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Reverse remodeling in dilated cardiomyopathy: dream come true?

In the current issue of IMAJ, Arad and co-authors [6] report that of their patients with delated cardiomyopathy, about a quarter eventually had reverse remodeling. Since we know that reverse remodeling is associated with a better prognosis, understanding its mechanism and identifying subgroups in which this process may or may not be relevant is obviously crucial. Several faults should be mentioned regarding the current study. The HF patients in this study cohort are noted for their diverse etiologies of dilated cardiomyopathy and we lack data on the index time period in which the HF1 disease along with the remodeling process started in each patient. Of note, the authors established the diagnosis of reverse remodeling by using echocardiography rather than more definitive technologies such as magnetic resonance imaging. These pitfalls, present in real-world daily life in most HF centers around the globe, reflect the difficulties inherent in “observational clinical studies” for understanding the fundamentals of the reverse remodeling process and further explore the true prevalence of reverse remodeling as well as “preconditions” to its occurrence. The definition of reverse myocardial remodeling is not straightforward and consequently various studies using echocardiography assessed different aspects of left ventricular systolic function and spatial configuration. Left ventricular end-diastolic size (diameter, volume) was assessed by some (correlating with LV2 wall stress) while others measured end-systolic size (assuming it holds geometric and functional informa-