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Remodelación Ventricular Postinfarto de Miocardio: Conceptos e Implicaciones Clínicas

ABSTRACT Tras infarto agudo de miocardio, el proceso de remodelación se caracteriza, clínicamente, por aumento de la cavidad ventricular. En la fase aguda, la dilatación ventricular es consecuencia del proceso de expansión del infarto, mientras que la dilatación cavitaria tardía es consecuencia del proceso de hipertrofia excéntrica. La remodelación ventricular desempeña un rol fundamental en la fisiopatología de la disfunción del ventrículo, tras infarto. Al reaccionar a la determinada agresión, las alteraciones genéticas, estructurales y bioquímicas de ese proceso resultarán en deterioración de la capacidad funcional del corazón, a largo plazo, y consecuente aparecimiento de las señales y síntomas de insuficiencia cardiaca y/o muerte súbita. Los mecanismos propuestos para explicar el aparecimiento de la disfunción ventricular son complejos, pero se destacan los que siguen a continuación: cambios en el tránsito de calcio; alteraciones de la vía beta-adrenérgica; alteraciones de las proteínas contráctiles; aumento de la muerte celular; acumulación de colágeno; alteraciones de las metaloproteasas; aumento del estrés oxidativo; déficit energético; alteraciones de las proteínas del citoesqueleto, de la membrana y de la matriz; y alteraciones de la geometría ventricular. Adicionalmente, la remodelación está asociada a mayor prevalencia de ruptura cardiaca, arritmias y formación de aneurismas, tras infarto. La remodelación, por lo tanto, está asociada a peor pronóstico postinfarto. De ese modo, el entendimiento de ese proceso es crítico, pues la evolución de la remodelación se puede cambiar por medio de diversas intervenciones terapéuticas.

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