Molecular changes occurring during reverse remodelling following left ventricular assist device support.

Remodelling is the central feature that occurs in the progression of heart failure. However, unloading of the heart with a left ventricular assist device (LVAD) can lead to reversal of many of the remodelling changes even in patients with advanced heart failure. LVAD unloading can also lead to improved myocardial function and this improvement can be sufficient to allow removal of the device leaving the patient to lead a normal life. We review the molecular changes that have been demonstrated with LVAD unloading in patients bridged to transplantation and also those that have occurred in the myocardium of patients that have recovered their myocardial function enough to have the device removed. Changes in both the myocyte and the matrix are reviewed.