An understanding of the process of left ventricular (LV) remodeling has led to greater knowledge of the pathophysiology of heart failure syndrome. This article examines the relationship between LV remodeling and clinical outcomes of heart failure syndrome from several different perspectives. The studies cited suggest that the post–myocardial infarction process is related to and associated with long-term progression of LV dysfunction, heart failure symptoms, and mortality. It is also demonstrated that drug therapies that slow or reverse the remodeling process appear to have favorable natural history effects in the short term as well as during long-term therapy.