Reverse remodeling in Dilated Cardiomyopathy: Insights and future perspectives

Abstract

Dilated Cardiomyopathy (DCM) has been classically considered a progressive disease of the heart muscle that inexorably progresses towards refractory heart failure, ventricular arrhythmias and heart transplant. However, the prognosis of DCM has significantly improved in the past few years, mostly as the result of successful therapy-induced reverse remodeling. Reverse remodeling is a complex process that involves not only the left ventricle, but also many other cardiac structures and it is now recognized both as a measure of therapeutic effectiveness and as an important prognostic tool. Nevertheless, several aspects of reverse remodeling remain unclear, including the best timing for its quantification, its predictors and its interaction with individual genetic backgrounds. In this review, we summarize our current understanding of reverse remodeling in patients with DCM and provide practical recommendations for the clinical management of this challenging patient population.

Fig. 1

Example of comprehensive reverse remodeling in DCM: note the improvement of LV shape/dimension and the improvement in MR severity between baseline (left panel) and follow-up after 12 months of optimal medical therapy. LVEF and right ventricular function also significantly improved at follow-up. Basal (left side): LVEF 16%; LVEDD 81 mm; LVEDVi 150 ml/m2; Severe MR; RV-FAC 13%; E/E' 18; LA area 34 cm2; LA volume 125 ml. Follow-up (right side): LVEF 56%; LVEDD 55 mm; LVEDVi 58 ml/m2; Mild MR; RV-FAC 48%; E/E' 6,1 LA area 23 cm2; LA volume 72 ml. Legend. LVEF: Left Ventricular Ejection Fraction; LVEDD: Left Ventricular End Diastolic Dimension; LVEDVi: Left Ventricular End Diastolic Volume indexed for body surface area; MR: Mitral Regurgitation; RV-FAC: Right Ventricle Fractional Fractional Area Change; LA: Left Atrium.