Left ventricular dysfunction and progression to clinical congestive heart failure: the case for earlier intervention

Progressive left ventricular dilatation and dysfunction can occur following transmural myocardial infarction and ventricular volumes are primary predictors of survival. The relationship between left ventricular dysfunction and clinical congestive heart failure is variable and left ventricular dysfunction is often advanced at the time of clinical presentation. Although modern treatment can provide definite haemodynamic and symptomatic benefit for patients with congestive heart failure and improve survival, such treatment is essentially palliative in many cases; there is therefore a need to consider earlier intervention. Experimental animal studies which have shown improved ventricular performance and survival with treatment following myocardial infarction strengthen the rationale for a preventive approach. Initial clinical studies have demonstrated that treatment can improve asymptomatic ventricular dysfunction following myocardial infarction. Immediate intervention following infarction may provide even more significant benefit and the results of ongoing large-scale studies are awaited to determine the value of this approach.