Chrysakis Nikolaos, Xanthopoulos Andrew, Magouliotis Dimitrios, Starling Randall C, Drakos Stavros G, Triposkiadis Filippos, Skoularigis John
Department of Cardiology, University Hospital of Larissa, 41110 Larissa, Greece.
Unit of Quality Improvement, Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41110 Larissa, Greece.
Diagnostics (Basel). 2023 Apr 21;13(8):1504. doi: 10.3390/diagnostics13081504.
In this paper, the feasibility of myocardial recovery is analyzed through a literature review. First, the phenomena of remodeling and reverse remodeling are analyzed, approached through the physics of elastic bodies, and the terms myocardial depression and myocardial recovery are defined. Continuing, potential biochemical, molecular, and imaging markers of myocardial recovery are reviewed. Then, the work focuses on therapeutic techniques that can facilitate the reverse remodeling of the myocardium. Left ventricular assist device (LVAD) systems are one of the main ways to promote cardiac recovery. The changes that take place in cardiac hypertrophy, extracellular matrix, cell populations and their structural elements, β-receptors, energetics, and several biological processes, are reviewed. The attempt to wean the patients who experienced cardiac recovery from cardiac assist device systems is also discussed. The characteristics of the patients who will benefit from LVAD are presented and the heterogeneity of the studies performed in terms of patient populations included, diagnostic tests performed, and their results are addressed. The experience with cardiac resynchronization therapy (CRT) as another way to promote reverse remodeling is also reviewed. Myocardial recovery is a phenomenon that presents with a continuous spectrum of phenotypes. There is a need for algorithms to screen suitable patients who may benefit and identify specific ways to enhance this phenomenon in order to help combat the heart failure epidemic.
在本文中，通过文献综述分析了心肌恢复的可行性。首先，分析了重塑和逆向重塑现象，从弹性体物理学角度进行探讨，并定义了心肌抑制和心肌恢复这两个术语。接着，综述了心肌恢复的潜在生化、分子和成像标志物。然后，工作重点转向可促进心肌逆向重塑的治疗技术。左心室辅助装置（LVAD）系统是促进心脏恢复的主要方式之一。回顾了心脏肥大、细胞外基质、细胞群体及其结构成分、β受体、能量学以及若干生物学过程中发生的变化。还讨论了使经历心脏恢复的患者脱离心脏辅助装置系统的尝试。介绍了将从LVAD中受益的患者的特征，并讨论了在纳入的患者群体、所进行的诊断测试及其结果方面所开展研究的异质性。还综述了作为促进逆向重塑的另一种方式的心脏再同步治疗（CRT）的经验。心肌恢复是一种呈现出连续表型谱的现象。需要有算法来筛选可能受益的合适患者，并确定增强这一现象的具体方法，以帮助应对心力衰竭的流行。
