrillar collagen. These remodeling changes are associated with modifications in left ventricular geometry and function that could be deleterious and have significant clinical manifestations. Some salutary effects of the treatment are related to modifications of the process of interstitial remodeling. Clinical studies with calcium channel antagonists, nitrates and, specially converting enzyme inhibitors have shown significant improvement in the degree of ventricular dilation, hemodynamics and exercise tolerance as a compared to placebo treated patients. Ongoing clinical studies will provide us with more definite information on the effects of converting enzyme inhibitors on long term prognosis as well as on myocardial remodeling after acute myocardial infarction.