Left ventricular remodelling post-myocardial infarction: pathophysiology, imaging, and novel therapies

Abstract

Most patients survive acute myocardial infarction (MI). Yet this encouraging development has certain drawbacks: heart failure (HF) prevalence is increasing and patients affected tend to have more comorbidities worsening economic strain on healthcare systems and impeding effective medical management. The heart’s pathological changes in structure and/or function, termed myocardial remodelling, significantly impact on patient outcomes. Risk factors like diabetes, chronic obstructive pulmonary disease, female sex, and others distinctly shape disease progression on the ‘road to HF’. Despite the availability of HF drugs that interact with general pathways involved in myocardial remodelling, targeted drugs remain absent, and patient risk stratification is poor. Hence, in this review, we highlight the pathophysiological basis, current diagnostic methods and available treatments for cardiac remodelling following MI. We further aim to provide a roadmap for developing improved risk stratification and novel medical and interventional therapies.

Graphical Abstract

Graphical Abstract

After a cardiac injury, comorbidites and various pathophysiologic mechanisms contribute to left ventricular remodelling and heart failure. Strategies to improve patient care beyond currently available treatment algorithms should include novel diagnostics, improved and treatment specific patient selection as well as novel therapies.