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Reversal of heart failure remodeling: is it maintained?
T Barry Levine1, Arlene B Levine, Janet Bolenbaugh
1Michigan Institute for Heart Failure and Transplant Care, Botsford General Hospital, Farmington Hills, Michigan, USA.
Background:
Reversal of heart failure remodeling has been observed with intensive heart failure therapy.
Hypothesis:
We hypothesized that reversal of heart failure remodeling may not be sustained in long-term follow-up.
Methods:
Sixty-one sequential patients with heart failure and left ventricular ejection fraction < or = 35%, who improved their ejection fraction by > or = 10% over baseline at follow-up, were prospectively followed and retrospectively analyzed. Each patient underwent echocardiography at baseline and biannually thereafter.
Results:
In all patients, left ventricular ejection fraction increased from 18 +/- 7% to 42 +/- 12% on uptitrated medical therapy. At follow-up over 20 +/- 8 (+/- standard deviation) months, this improvement was sustained in 38 patients ("Improved"). A relapse in remodeling occurred in the remaining 23 patients ("Relapsed"), with ejection fraction falling to 24 +/- 7%. For Improved and Relapsed patients, baseline echocardiographic and clinical parameters were equivalent. However, Improved patients tended to be younger, with shorter heart failure duration. Improved patients had more effective improvement in ejection fraction than Relapsed patients (45 +/- 13% vs. 36 +/- 8%, p = 0.005), with greater reductions in chamber size and mitral regurgitation.
Conclusion:
Reversal of heart failure remodeling may be sustained in only two-thirds of patients at long-term follow-up. In contrast to Relapsed patients, Improved patients tended to be younger, with shorter heart failure duration and a more complete recovery of left ventricular systolic function.