Key result
LV reverse remodelling and LVEF recovery in HFrEF are associated with improved clinical outcomes.
Why the study?
Improvement of LVEF after new-onset HFrEF is observed more frequently with comprehensive HF therapy, leading to the new HFimpEF category and prompting a review of reverse remodelling definitions, predictors, and management.
Reverse remodelling in HFrEF is a major therapeutic target, and its prediction relies on a combination of clinical history, advanced imaging like LV global longitudinal strain, and biomarkers such as NT-proBNP and ST2.
Supports targeting reverse remodelling in HFrEF; leaves open prospective validation of predictive profiles before routine use.
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.
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Chudý et al. (2022) conducted a review in Heart failure with reduced ejection fraction (HFrEF) and heart failure with improved ejection fraction (HFimpEF). Heart failure therapy and reverse remodelling was evaluated. Left ventricular reverse remodelling and improvement of ejection fraction in HFrEF patients are associated with better clinical outcomes and can be predicted by specific clinical, imaging, and biomarker profiles.
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