Key result
GDMT withdrawal sparks high rates of recurrent ventricular dysfunction, showing reverse remodeling represents remission rather than cure.
Why the study?
Cardiac reverse remodelling carries significant prognostic implications in heart failure, but management of heart failure with improved ejection fraction remains debated.
Cardiac reverse remodelling in HFrEF should be considered a therapy-dependent remission in most patients, supporting current guideline recommendations to continue medical therapy indefinitely to prevent recurrence.
Answers are grounded in this paper and cite their sources.
Cautions against routine GDMT withdrawal after HFrEF remodelling; leaves open selective de-escalation trials in defined subsets.
Cardiac reverse remodelling (RR) is a complex process involving structural and functional recovery of the myocardium, with significant implications for the prognosis of patients with heart failure (HF). This review summarises current concepts, underlying mechanisms, therapeutic strategies, and clinical implications of RR, while distinguishing it from myocardial recovery and remission. Both pharmacological therapies and non-pharmacological interventions have shown potential to induce RR in selected populations. Clinical features, echocardiographic parameters, advanced imaging findings, and biomarkers help stratify patients according to the likelihood of recovery and risk of relapse. The management of HF with improved ejection fraction remains debated. High recurrence rates are seen after therapy discontinuation; however, evidence suggests that partial withdrawal may be safe in specific patient profiles. RR should be considered a central therapeutic goal in HF care, although its extent and stability vary widely. Differentiating between transient improvement, remission under therapy, and true myocardial recovery is critical for guiding long-term treatment decisions, highlighting the importance of individualised follow-up.
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A 2025 study conducted a review in Heart failure with reduced ejection fraction (HFrEF). Guideline-directed medical therapy vs. Therapy withdrawal or discontinuation was evaluated. Cardiac reverse remodelling in heart failure typically represents a therapy-dependent remission rather than a true cure, as withdrawal of guideline-directed medical therapy is associated with high rates of recurrent ventricular dysfunction.
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