New Therapeutic Strategies for Ventricular Remodeling in Acute Myocardial Infarction and Pressure Overload: The Long Way to Heaven

Despite the striking improvements recently achieved in the diagnosis and treatment of acute myocardial infarction (AMI), this condition remains a leading cause of death worldwide. The term “ventricular remodeling” refers to changes in ventricular geometry (dilation, sphericity, wall thinning) and stiffness, as well as molecular and functional changes including both cardiomyocytes , other cells of the heart and extracellular matrix. As a result, over recent years much interest has been devoted to understanding the role and the pathways involved in the setting of the inflammation in AMI as well as in overload conditions but to date, however, there is a lack of real anti-inflammatory treatments for these conditions. This topic has been recently highlighted by Seropian et al., in a detailed paper focusing on anti-inflammatory strategies for ventricular remodelling following ST-segment elevation myocardial infarction (STEMI), concluding that more studies are needed to determine the most appropriate strategies to restore the inflammatory balance and ameliorate remodelling after acute myocardial infarction (AMI). This holds even truer given the established heterogeneity among different anti-inflammatory agents, as clearly demonstrated in many different pathophysiologic conditions. We agree that this entire process should be considered as a complex biological milieu finally evolving into maladaptive remodelling, with the result to be still a slippery therapeutic target. Nonetheless, the report raises additional issues that need to be addressed in order to enlighten the corresponding hidden side of the moon.