在许多心脏病中可见心室重塑,表现在左室扩张和改变其几何形状,并常见射血分数降低。 重塑的发生是由于能引起重塑的主要刺激激活了细胞释放递质,包括去甲肾上腺素、血管紧张素Ⅱ、醛固酮、内皮素、氧自由基、细胞因子、生长因子等。因此,抗重塑疗法即应采用针对这些递质的治疗,以减缓或停止重塑过程。 在心力衰竭时虽然应用ACE抑制剂治疗,但是死亡率仍高。在ACE抑制剂基础上加用β-受体阻滞剂或螺内酯可进一步稍稍改善生存率,但是可能还需要阻滞所有介导重塑的途径才能完全防止或停止重塑过程,从而基本上改善心力衰竭的预后。因此,对明显的心力衰竭的治疗策略应移向这个方向,并且基于降低死亡率,目前似应以ACE抑制剂、β阻滞剂和螺内酯为慢性心力衰竭的一线疗法。将来还会有联合应用ACE抑制剂和(或)一种AT_1-受体阻滞剂、一种β-受体阻滞剂、螺内酯和一种内皮素-A受体阻滞剂治疗心力衰 Ventricular remodeling is seen in many heart diseases, manifesting in the left ventricle to dilate and alter its geometry, with a common drop in ejection fraction. Remodeling occurs because the major stimuli that cause remodeling activate cells to release neurotransmitters, including norepinephrine, angiotensin II, aldosterone, endothelin, oxygen free radicals, cytokines, growth factors, and the like. Therefore, anti-remodeling therapy should be used for the treatment of these neurotransmitters to slow or stop the remodeling process. Although ACE inhibitors are used in heart failure, the mortality rate is still high. The addition of beta-blockers or spironolactone to ACE inhibitors further slightly improves survival but may also require the need to block all pathways that mediate remodeling to completely prevent or stop the remodeling process and thereby substantially improve The prognosis of heart failure. Therefore, treatment strategies for overt heart failure should move in this direction and, based on mortality reductions, should now appear as first-line therapy for chronic heart failure with ACE inhibitors, beta blockers and spironolactone. In the future there will also be a combination of ACE inhibitors and / or an AT1-receptor blocker, a beta-blocker, spironolactone and an endothelin-A receptor blocker for the treatment of heart failure