REVIEW

Reverse remodelling in heart failure with cardiac resynchronisation therapy

M St John Sutton, M G Keane

Division of Cardiology, Department of Medicine, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA

Correspondence to:
M St John Sutton
Division of Cardiology, Department of Medicine, University of Pennsylvania Medical Center, Room 9017, Gates Pavilion, 3400, Spruce Street, Philadelphia, PA 19104, USA; suttonm{at}mail.med.upenn.edu

This review examines the use of cardiac resynchronisation therapy (CRT) for chronic, severe, systolic heart failure. Left ventricular (LV) remodelling is the final common pathway of systolic heart failure and portends a poor prognosis. It is characterised by progressive LV dilatation, deterioration of ventricular contractile function and distortion of LV cavity shape. The LV remodelling process is triggered by prolonged pressure or volume overload, loss of contracting myocytes from myocardial infarction, genetic abnormalities of contractile proteins or exposure to cardiotoxic agents. Current therapeutic strategies for systolic heart failure aim to slow or halt the remodelling process. "Reverse remodelling" is a relatively new concept, where progressive LV dilatation and deterioration in contractile function are not simply arrested, but partially reversed. Cardiac resynchronisation therapy is a novel and effective treatment for systolic heart failure, and is associated with reverse remodelling of the LV.

Abbreviations: CARE-HF, Cardiac Resynchronisation in Heart Failure; CRT, cardiac resynchronisation therapy; LV, left ventricular; LVEF, left ventricular ejection fraction; MIRACLE, Multicenter InSync Randomised Clinical Evaluation; NYHA, New York Heart Association

Keywords: heart failure; resynchronisation; ventricular remodelling; echocardiography

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