Reversal of heart failure remodeling: is it maintained?
BACKGROUND
Reversal of heart failure remodeling has been observed with intensive heart failure therapy.


OBJECTIVE
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.


CONCLUSIONS
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.
Levine
T Barry
TB
Michigan Institute for Heart Failure and Transplant Care, Botsford General Hospital, Farmington Hills, Michigan, USA.
Levine
Arlene B
AB
Bolenbaugh
Janet
J
Green
Pamela R
PR
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D009202:Cardiomyopathies / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D006830:Hydralazine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D009566:Nitrates / Q000627:therapeutic use; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014664:Vasodilation / Q000187:drug effects / Q000502:physiology; D014665:Vasodilator Agents / Q000627:therapeutic use; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D020257:Ventricular Remodeling / Q000502:physiology
D000319:Adrenergic beta-Antagonists; D009566:Nitrates; D014665:Vasodilator Agents; D006830:Hydralazine