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Mann
Mann
Mann
C 2005 Springer Science + Business Media, Inc. Manufactured in The Netherlands.
Natural history studies have shown that left heart failure, respectively. The next series of arti-
ventricular (LV) remodeling, with an attendant cles by Sharov et al., Gupta et al. and Rastogi et al.
change in the shape of the ventricle from a pro- consider the ultrastructural, cellular and molecu-
late ellipse to a more spherically shaped ventri- lar basis for the salutary effects of the CSD in ex-
cle, is directly related to future deterioration in perimental animal models, with an emphasis on
LV performance and less favorable clinical out- the changes that occur in excitation contraction
comes in patients with heart failure [1–4]. In- coupling, as well as reversal of the fetal gene pro-
deed, there is increasing evidence that LV remod- gram.
eling can contribute to the progression of heart Taken together the studies reviewed in the cur-
failure by virtue of the de novo mechanical and rent symposium are intended to summarize the
energetic burdens that are created by the physi- relevant literature that supports targeting car-
ologically unfavorable changes that occur in the diac remodeling in heart failure in progressive
remodeled ventricle (reviewed in) [5]. Although heart failure, as well as provide the rational for us-
current pharmacological approaches with renin ing passive mechanical constraint devices to pre-
angiotensin/aldosterone system antagonists, beta- vent cardiac remodeling. Accordingly, this review
blockers and/or bi-ventricular pacemakers will should prove to be useful to both clinicians and
limit and/or partially reverse LV remodeling [6– scientists who are interested in not only under-
10], heart failure continues to progress in a sig- standing the role of cardiac remodeling in heart
nificant number of patients despite optimal medi- failure, but who are also interested in under-
cal and device therapy. However, to date there are standing the role of novel devices that are be-
no device therapies that have been developed that ing designed to prevent and/or reverse cardiac
directly address the emerging clinical problem of remodeling.
progressive LV remodeling in patients with heart
failure.
The current issue of Heart Failure Reviews References
presents a state-of-the-art review of a novel device,
the CorCapTM Cardiac Support Device (Acorn Car- 1. Cohn JN. Structural basis for heart failure: Ventricular
diovascular, Inc., St. Paul, MN), that is designed remodeling and its pharmacological inhibition. Circulation
to provide circumferential diastolic support to the 1995;91:2504–2507.
2. Douglas PS, Morrow R, Ioli A, et al. Left ventricular shape,
heart, thereby reducing LV diastolic wall stress
afterload,and survival in idiopathic dilated cardiomyopa-
and attenuate the deleterious changes that de- thy. J Am Coll Cardiol 1989;13:311–315.
velop in the remodeled heart. This symposium be- 3. Vasan RS, Larson MG, Benjamin EJ, et al. Left ven-
gins with a review article by Mann, who discusses tricular dilation and the risk of congestive heart failure
the role of LV remodeling in the pathogenesis of in people without myocardial infarction. N Engl J Med
heart failure, with a focus on how changes in LV 1997;336:1350–1355.
size and shape play a critical role in the devel- 4. St.John Sutton MG, Pfeffer MA, Plappert T, et al. Quanti-
opment and progression of heart failure. This is tative two-dimensional echocardiographic measurements
followed by an article by Walsh who discusses en- are major predictors of adverse cardiovascular events af-
gineering principles and device characteristics of ter acute myocardial infarction. The protective effects of
captopril. Circulation 1994;89:68–75.
the CorCapTM CSD. The third article by Sabbah
5. Mann DL, Bristow MR. Mechanisms and models in heart
and colleagues reviews the hemodynamic effects of failure: the biomechanical model and beyond. Circulation
the CSD in experimental models of chronic heart 2005;111(21):2837–2849.
failure, whereas the next two articles by Power 6. Quinones MA, Greenberg BH, Kopelen HA, et al. Echocar-
and Acker discuss the effects of the CSD in pacing diographic predictors of clinical outcome in patients with
induced tachcyardia and post-infarction models of left ventricular dysfunction enrolled in the SOLVD registry
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94 Mann and Chair