Mechanisms of myocardial reverse remodelling and its clinical significance: A scientific statement of the ESC Working...

Area of Science:

• Cardiology and cardiovascular research.
• Translational medicine and therapeutic interventions.

Background:

• Cardiovascular disease (CVD) is a major global cause of death, leading to diverse cardiac remodelling.
• Cardiac reverse remodelling (RR), an improvement in heart geometry and function, is a desired treatment outcome but challenging to achieve consistently.
• Current CVD treatments often slow progression rather than induce significant RR, necessitating new approaches.

Purpose of the Study:

• To define cardiac reverse remodelling (RR) and elucidate its pathophysiological mechanisms.
• To review pharmacological and non-pharmacological interventions promoting RR, focusing on the left heart.
• To explore predictors of RR extent, prognostic significance, and future strategies.

Main Methods:

• Comprehensive review of existing scientific literature on cardiac remodelling and reverse remodelling.
• Analysis of therapeutic interventions including drugs, devices, and surgical procedures.
• Examination of physiological responses and animal models relevant to cardiac RR.

Main Results:

• Cardiac RR is influenced by insult type, patient factors (sex, age, genetics), and comorbidities.
• Various interventions (medications, CRT, VADs, surgery) can trigger RR, assessed by changes in cardiac geometry and function.
• Predictive models and objective clinical endpoints for sustained RR remain limited and debated.

Conclusions:

• Defining and promoting cardiac reverse remodelling is crucial for improving CVD patient outcomes.
• Further research is needed to develop strategies for sustained RR and reliable prediction of treatment success.
• Understanding RR mechanisms and predictors is key to advancing CVD management.