The prediction of adverse cardiac remodelling following myocardial infarction: defining the need for a dynamic multimarker approach

Myocardial infarction (MI) initiates a complex process of repair and adaptation that may lead to adverse remodelling. Left ventricular (LV) remodelling involves both cellular and extracellular components of the myocardium and includes changes on a molecular, cellular and interstitial level with subsequent alterations in the size, shape and function of the LV.1 LV remodelling may be a part of the physiological response to cardiac injury, and in this context, it may be considered as a physiological or adaptive process (adaptive remodelling). On the other hand, while a balanced and incidental response may be beneficial, adverse remodelling is associated with extensive and persistent maladaptive changes within the LV with progressive loss of cardiac function and subsequently, clinical deterioration. Early identification of patients at risk of adverse remodelling is essential to guide treatment and follow-up in this important group of patients with a high risk of adverse clinical events. In the current issue of the Journal, Urbano-Moral et al 2 present an interesting study addressing the ability of circulating biomarkers to predict adverse LV remodelling (see page 1153) . The study was performed in 112 consecutive patients surviving for 6 months, with acute ST-elevation myocardial infarction, successfully revascularized by percutaneous coronary intervention. LV remodelling …