Reverse Cardiac Remodeling: A Marker of Better Prognosis in Heart Failure

Abstract

In heart failure syndrome, myocardial dysfunction causes an increase in neurohormonal activity, which is an adaptive and compensatory mechanism in response to the reduction in cardiac output. Neurohormonal activity is initially stimulated in an attempt to maintain compensation; however, when it remains increased, it contributes to the intensification of clinical manifestations and myocardial damage. Cardiac remodeling comprises changes in ventricular volume as well as the thickness and shape of the myocardial wall. With optimized treatment, such remodeling can be reversed, causing gradual improvement in cardiac function and consequently improved prognosis.

Cardiac Remodeling: Concepts, Clinical Impact, Pathophysiological Mechanisms and Pharmacologic Treatment

“…In the consolidated strategy group, angiotensin-converting enzyme inhibitors, beta blockers, and aldosterone antagonists have been consistently shown to decrease remodeling in animal models. 44 - 47 These findings have been validated in clinical trials, and these drugs are currently indicated for patients with ejection fraction of < 40%. 47 …”

Oxidative Stress andSalvia miltiorrhizain Aging-Associated Cardiovascular Diseases

“…Patients with reverse remodeling during treatment have better outcomes and lower mortality than those without such remodeling [118]. Tanshinone VI protects the myocardium against I/R injury and attenuates the progression of myocardial remodeling in vitro [119].…”

Angiotensin converting enzyme inhibitors and interstage failure in infants with hypoplastic left heart syndrome

“…Physicians may believe that ACE‐I therapy will be helpful based on the demonstrated salutary effect ACE‐I therapy has in children (1 month–14 years) with heart failure; ACE‐I drugs lower aortic pressure, systemic vascular resistance, and atrial pressure in these children . ACE‐I therapy has also been associated with reduced ventricular dilation, which improves the prognosis in patients with heart failure . The differential effects of ACE‐I in children with heart failure when compared with infants with single ventricle defects may suggest age‐related differences in pharmacodynamics or end‐organ response.…”

“…15 ACE-I therapy has also been associated with reduced ventricular dilation, which improves the prognosis in patients with heart failure. 25,26 The differential effects of ACE-I in children with heart failure when compared with infants with single ventricle defects may suggest age-related differences in pharmacodynamics or end-organ response.…”