Review ArticlePharmacologic and Endovascular Reversal of Left Ventricular Remodeling
Section snippets
Reversal of Left Ventricular Remodeling
LVRR is defined as improvement in LV ejection fraction (LVEF) accompanied by a decrease in LV volume and end-diastolic dimension (LVEDD). Changes in these parameters may be due to resolution of the pathologic process or to favorable effects of interventions on cardiac loading conditions. A key feature of LVRR is that the decrease in LV size and configuration persists after withdrawal of therapeutic intervention(s), suggesting that sustained changes reflect intrinsic biological reversal rather
Beta-adrenergic Receptor Blockade
The long-term effects of BARB therapy with the use of metoprolol succinate or carvedilol on LV systolic function and size have been extensively studied in patients with moderate to severe heart failure with reduced ejection fraction (HFrEF). Eichhorn et al showed improved LVEF, diastolic dimension, and myocardial efficiency after 3 months of metoprolol succinate at 50 mg twice a day.30 Several large randomized trials have demonstrated improved survival with the use of long-term BARB in
Conclusion
Changes in LVEF and LV volumes can result from alterations in cardiac loading conditions or from LVRR. Reversal of remodeling is considered to have occurred when LVEF and LV volumes normalize (LVEF ≥50% and LVEDDI ≤33 mL/m2) or when partial improvement in LVEF and LVvolumes is associated with an improvement in LV contractility. Furthermore, sustained steady-state LVEF and LV volumes after cessation of intervention provide strong evidence that LVRR has occurred. Interventions including ACEI,
Disclosures
None.
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Cited by (17)
Left ventricular volume change and long-term outcomes in ischaemic cardiomyopathy with or without surgical revascularisation: A post-hoc analysis of a randomised controlled trial
2022, eClinicalMedicineCitation Excerpt :Among patients with ischaemic cardiomyopathy, progressive enlargement of left ventricular volume due to infarct expansion, scar formation and decompensated cardiac hypertrophy following myocardial infarction,2 as measured by a higher left ventricular end-systolic volume index (ESVI), has been identified as a strong prognostic predictor.3,4 Left ventricular volume change, which is considered an early signal of pharmacological efficacy on long-term outcomes,5,6 can be achieved in patients with ischaemic cardiomyopathy after appropriate medical therapy or revascularisation.7,8 Whether the association between post-therapeutic left ventricular volume change and long-term outcomes in ischaemic cardiomyopathy is influenced by the performance of coronary artery bypass grafting (CABG) remains unclear.
Targeted Mono-Therapy for Newly Diagnosed Dilated Cardiomyopathy
2019, Journal of Cardiac FailureCitation Excerpt :Long-term ACEI lessens cardiac loading conditions and thereby increases left ventricular ejection fraction (LVEF) in patients with HFrEF. However, long-term ACEI does not reverse left ventricular (LV) remodeling as LVEF returns to pretreatment values within 15 days of ACEI discontinuation.6 The use of ARB is recommended in patients with HFrEF who are intolerant to ACEI.1
Sustained Cardiac Recovery Hinges on Timing and Natural History of Underlying Condition
2018, American Journal of the Medical SciencesCitation Excerpt :Reviewing LV recovery in patients with new onset dilated cardiomyopathy, Givertz et al7 noted normalization of LV function in 7-25% of patients. Predictors of LVEF recovery during BARB have been previously reviewed.21 O’Keefe et al16 observed approximately 2-fold greater improvement in LVEF in patients with recent onset NICM than in patients with ICM.
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Conflicts of interest: none.