Elsevier

JACC: Heart Failure

Volume 7, Issue 9, September 2019, Pages 782-794
JACC: Heart Failure

State-of-the-Art Review
Imaging, Biomarker, and Clinical Predictors of Cardiac Remodeling in Heart Failure With Reduced Ejection Fraction

https://doi.org/10.1016/j.jchf.2019.06.004Get rights and content
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Highlights

  • Ventricular remodeling is a pivotal process associated with progression of heart failure with reduced ejection fraction.

  • Remodeling results from hemodynamic stress, myocyte injury, cell death, and fibrosis.

  • Remodeling is associated with reduction in ejection fraction and increased volumes and is associated with worse prognosis, whereas its reversal is typically accompanied by improved symptoms, better quality of life, and lower risk of hospitalization or death.

  • Circulating and imaging biomarkers may identify remodeling before it is clinically evident.

Abstract

In response to injury, hemodynamic changes, or neurohormonal activation, the heart undergoes a series of structural and functional changes that have been termed cardiac remodeling. Remodeling is defined as changes in cardiac geometry and/or function over time and can be measured in terms of changes in cardiac chamber dimensions, wall thickness, volumes, mass, and ejection fraction at serial imaging examinations. As to cardiac chambers, left ventricular (LV) remodeling has been best studied in patients with heart failure with reduced ejection fraction. Although LV remodeling may compensate for abnormal hemodynamic parameters and function in the short term, left unchecked, it is associated with worsening cardiac function and poor prognosis. On the other hand, reversing LV geometry and/or function closer to that of a normal heart (also known as reverse remodeling) is associated with improved cardiac function and better prognosis. Because of its close relationship with clinical outcomes, remodeling may potentially be targeted in clinical management and used in trials as a surrogate endpoint. Standardized definition of remodeling and reliable tools to predict and monitor the presence, direction, and magnitude of cardiac remodeling are needed. Together with clinical and imaging findings, circulating biomarkers (most notably N-terminal pro–B-type natriuretic peptide, high-sensitivity troponin, and soluble suppression of tumorigenesis-2) may be helpful in this respect.

Key Words

heart failure
predictors
reverse remodeling

Abbreviations and Acronyms

CMR
cardiac magnetic resonance
CRT
cardiac resynchronization therapy
HF
heart failure
HFrEF
heart failure with reduced ejection fraction
LGE
late gadolinium enhancement
LVEDV
left ventricular end-diastolic volume
LVEF
left ventricular ejection fraction
LVESF
left ventricular end-systolic volume
MI
myocardial infarction
NT-proBNP
N-terminal pro–B-type natriuretic peptide
sST2
soluble suppression of tumorigenesis-2

Cited by (0)

Dr. Gaggin has received research support from Clark Fund for Cardiac Research Innovation, Roche Diagnostics, Jana Care, Ortho Clinical, and Novartis; is a consultant for Merck & Co. and Roche Diagnostics; and has received payments for serving on clinical endpoint committees from Radiometer. Dr. Januzzi is supported in part by the Hutter Family Professorship; is a Trustee of the American College of Cardiology; has received grant support from Novartis Pharmaceuticals, Roche Diagnostics, Abbott, Singulex, and Prevencio; has received consulting income from Abbott, Janssen, Novartis, Pfizer, Merck, and Roche Diagnostics; and participates in clinical endpoint committees/data safety monitoring boards for Abbott, AbbVie, Amgen, Boehringer-Ingelheim, Janssen, and Takeda. Barry Greenberg, MD, served as Guest Editor for this paper. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Drs. Aimo and Gaggin contributed equally to this work and are co-first authors.