ABSTRACT
The goal of delaying progression or inducing regression of pathological cardiac hypertrophy and dilation, so-called “reverse remodeling,” has emerged as an important therapeutic target in the treatment of dilated cardiomyopathies. In some of the most dramatic examples of reverse remodeling have been observed following placement of left ventricular assist devices (LVADs) in patients with medically refractory heart failure awaiting heart transplantation. Beyond the strong stimuli for reverse remodeling engendered by sustained LVAD support, another key feature of the bridge to transplant use of LVAD support is the ability to document the myocardial adaptations to this therapeutic intervention at the tissue level. This opportunity derives from the typical removal of a core of transmural left ventricular tissue at the time of LVAD implantation and the removal of the remainder of the heart at the time of transplantation. Studies conflict regarding the effects of LVAD support on the remodeling of the extracellular matrix.
