Author + information
- Received March 11, 2019
- Revision received June 6, 2019
- Accepted June 6, 2019
- Published online August 7, 2019.
- Alberto Aimo, MDa,∗,
- Hanna K. Gaggin, MD, MPHc,d,∗,
- Andrea Barison, MD, PhDa,b,
- Michele Emdin, MD, PhDa,b and
- James L. Januzzi Jr., MDc,d,e,∗ (, )@JJHeart_doc
- aInstitute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy
- bCardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
- cMassachusetts General Hospital, Boston, Massachusetts
- dHarvard Medical School, Boston, Massachusetts
- eBaim Institute for Clinical Research, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. James L. Januzzi, Jr., Massachusetts General Hospital, 32 Fruit Street, Yawkey 5B, Boston, Massachusetts 02114.
• 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.
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.
↵∗ Drs. Aimo and Gaggin contributed equally to this work and are co-first authors.
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.
- Received March 11, 2019.
- Revision received June 6, 2019.
- Accepted June 6, 2019.
- 2019 American College of Cardiology Foundation
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