Remodeling

[Erin]

Dr. Fett, would you please explain to me what it means, that the heart undergoes remodeling? Some questions:

1. Is that a result of acute heart failure? Cardiomyopathy? Both?

2. What exactly stands to get remodeled?

3. What enables the heart and its parts to return to normal shape? What conditions would cause the heart to retain the remodeling?

4. How does Coreg play a role?

Thanks so much.

[JAMESFETT]

Dr. Fett, would you please explain to me what it means, that the heart undergoes remodeling? Some questions:

1. Is that a result of acute heart failure? Cardiomyopathy? Both?
(The remodeling of which we speak does not mean simply repair or healing. It refers to the shape of the left ventricle, which in its normal shape is somewhat oblong, not circular. The remodeling that occurs with dilated cardiomyopathy is a more rounded, spherical shape that is less efficient as a pump. Thus when we speak of remodeling in this situation it is a negative and adverse development, and we would like to reverse it or prevent it.--JDF)

2. What exactly stands to get remodeled? (See above--JDF)

3. What enables the heart and its parts to return to normal shape? What conditions would cause the heart to retain the remodeling?
(What favors preventing the undesirable remodeling is an early diagnosis and effective treatment of dilated cardiomyopathy with ACE-I and Beta-blockers. It is not possible usually to totally reverse the adverse remodeling; but it is possible to minimize it. When the expert eye looks at an echo of the left ventricle, even when recovery of EF exceeds 50 percent, it may often be possible to detect the abnormal shape of the left ventricle, and to know that even if systolic function is returned to a minimally normal level, absolute and complete recovery to normal earlier status may not be the case. ---JDF)

4. How does Coreg play a role?
(See above. From limited studies it appears that carvedilol (Coreg) MAY reverse the undesirable remodeling better than other beta-blockers and/or ACE-inhibitors.--JDF)

[Erin]

Thank you, Dr. Fett. Why does the LV change shape? Is it trying to compensate for the stress on it due to cardiomyopathy?

Thanks again.

[JAMESFETT]

It's because of fundamental changes to the "cytoskeleton" the framework of the left ventricle. Bridges and bonds are damaged by whatever the insulting factor is, beit autoimmunity and/or virus, etc, and that causes a structual collapse in varying degrees. If severe enough the shape will change. Of course there is considerable cushion of reserve before that happens--which turns out to be the best "window of opportunity" to prevent or reverse it.

JD

[reezlemom]

That's a really great question, I'd wondered some of the same things myself. So now I'd like to add to it by asking; does remodeling always happens in cardiomyopathy?

[JAMESFETT]

No, definitely not always; and sometimes only so slight that when recovery is complete the shape and size of the left ventricle have returned to absolutely normal appearance. The greater dilatation and change of shape relate to the extensiveness of "injury." (In this case "injury" refers to the amount of viral or other infectious agent damage, the extent of autoimmune myocarditis, the damage by drugs and or toxins, etc.)

JD

[Erin]

So this is another reason why early detection/proper treatment is so important.

It's really interesting.

Thanks, Dr. Fett.

[reezlemom]

Cool. Yes, just another of the million reasons early detection is so vital.