Effects of angiotensin converting enzyme inhibitors on remodeling in clinical trials

Angiotensin converting enzyme (ACE) inhibitors are a cornerstone of therapy for heart failure. Large-scale clinical trials show that ACE inhibitors reduce morbidity and mortality in heart failure patients and myocardial infarction (MI) survivors with left ventricular dysfunction. Cardiac remodeling is the term used to describe a series of prototypic changes in cardiac structure that occur in response to injury or prolonged increase in cardiac load. These changes include an increase in chamber volumes and muscle mass and changes in the configuration of the left ventricle. Remodeling results in a deterioration in cardiac function and plays a major role in the progression of heart failure. Although the ACE inhibitors have numerous effects that might be beneficial in heart failure patients, there is substantial evidence that their ability to inhibit cardiac remodeling is directly associated with a favorable impact on the clinical course. This article reviews evidence directly relating the administration of ACE inhibitors with an inhibition of structural remodeling of the heart in heart failure and post-MI patients.