ABSTRACT
Heart failure is pandemic throughout the industrialized world. In the United States alone it is estimated that there are nearly 5 million individuals with this condition. Moreover, the prevalence of heart failure is likely to increase substantially over the next several decades. There are numerous reasons for this, including the aging of the population and increased prevalence of risk factors for heart failure such as obesity and diabetes. Greater awareness of the signs and symptoms of heart failure, availability of diagnostic tests that facilitate early detection of this condition and longer survival of existing patients will also contribute to increased prevalence. Ironically, another major factor is the improved survival of patients who have suffered myocardial injury of one type or another. It is now recognized that injury to the heart, whether due to a myocardial infarction (MI) or some other cause, initiates a complex series of changes in myocardial structure and function that has been termed cardiac remodeling. Although remodeling initially helps to maintain cardiac performance, the process is largely maladaptive, and if allowed to continue it causes progressive deterioration in cardiac function and results in heart failure. The central role of remodeling in the development of cardiac dysfunction is substantiated by evidence from clinical trials showing that therapies that inhibit or reverse the remodeling process are highly effective in preventing and treating heart failure.
