Reverse Remodelling, Myocardial Recovery and Remission in Heart Failure with Reduced Ejection Fraction: Clinical Implications and Management Strategies

Cardiac reverse remodelling (RR) is a complex process involving structural and functional recovery of the myocardium, with significant implications for the prognosis of patients with heart failure (HF). This review summarises current concepts, underlying mechanisms, therapeutic strategies, and clinical implications of RR, while distinguishing it from myocardial recovery and remission. Both pharmacological therapies and non-pharmacological interventions have shown potential to induce RR in selected populations. Clinical features, echocardiographic parameters, advanced imaging findings, and biomarkers help stratify patients according to the likelihood of recovery and risk of relapse. The management of HF with improved ejection fraction remains debated. High recurrence rates are seen after therapy discontinuation; however, evidence suggests that partial withdrawal may be safe in specific patient profiles. RR should be considered a central therapeutic goal in HF care, although its extent and stability vary widely. Differentiating between transient improvement, remission under therapy, and true myocardial recovery is critical for guiding long-term treatment decisions, highlighting the importance of individualised follow-up.