Ventricular Remodeling in Heart Failure

Heart failure (HF) affects 5.7 million Americans, costs $30.7 billion annually, and is associated with a 50% 5-year mortality. The lifetime risk of HF in Americans is approximately 26%. Left ventricular (LV) remodeling is the culmination of a complex series of transcriptional, signaling, structural, electrophysiological, and functional events occurring within the cardiac myocyte and other elements of the LV. This chapter focuses on patterns of structural LV remodeling in HF as assessed by noninvasive imaging techniques. Given the burden of HF with preserved ejection fraction (HFpEF), and lack of clarity regarding pathophysiology of this heterogeneous syndrome, we will place particular emphasis on what is known—and not known—about ventricular remodeling in HFpEF.