Left Ventricular Reverse Remodeling in Heart Failure: Remission to Recovery

Increased left ventricular dilation and reduced systolic function are consistently associated with a poor prognosis and worse clinical outcomes. In this review, we discuss the pathophysiological mechanisms, use of cardiac imaging, and clinical implications of adverse cardiac remodeling. Unique situations with evidence of spontaneous recovery and their underlying mechanisms are evaluated. A comprehensive appreciation of current evidence surrounding the array of therapeutic tools available to promote reverse remodeling and improve clinical outcomes, including medical management, revascularization, cardiac synchronization therapy, mitral valve repair or replacement, and surgical procedures, such as left ventricular assist device implantation and ventricular reconstruction, are provided. There is an ongoing need for further research identifying potential mechanistic pathways and optimal patient selection criteria for therapeutic approaches promoting reverse remodeling and myocardial recovery.