Key result
Heart failure therapies induce reverse remodeling, but true myocardial recovery remains rare at ~1%.
Why the study?
There is uncertainty and lack of clarity in distinguishing myocardial recovery from reverse remodeling in heart failure patients undergoing medical or device therapies.
This review provides a conceptual framework distinguishing 'myocardial recovery' (reversible damage with freedom from recurrent events) from 'myocardial remission' (phenotypic reversal but irreversible damage with recurrent events).
Medical and device therapies that reduce heart failure morbidity and mortality also lead to decreased left ventricular (LV) volume and mass, and a more normal elliptical shape of the ventricle. These are due to changes in myocyte size, structure and organization that have been referred to collectively as “reverse remodeling.” Moreover, there are subsets of patients whose hearts have undergone reverse remodeling either spontaneously, or following medical or device therapies, and whose clinical course is associated with freedom from future heart failure events. This phenomenon has been referred to as “myocardial recovery.” Despite the frequent interchangeable use of the terms myocardial recovery and reverse remodeling to describe the reversal of various aspects of the heart failure phenotype following medical and device therapy, the literature suggests that there are important differences between these two phenomenon, and that myocardial recovery and reverse remodeling are not synonymous. In the following review, we will discuss the biology of cardiac remodeling, cardiac reverse remodeling and myocardial recovery, with the intent of providing a conceptual framework for understanding myocardial recovery.
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Mann et al. (2012) conducted a review in Heart Failure. Medical and device therapies for heart failure was evaluated. Medical and device therapies induce cardiac reverse remodeling, but true myocardial recovery is rare (e.g., a 1.4% LVAD explantation rate), suggesting a distinction between functional remission and true biological recovery.
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