Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Aug 20;20(4):42-53.
doi: 10.14797/mdcvj.1381. eCollection 2024.

Role of Imaging and Biomarkers in Identifying, Monitoring, and Promoting Myocardial Recovery

Evelyne Meekers  1   2 , Matthias Dupont  1
Affiliations
Review

Role of Imaging and Biomarkers in Identifying, Monitoring, and Promoting Myocardial Recovery

Evelyne Meekers et al. Methodist Debakey Cardiovasc J. .

Abstract

Reverse remodeling, the overarching concept behind myocardial recovery, describes the process in which the maladaptive cardiac structural and functional alterations are reversed by removing the underlying etiology or by therapy. This review addresses different imaging modalities and biomarkers as possible predictors for reverse remodeling in patients with chronic heart failure. Although echocardiography remains the imaging modality of choice in daily practice, the presence and amount of fibrosis on cardiac magnetic resonance is a better predictor and inversely correlated with the likelihood for reverse remodeling. A decrease in NT-proBNP levels and serum soluble ST3 during follow-up is associated with better clinical and structural outcomes. The role of troponins and galectine-3 is less clear. There is a promising role for microRNAs in the future, although more research is necessary. Accurate predictors of reverse remodeling could help identify patients with an increased likelihood for reverse remodeling and, in turn, improve patient-tailored medicine.

Keywords: biomarkers; cardiac magnetic resonance; echocardiography; heart failure; imaging; myocardial recovery; reverse remodeling.

PubMed Disclaimer

Conflict of interest statement

The authors have no competing interests to declare.

Figures

LGE CMR image of patient with ischemic cardiomyopathy and severe LVEF
Figure 1
Late gadolinium enhancement on cardiac magnetic resonance. Late gadolinium enhancement (LGE) cardiac magnetic resonance image obtained in a patient with ischemic cardiomyopathy. Severe reduced left ventricular ejection fraction (LVEF 17%) with approximately 40% LGE in the left ventricle. Despite optimal medical therapy, no myocardial recovery was expected. Four years later, due to recurrent sustained ventricular tachycardia, the patient was referred for left ventricular assist device.
Different biomarkers according to their pathophysiological action
Figure 2
Different biomarkers according to their pathophysiological action.
sST2 and galectin-3 as markers of fibrosis
Figure 3
sST2 and galectin-3 as markers of fibrosis. As a response to cardiac damage, macrophage activation results in the production of galectin-3, which leads to fibroblast activation and the release of IL-33. Normally, IL-33 binds to ST2L, by which it initiates an antihypertrophic an antifibrotic pathway. sST2 works as a decoy receptor, preventing the binding of IL-33 to ST2L. IL-33: interleukin-33; sST2: soluble suppression of tumorigenicity 2; ST2L: suppression of tumorigenicity 2 ligand
See this image and copyright information in PMC

References

    1. Yan CL, Grazette L. A review of biomarker and imaging monitoring to predict heart failure recovery. Front Cardiovasc Med. 2023. Apr 6:10:1150336. doi: 10.3389/fcvm.2023.1150336 - DOI - PMC - PubMed
    1. Aimo A, Gaggin HK, Barison A, Emdin M, Januzzi JL Jr. Imaging, Biomarker, and Clinical Predictors of Cardiac Remodeling in Heart Failure With Reduced Ejection Fraction. JACC Heart Fail. 2019. Sep;7(9):782-794. doi: 10.1016/j.jchf.2019.06.004 - DOI - PubMed
    1. Lupón J, Gavidia-Bovadilla G, Ferrer E, et al. Dynamic Trajectories of Left Ventricular Ejection Fraction in Heart Failure. J Am Coll Cardiol. 2018. Aug 7;72(6):591-601. doi: 10.1016/j.jacc.2018.05.042 - DOI - PubMed
    1. Kim GH, Uriel N, Burkhoff D. Reverse remodelling and myocardial recovery in heart failure. Nat Rev Cardiol. 2018. Feb;15(2):83-96. doi: 10.1038/nrcardio.2017.139 - DOI - PubMed
    1. Chrysakis N, Xanthopoulos A, Magouliotis D, et al. Myocardial Recovery. Diagnostics (Basel). 2023. Apr 21;13(8):1504. doi: 10.3390/diagnostics13081504 - DOI - PMC - PubMed