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Cardiac remodeling at the population level—risk factors, screening, and outcomes

Nature Reviews Cardiology volume 8, pages 673–685 (2011)Cite this article

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Abstract

The prevalence of heart failure is increasing in the western world. Current efforts aim to identify heart failure at its earliest and preclinical stages in order to begin treatment and prevent deterioration before the symptoms escalate. Cardiac remodeling is the process of structural and functional changes in the left ventricle in response to internal or external cardiovascular damage or influence by pathogenic risk factors, and is a precursor of clinical heart failure. Cardiac remodeling is classified as isolated cardiac hypertrophy or as hypertrophy in combination with left ventricular dilatation, and has been used as a surrogate end point in clinical trials. In this article, we review population-based studies of cardiac remodeling, providing insights into the associations between remodeling and risk factors such as age, sex, ethnicity, body stature and composition, and disease. We also highlight the importance of screening for subclinical heart failure and describe the strategies used to do so.

Key Points

  • Cardiac remodeling refers to the structural and functional changes of left ventricle in response to internal or external cardiovascular damage or pathogenic risk factors; cardiac remodeling precedes clinical heart failure

  • Geometric patterns of cardiac remodeling are defined by evaluation of left ventricular (LV) volumes and mass by imaging modalities, such as echocardiography or MRI

  • LV mass and volumes vary by age, sex, body stature and composition, and risk factors for cardiovascular disease

  • Patients with elevated or increasing LV mass, LV dilatation, or both, have unfavorable cardiovascular outcomes

  • Echocardiography is the least-expensive and most-widely available imaging modality to screen for LV remodeling; however, no current evidence supports screening for LV remodeling in the general population

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Figure 1: Kaplan–Meier curves for incident CHF by sex-specific quartiles of LV mass.
Figure 2: The patterns of cardiac remodeling, as defined by evaluation of LV mass and end-diastolic volume.
Figure 3: Wall stress increases the tension in the myocardium and thus reduces myocardial blood flow and counteracts myocardial shortening.
Figure 4: Concentric and eccentric hypertrophy can be distinguished by the orientation in which individual sarcomeres are added.
Figure 5: The sex-specific associations between age groups and LV volume and mass in the MESA study.

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Authors and Affiliations

  1. Division of Cardiology, Johns Hopkins University School of Medicine,

    Ola Gjesdal & Joao A. Lima

  2. 600 North Wolfe Street, Blalock 524D1, Baltimore, 21287-0845, MD, USA

    Ola Gjesdal & Joao A. Lima

  3. Radiology and Imaging Sciences, NIH Clinical Center, National Institute of Biomedical Imaging and Bioengineering, 9000 Rockville Pike, Bethesda, 20892, MD, USA

    David A. Bluemke

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O. Gjesdal researched data for the article. All authors contributed substantially to the discussion of content, and reviewed and edited the manuscript before submission

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Gjesdal, O., Bluemke, D. & Lima, J. Cardiac remodeling at the population level—risk factors, screening, and outcomes. Nat Rev Cardiol 8, 673–685 (2011). https://doi.org/10.1038/nrcardio.2011.154

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