Heart Failure Reviews, 10, 93–94, 2005


C 2005 Springer Science + Business Media, Inc. Manufactured in The Netherlands.
Cardiac Remodeling as Therapeutic Target: Treating Heart
Failure with Cardiac Support Devices
Natural history studies have shown that left
ventricular (LV) remodeling, with an attendant
change in the shape of the ventricle from a pro-
late ellipse to a more spherically shaped ventri-
cle, is directly related to future deterioration in
LV performance and less favorable clinical out-
comes in patients with heart failure [1–4]. In-
deed, there is increasing evidence that LV remod-
eling can contribute to the progression of heart
failure by virtue of the de novo mechanical and
energetic burdens that are created by the physi-
ologically unfavorable changes that occur in the
remodeled ventricle (reviewed in) [5]. Although
current pharmacological approaches with renin
angiotensin/aldosterone system antagonists, beta-
blockers and/or bi-ventricular pacemakers will
limit and/or partially reverse LV remodeling [6–
10], heart failure continues to progress in a sig-
nificant number of patients despite optimal medi-
cal and device therapy. However, to date there are
no device therapies that have been developed that
directly address the emerging clinical problem of
progressive LV remodeling in patients with heart
failure.
The current issue of Heart Failure Reviews
presents a state-of-the-art review of a novel device,
the CorCapTM Cardiac Support Device (Acorn Car-
diovascular, Inc., St. Paul, MN), that is designed
to provide circumferential diastolic support to the
heart, thereby reducing LV diastolic wall stress
and attenuate the deleterious changes that de-
velop in the remodeled heart. This symposium be-
gins with a review article by Mann, who discusses
the role of LV remodeling in the pathogenesis of
heart failure, with a focus on how changes in LV
size and shape play a critical role in the devel-
opment and progression of heart failure. This is
followed by an article by Walsh who discusses en-
gineering principles and device characteristics of
the CorCapTM CSD. The third article by Sabbah
and colleagues reviews the hemodynamic effects of
the CSD in experimental models of chronic heart
failure, whereas the next two articles by Power
and Acker discuss the effects of the CSD in pacing
induced tachcyardia and post-infarction models of
Douglas L. Mann MD
Don W Chapman Chair, Professor of Medicine, Molecular
Physiology and Biophysics, Chief, Section of Cardiology,
Director, Winters Center for Heart Failure Research, Baylor
College of Medicine, St. Luke’s Episcopal Hospital
heart failure, respectively. The next series of arti-
cles by Sharov et al., Gupta et al. and Rastogi et al.
consider the ultrastructural, cellular and molecu-
lar basis for the salutary effects of the CSD in ex-
perimental animal models, with an emphasis on
the changes that occur in excitation contraction
coupling, as well as reversal of the fetal gene pro-
gram.
Taken together the studies reviewed in the cur-
rent symposium are intended to summarize the
relevant literature that supports targeting car-
diac remodeling in heart failure in progressive
heart failure, as well as provide the rational for us-
ing passive mechanical constraint devices to pre-
vent cardiac remodeling. Accordingly, this review
should prove to be useful to both clinicians and
scientists who are interested in not only under-
standing the role of cardiac remodeling in heart
failure, but who are also interested in under-
standing the role of novel devices that are be-
ing designed to prevent and/or reverse cardiac
remodeling.
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93
94 Mann and Chair
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