Reversal of heart failure remodeling: Is it maintained?

• Published in: Clinical cardiology (Mahwah, N.J.) Vol. 26; no. 9; pp. 419 - 423
• Main Authors: Levine, T. Barry, Levine, Arlene B., Bolenbaugh, Janet, Green, Pamela R.
• Format: Journal Article
• Language: English
• Published: New York Wiley Periodicals, Inc 01.09.2003; Wiley
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Adult; Aged; angiotensin‐converting enzyme inhibitor; beta blockers; Biological and medical sciences; Blood Pressure - physiology; Cardiomyopathies - drug therapy; Cardiomyopathies - mortality; Cardiomyopathies - physiopathology; Cardiotonic agents; Cardiovascular system; Clinical Investigation; Clinical Investigations; Echocardiography; Female; Follow-Up Studies; Heart Failure - drug therapy; Heart Failure - mortality; Heart Failure - physiopathology; heart failure remodeling; Heart Rate - physiology; Heart Ventricles - pathology; Heart Ventricles - physiopathology; Humans; Hydralazine - therapeutic use; Male; Medical sciences; Middle Aged; Mitral Valve Insufficiency - drug therapy; Mitral Valve Insufficiency - mortality; Mitral Valve Insufficiency - physiopathology; nitrates; Nitrates - therapeutic use; Pharmacology. Drug treatments; relapse; Retrospective Studies; Severity of Illness Index; Stroke Volume - physiology; Survival Analysis; Time Factors; Treatment Outcome; Vasodilation - drug effects; Vasodilation - physiology; Vasodilator Agents - therapeutic use; Ventricular Dysfunction, Left - drug therapy; Ventricular Dysfunction, Left - mortality; Ventricular Dysfunction, Left - physiopathology; Ventricular Remodeling - physiology; Cardiotonic agent; Prognosis; Vasodilator agent; Digoxin; Isosorbide; Cardiovascular disease; nitrates; beta blockers; heart failure remodeling; Vascular remodeling; Peptidyl-dipeptidase A; Heart disease; Glycoside; Left ventricle performance; Digitalis drug; Human; Heart failure; Lisinopril; Enzyme; relapse; Enzyme inhibitor; Peptidases; Chemotherapy; Treatment; Carvedilol; angiotensin-converting enzyme inhibitor; Hydrolases; Peptidyl-dipeptidases; Beta blocking agent
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.4960260908

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 ≤ 35%, who improved their ejection fraction by ≥ 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 inejection 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.