Novel therapies for reversal of left ventricular remodeling

Novel therapies for reversal of left ventricular remodeling

Novel therapies for reversal of left ventricular remodeling: Left ventricular (LV) remodeling includes infarct expansion, wall thinning and LV dilatation. There is a direct relation between remodeling and mortality, though initially LV remodeling is beneficial.

Statin has been found to reduce apoptosis and may help in reducing ventricular remodeling. But GISSI-HF trial with rosuvastatin did not find any significant difference in this aspect.
Cytokines can cause ventricular remodeling, but targeting cytokines did not show any benefit.

Endothelin 1 is another molecule involved in remodeling, but antagonists failed to show any use in reducing ventricular remodeling. The same was true of vasopressin antagonists.
Stem cells are pluripotent cells which can regenerate myocardium. Some studies have shown good results while others failed to prove it. Stem cell therapy is yet to come from bench to bedside in reversing ventricular remodeling. The optimum route, timing and type of stem cells to be used are yet to be established.
Surgical restoration of the shape of the LV has been tried, like dynamic cardiomyoplasty and Batista procedure have been tried. STICH trial failed to demonstrate any clinically significant benefit for anatomical restoration.

CRT has been shown to be beneficial in improving ventricular remodeling and symptoms of heart failure.

Obstructive sleep apnoea (OSA) can cause heart failure. Treatment of OSA with continuous positive airway pressure (CPAP) was found to be useful in reducing ventricular remodeling.

Conventional therapies for reversal of ventricular remodeling like ACE inhibitors, beta blockers, CRT and ICD are so effective in reducing mortality in heart failure that any benefit with novel therapies will need very large studies to demonstrate any benefit.