Left ventricular reverse remodelling and its predictors in non‐ischaemic cardiomyopathy

Abstract

Adverse remodelling following an initial insult is the hallmark of heart failure (HF) development and progression. It is manifested as changes in size, shape, and function of the myocardium. While cardiac remodelling may be compensatory in the short term, further neurohumoral activation and haemodynamic overload drive this deleterious process that is associated with impaired prognosis. However, in some patients, the changes may be reversed. Left ventricular reverse remodelling (LVRR) is characterized as a decrease in chamber volume and normalization of shape associated with improvement in both systolic and diastolic function. LVRR might occur spontaneously or more often in response to therapeutic interventions that either remove the initial stressor or alleviate some of the mechanisms that contribute to further deterioration of the failing heart. Although the process of LVRR in patients with new-onset HF may take up to 2 years after initiating treatment, there is a significant portion of patients who do not improve despite optimal therapy, which has serious clinical implications when considering treatment escalation towards more aggressive options. On the contrary, in patients that achieve delayed improvement in cardiac function and architecture, waiting might avoid untimely implantable cardioverter-defibrillator implantation. Therefore, prognostication of successful LVRR based on clinical, imaging, and biomarker predictors is of utmost importance. LVRR has a positive impact on prognosis. However, reverse remodelled hearts continue to have abnormal features. In fact, most of the molecular, cellular, interstitial, and genome expression abnormalities remain and a susceptibility to dysfunction redevelopment under biomechanical stress persists in most patients. Hence, a distinction should be made between reverse remodelling and true myocardial recovery. In this comprehensive review, current evidence on LVRR, its predictors, and implications on prognostication, with a specific focus on HF patients with non-ischaemic cardiomyopathy, as well as on novel drugs, is presented.

A year in heart failure: updates of clinical and preclinical findings

“…In their comprehensive review, Hnat et al . elaborated the distinctions between reverse remodelling and true myocardial recovery and also addressed current evidence on left ventricular reverse remodelling and its prognosis, giving an emphasis on HF patients with non‐ischaemic cardiomyopathy, and on novel cardiac medications 56 …”

“…In their comprehensive review, Hnat et al elaborated the distinctions between reverse remodelling and true myocardial recovery and also addressed current evidence on left ventricular reverse remodelling and its prognosis, giving an emphasis on HF patients with non-ischaemic cardiomyopathy, and on novel cardiac medications. 56 Using a systems biology approach Zhang et al aimed at uncovering the genetic links of SARS-CoV-2 infections with HF co-morbidities. Gene expression profiles of HF and COVID-19 were retrieved from a large database.…”

Left atrial conduit strain derived from cardiac magnetic resonance is an independent predictor of left ventricular reverse remodeling in patients with nonischemic cardiomyopathy

“…During disease progression, energetic abnormalities, toxic injury, and inflammation lead to adverse ventricular remodeling. It is characterized by changes in the shape, size, and function of the heart muscle [ 1 ]. Fortunately, due to natural recovery and guideline-directed medical treatment (GDMT), these changes are reversible in some patients and are known as left ventricular reverse remodeling (LVRR) [ 2 ].…”

“…However, a significant proportion of patients fail to achieve improvement after optimal treatment. In this case, predicting LVRR could guide decision-making when considering more active treatments, such as implantable cardioverter-defibrillator (ICD), cardiac resynchronization therapy, and even heart transplantation [ 1 ]. Moreover, a meta-analysis conducted by Kramer et al proved that patients with LVRR have a lower mortality rate in the long term [ 4 ].…”

Effect of pueraria on left ventricular remodelling in HFrEF: A systematic review and meta-analysis

“…This has placed a significant burden on healthcare and social systems [ 3 ]. Left ventricular (LV) remodeling refers to changes in LV structure, which are characterized by changes in LV size, shape, and a reduction in LVEF [ 4 ]. LV remodeling is the primary pathology of HFrEF occurrence and development, and it is also a key factor that influences the morbidity and mortality of HFrEF [ 5 ].…”