Ventricular Remodeling

Ventricular remodeling (or cardiac remodeling) refers to the changes in size, shape, structure and physiology of the heart after injury to the myocardium. The injury is typically due to acute myocardial infarction (usually transmural or ST segment elevation infarction), but may be from a number of causes that result in increased pressure or volume overload (forms of strain) on the heart. Chronic hypertension, congenital heart disease with intracardiac shunting, and valvular heart disease may also lead to remodeling. After the insult occurs, a series of histopathological and structural changes occur in the left ventricular myocardium that lead to progressive decline in left ventricular performance. Ultimately, ventricular remodeling may result in diminished contractile (systolic) function and reduced stroke volume.

Medically speaking, "ventricular remodeling" implies a decline in function (even though the word "remodeling" usually implies improvement). Remodeling of the of the ventricles under left/right pressure demand make mismatches inevitable. Pathologic pressure mismatches between the pulmonary and brain/systemic circulation guide compensatory remodeling of the left and right ventricles. The term "reverse remodeling" in cardiology implies an improvement in ventricular mechanics and function following a remote injury or pathologic process.

Concentric hypertrophy is due to pressure overload, while eccentric hypertrophy is due to volume overload.