[Left ventricular post-infarction remodeling. Natural history and therapeutic implications]

Post-infarction remodeling consists of changes in the size and shape of the left ventricular cavity taking place after myocardial necrosis. These changes in ventricular geometry involve the infarcted area as well as the myocardium situated at a distance from the infarct. The main factors of remodeling are the location, transmurality and extent of the necrosis, the current ventricular load, the patency of the artery responsible for the infarction, the distribution of coronary lesions and the absence of functional collateral circulation. Remodeling begins early and progresses during the weeks and months which follow the acute episode. Dilatation of the left ventricle is of poor prognosis, the principal complication being the development of congestive heart failure. Concerning treatment, the arterial recanalization obtained in the first hours is usually accompanied by a lesser ventricular dilatation. In case of extensive infarct with alteration of the global ventricular function, vasodilators, and notably angiotensin-converting enzyme inhibitors, attenuate the remodeling process and improve the mid- or long-term prognosis.