doi: 10.1161/CIRCULATIONAHA.105.554725
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(Circulation. 2005;112:1245-1247.)
© 2005 American Heart Association, Inc.
Editorial |
Preservation of Cardiac Extracellular Matrix by Passive Myocardial Restraint
An Emerging New Therapeutic Paradigm in the Prevention of Adverse Remodeling and Progressive Heart Failure
From the Division of Cardiology, Department of Medicine, and the Burns and Allen Research Institute, Cedars Sinai Medical Center, and David Geffen School of Medicine at the University of California at Los Angeles.
Correspondence to P.K. Shah, MD, Suite 5531, Division of Cardiology, Cedars Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048. E-mail shahp@cshs.org
Key Words: Editorials • remodeling • heart failure • metalloproteinase
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
Congestive heart failure is a burgeoning problem, especially in older adults, affecting nearly 0.1% of subjects >65 years old, accounting for nearly 20% of all hospitalizations in this age group, and costing the healthcare system a bundle.1 Several experimental observations have demonstrated an important role for progressive dilation and geometric remodeling of the left ventricle in worsening cardiac pump function.2 The results of experimental studies on the adverse implications of ventricular dilation and remodeling have been confirmed in clinical and epidemiological studies of depressed ventricular function and congestive heart failure in humans.2,3 Studies of the natural history of left ventricular dysfunction provide evidence to directly implicate left ventricular dilation and remodeling to an adverse clinical outcome in patients with congestive heart failure. Ventricular dilation and remodeling impose an increased mechanical disadvantage to the pump function by increasing wall stress and consequently the hemodynamic load and by contributing to mitral regurgitation and possibly arrhythmogenesis in patients with congestive heart failure independently of the neurohormonal status. Therapeutic trials have also shown that the majority of clinically useful and approved treatment modalities in heart failure attenuate or reverse ventricular dilation and remodeling.4–8 Despite multiple drug therapies, including neurohormonal blockade, progressive ventricular dilation and adverse remodeling frequently continue in many patients with depressed ventricular function. Although orthotopic cardiac transplantation is highly successful in alleviating heart failure and improving survival, limited donor supply, organ rejection, and complications related to immunosuppressive therapy continue to limit the utility of this procedure. In recent years, several new nonpharmacological
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