Prediction of Left Ventricular Reverse Remodelling: A Mini Review on Clinical Aspects

Abstract

Improvement of left ventricular ejection fraction (LVEF) in patients after the first manifestation of heart failure with reduced ejection fraction (HFrEF) has currently been observed more frequently than it was years ago. This appears to be due to the early initiation of comprehensive HF therapy. According to these observations, a new HF syndrome category, heart failure with improved ejection fraction (HFimpEF), was introduced. In this short review, we present definitions of reverse remodelling, myocardial remission, and myocardial recovery. We provide an overview of clinical research aimed at evaluating reverse remodelling in different populations of patients with HFrEF. Clinical and imaging characteristics and biomarkers identified as predictors of reverse remodelling and improvement of the LVEF are discussed. We also briefly address the current views on the management of patients with HFimpEF. In-depth study and knowledge of the molecular mechanisms underlying the reverse remodelling process may lead to the identification of new individualized therapeutic approaches for HFrEF.

Keywords: Biomarkers; Cardiac remission; Clinical predictors; Heart failure with improved ejection fraction; Myocardial remission; Reverse remodelling.

Fig. 1

Factors associated with RR. ACEi, angiotensin-converting enzyme inhibitors; ARBs, angiotensin receptor blockers; ARNI, angiotensin receptor-neprilysin inhibitor; BBs, beta blockers; CRT, cardiac resynchronization therapy; LBBB, left bundle branch block; GLS, global longitudinal strain; LGE, late gadolinium enhancement; LVAD, left ventricle assist device; MR, mitral regurgitation; MRA, mineralocorticoid receptor antagonist; MRI, magnetic resonance; NT-proBNP, N-terminal prohormone of brain natriuretic peptide; RV, right ventricle; SGLT2i, sodium-glucose cotransporter-2 inhibitors; ST2, ST2 cardiac biomarker.