About this Research Topic
In April 1998, the International Forum on Cardiac Remodeling held its first meeting in Atlanta, Georgia, and issued a Consensus Paper on the "concept and clinical implications of cardiac remodeling". The group suggested defining cardiac remodeling as "genome expression, molecular, cellular and interstitial changes that are manifested clinically as changes in size, shape, and function of the heart after cardiac injury". This definition was refined later by other researchers to include inflammatory, metabolic, neurohormonal, and electrophysiological changes and, importantly, included the understanding that cardiac remodeling is an ongoing active process with detrimental effects.
The paradigm shift in the treatment approach towards heart failure with reduced ejection fraction came alongside the growing evidence on the clinical effect as well as the reverse remodeling effect of fundamental heart failures therapies such as beta-blockers and angiotensin-converting enzymes. Other therapeutics, from diverse cardiovascular arenas, also showed beneficial results and improved our understanding of cardiac remodeling and reverse cardiac remodeling. To name a few: correction of valvular diseases; cardiac resynchronization therapy; mechanical unloading; novel HF drugs; and direct interventions aimed at genomic expression alteration.
While the basic science of cardiac remodeling and reverse cardiac remodeling is accumulating and new discoveries continue to emerge, the implication of reverse cardiac remodeling in the clinical setting is intriguing and challenging for many reasons: who is the patient who might experience reverse cardiac remodeling, and to what extent? What is the optimal method for inducing reverse cardiac remodeling? What are the long-term implications of reverse cardiac remodeling and are they sustainable? Furthermore, though cardiac remodeling is defined as changes in left ventricular geometry and not necessarily its dilatation, cardiac remodeling is perceived as the ongoing dilatation and contractile dysfunction of the left ventricle, neglecting many times the aspect of thickening, fibrosis, and extracellular matrix changes which are the hallmark of a growing proportion of heart failure patients, that is - heart failure with preserved ejection fraction.
This Research Topic aims to explore the concept of reverse cardiac remodeling and recovered myocardial function through the presentation of novel basic science along with clinical studies investigating this important topic.
Keywords: Cardiac Remodeling
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