Sustained Cardiac Recovery Hinges on Timing and Natural History of Underlying Condition

The review underlines that advanced heart failure (AHF) patients who experience sustained cardiac recovery in the current left ventricular assist device (LVAD) era have similar clinical characteristics to those who experienced myocardial recovery in the pre-LVAD era. They are young, do not have coronary artery disease and were treated for idiopathic dilated cardiomyopathy within weeks to months of experiencing symptoms. As recently shown with progressive remodeling of the transverse tubular system, AHF results in myocyte and extracellular matrix alterations that with time become irreversible. Young age, short duration of symptoms and LV systolic dysfunction as evidenced by smaller LV cavity dimension are primary determinants of sustained cardiac recovery in patients with AHF. Mechanical circulatory support can be life saving in patients with low-cardiac output and end-organ dysfunction. However, the underlying condition and not mechanical circulatory support appears to be the primary determinant of sustained myocardial recovery.