This JACC Scientific Expert Panel reviews the biology of reverse LV remodeling and provides guidelines for defining, diagnosing, and managing patients with heart failure with recovered ejection fraction.
This document addresses the lack of standard definitions and clinical data by providing expert guidelines for the management of patients with heart failure with recovered ejection fraction.
Reverse left ventricular (LV) remodeling and recovery of LV function are associated with improved clinical outcomes in patients with heart failure with reduced ejection fraction. A growing body of evidence suggests that even among patients who experience a complete normalization of LV ejection fraction, a significant proportion will develop recurrent LV dysfunction accompanied by recurrent heart failure events. This has led to intense interest in understanding how to manage patients with heart failure with recovered ejection fraction (HFrecEF). Because of the lack of a standard definition for HFrecEF, and the paucity of clinical data with respect to the natural history of HFrecEF patients, there are no current guidelines on how these patients should be followed up and managed. Accordingly, this JACC Scientific Expert Panel reviews the biology of reverse LV remodeling and the clinical course of patients with HFrecEF, as well as provides guidelines for defining, diagnosing, and managing patients with HFrecEF.
“The goal for all patients with HFrEF should be to search for, and treat, reversible precipitants of HF and for those with chronic HF to get them on to guideline-directed medical therapy (ACEi/ARB, beta-blocker, and MRA). Moreover, in appropriate patients who don't respond to medical therapy with improvement in their LVEF, consider them for device therapy (ICD with or without cardiac resynchronization therapy).”
Wilcox et al. (2020) conducted a review in Heart failure with recovered ejection fraction (HFrecEF). This JACC Scientific Expert Panel reviews the biology of reverse LV remodeling and provides guidelines for defining, diagnosing, and managing patients with heart failure with recovered ejection fraction.