Advances in medical and device therapies have demonstrated the capacity of the heart to reverse the failing phenotype. The development of normative changes to ventricular size and function led to the concept of reverse remodelling. Among heart failure therapies, durable mechanical circulatory support is most consistently associated with the largest degree of reverse remodelling. Accordingly, research to analyse human tissue after a period of mechanical circulatory support continues to yield a wealth of information. In this Review, we summarize the latest findings on reverse remodelling and myocardial recovery. Accumulating evidence shows that the molecular changes associated with heart failure, in particular in the transcriptome, metabalome, and extracellular matrix, persist in the reverse-remodelled myocardium despite apparent normalization of macrolevel properties. Therefore, reverse remodelling should be distinguished from true myocardial recovery, in which a failing heart regains both normal function and molecular makeup. These findings have implications for future research to develop therapies to repair fully the failing myocardium. Meanwhile, recognition by society guidelines of this new clinical phenotype, which is coming to be known as a state of heart failure remission, underscores the need to accurately define and identify reverse modelled myocardium for the establishment of appropriate therapies.

医学和器械疗法的进步表明，心脏具有逆转失败的表型的能力。心室大小和功能的规范性变化的发展导致了反向重塑的概念。在心力衰竭治疗中，持久的机械循环支持与最大程度的逆重塑始终保持一致。因此，经过一段时间的机械循环支持后对人体组织进行分析的研究继续产生大量信息。在这篇综述中，我们总结了逆向重构和心肌恢复的最新发现。越来越多的证据表明，与心力衰竭相关的分子变化，特别是在转录组，代谢组和细胞外基质中，尽管宏观水平特性明显正常化，但仍保留在逆重塑的心肌中。因此，逆向重塑应与真正的心肌恢复有所区别，在这种情况下，衰竭的心脏既可以恢复正常功能，又可以恢复分子组成。这些发现对未来研究开发可以完全修复衰竭心肌的疗法具有重要意义。同时，被社会指导方针认可的这种新的临床表型被称为心力衰竭缓解状态，突显了需要准确定义和识别反向建模的心肌以建立适当的治疗方法。这些发现对未来研究开发可以完全修复衰竭心肌的疗法具有重要意义。同时，被社会指导方针认可的这种新的临床表型被称为心力衰竭缓解状态，突显了需要准确定义和识别反向建模的心肌以建立适当的治疗方法。这些发现对未来研究开发可以完全修复衰竭心肌的疗法具有重要意义。同时，被社会指导方针认可的这种新的临床表型被称为心力衰竭缓解状态，突显了需要准确定义和识别反向建模的心肌以建立适当的治疗方法。