eft ventricular (LV) remodeling after myocardial infarction (MI) is a process producing changes in LV geometry, such as progressive cavity dilatation, following infarct expansion, and it contributes to the development of heart failure (HF). 1 Inhibition of the cardiac renin -angiotensin system (RAS) prevents both LV remodeling and the transition from a compensatory state to decompensated HF after MI. [1][2][3][4] However, the precise mechanisms for the development of LV remodeling and the benefits of RAS inhibition have not been fully elucidated.Accumulating evidence suggests that the inflammatory response is a key component of the structural deterioration associated with post-MI LV remodeling. [5][6][7][8][9][10][11] Monocyte chemoattractant protein-1 (MCP-1), a C-C chemokine with potent chemotactic and activating effects on monocytes, is known to make a major contribution to the pathogenic role of inflammation in cardiovascular diseases. MCP-1 contributes to the progression of atherosclerosis and vascular remodeling after coronary angioplasty. [12][13][14][15] Recently, it has Circulation Journal Vol. 72, October 2008 been demonstrated that the expression of MCP-1 in the myocardium increases during the early phase of MI, 5,10,[16][17][18] and that targeted deletion or pharmacological inhibition of MCP-1 prevents early post-MI LV remodeling. 17,19 However, the role of myocardial MCP-1 during the chronic phase of MI remains to be elucidated.The border zone region has been defined as uniquely dysfunctional myocardium, adjacent to an infarct, that is normally perfused, but remains hypocontractile. The progressive extension of border zone myocardium to normally perfused myocardium during the chronic phase of MI leads to late-phase HF following MI. 20 Of the inflammatory cells, macrophages are present in highest numbers and for longest period in the border zone and infarcted regions. 7,21 Macrophages play a central role in the pathogenesis of fibrosis, therefore it is plausible that persistent macrophage infiltration might contribute to the expansion of myocardial fibrosis in the border zone region, leading to progressive LV dysfunction.RAS participates in the inflammatory response, and angiotensin II (AngII) stimulates production of MCP-1 in a variety of cells via AngII type 1 receptors in vivo and in vitro. [22][23][24][25][26][27][28] A previous study has demonstrated increased angiotensin-converting enzyme expression in the border zone and infarcted myocardium. 29 We therefore hypothesized that increased MCP-1 expression and macrophage infiltration would be detectable in the border zone, as well as infarcted region, during the chronic phase of MI, and that inhibition of angiotensin signaling by an AngII type 1 re- Background Monocyte chemoattractant protein-1 (MCP-1) is a key mediator of left ventricular (LV) remodeling during the early phase of myocardial infarction (MI). The hypothesis tested was that myocardial MCP-1 expression would increase during the chronic phase of MI and an angiotensin-II type 1 rece...