heart failure with reduced ejection fraction (HF-REF) is associated with left ventricular remodeling in most patients which is grossly defined by LV dilation, and is associated with poor prognosis. Positive or reverse remodeling (RR) was also described but its exact contribution is poorly documented.

to analyze prevalence of RR in a cohort of outpatients with HF-REF and to characterize its determinants and prognostic impact.

inclusion criteria were: available detailed echographic files; beta-blockers ACE-I or ARB introduced before the study; left ventricular EF (LVEF)<0.45 and left ventricular end diastolic dimension>33mm/m² at the first echography; at least one other examination between 3 and 12 months; clinical follow-up of 3 years or more (cardiac death or cardiac transplantation). RR was defined as the combination of a decrease of LV end diastolic diameter>10% and an increase in LVEF>10% (or last EF>0.50) between the two echocardiographies.

we included 196 patients between 2008 and 2010. RR was observed in 21 patients (10%). As compared with others patients, RR was associated with significantly higher BMI (27.3 vs 25.3), obesity (28 vs 10%), de novo HF (81 vs 46%) and lower initial LVEF (0.26 vs 0.30). In multivariate regression analysis, de novo HF and obesity were independently predictive of the RR. Over amean follow-up of 60 months, the rate of death or cardiac transplantation was 4% in RR patients and 14% in the other group (p<0.01). In Cox-regression analysis, independent predictors of prognosis were de novo HF, obesity and RR (p<0.01). After adjustement, RR remains associated with better prognosis (HR 0.22; CI95% 0.06-0.95; p=0.04).

RR occurs in a small proportion of patients with HF-REF and is related to good prognosis. While de novo HF appears to be the strongest determinant of RR, our results suggest that obesity could be a novel and intriguing player in underlying mechanisms of RR.