Ventricular remodeling in heart failure and the effect of β-blockade

Left ventricular (LV) remodeling has an important role in the progression of cardiovascular disease. An understanding of the process of LV remodeling has led to greater knowledge of the pathophysiology of heart failure. Drug therapies that slow or reverse the remodeling process seem to have favorable natural history effects in short-term and long-term therapy. Angiotensin-converting enzyme (ACE) inhibitors have been associated with a significant reduction in mortality, and the effect of β-blockers on the remodeling process has now been studied across much of the spectrum of severity in patients with heart failure. β-Blockade seems to add favorable and independent effects on the post–myocardial infarction remodeling process over and above those of ACE inhibitors. A combination of both drugs shows the greatest reduction in mortality (ie, the most favorable reverse remodeling). Differences in their effect on remodeling have been recently shown among the β-blockers. Several studies and a meta-analysis suggest that carvedilol may be more favorable to outcome, having the most effect on LV remodeling.