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Review
. 2023 Dec;10(6):3258-3275.
doi: 10.1002/ehf2.14555. Epub 2023 Oct 23.

Cardiac reverse remodelling by imaging parameters with recent changes to guideline medical therapy in heart failure

Matthew Kodsi  1 , David Makarious  1   2 , Gary C H Gan  1 , Preeti Choudhary  1   2 , Liza Thomas  1   2   3
Affiliations
Review

Cardiac reverse remodelling by imaging parameters with recent changes to guideline medical therapy in heart failure

Matthew Kodsi et al. ESC Heart Fail. 2023 Dec.

Abstract

Recently established heart failure therapies, including sodium glucose co-transporter 2 inhibitors, angiotensin-neprilysin inhibitors, and cardiac resynchronization therapy, have led to both clinical and structural improvements. Reverse remodelling describes the structural and functional responses to therapy and has been shown to correlate with patients' clinical response, acting as a biomarker for treatment success. The introduction of these new therapeutic agents in addition to advances in non-invasive cardiac imaging has led to an expansion in the evaluation and the validation of cardiac reverse remodelling. Methods including volumetric changes as well as strain and myocardial work have all been shown to be non-invasive end-points of reverse remodelling, correlating with clinical outcomes. Our review summarizes the current available evidence on reverse remodelling in heart failure by the non-invasive cardiac imaging techniques, in particular transthoracic echocardiography.

Keywords: Echocardiography; Heart failure therapies; Reverse remodelling.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Timeline of heart failure therapies and advances in imaging in heart failure.
Figure 2
Figure 2
Measurement of LV strain and myocardial work. A2C, apical two chamber; A3C, apical three chamber; A4C, apical four chamber; BP, blood pressure; GCW, global constructive work; GLS, global longitudinal strain; GWE, global work efficiency; GWI, global work index; GWW, global wasted work; LVEF, left ventricular ejection fraction; PSAX, parasternal short axis. *Lowest normal values for myocardial work in men and women were 1270 mmHg% and 1310 mmHg% for GWI, 1650 mmHg% and 1544 mmHg% for GCW, and 90 and 91% for GWE, respectively.
Figure 3
Figure 3
Therapeutic targets of reverse remodelling. ACE‐I, angiotensin‐converting enzyme inhibitors; ApRock, apical rocking; ARNI, angiotensin receptor neprylisin inhibitor; BB, beta‐blocker; CRT, cardiac resynchronization therapy; GLS, global longitudinal strain; LA, left atrium; LV, left ventricle; LVEF, left ventricular ejection fraction; MRA, mineralocorticoid antagonist; SF, septal flash; SGLT2i, sodium‐glucose transporter 2 inhibitor.
See this image and copyright information in PMC

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