Mysterious Reverse Left Ventricular Remodeling Despite Suboptimal Medical Therapy: A Case Report

Left ventricular reverse remodeling is an important feature of recovery in heart failure, usually associated with appropriate medical or device-based therapy. We report an unusual case of marked reverse remodeling despite suboptimal medical treatment. A 72-year-old woman presented with epigastric pain and NYHA class III exertional dyspnea. Electrocardiography showed sinus rhythm with complete left bundle branch block. Echocardiography revealed a dilated left ventricle, regional wall-motion abnormalities, and reduced ejection fraction of 36%. Coronary angiography demonstrated a severe distal left anterior descending artery lesion, while viability assessment showed no viability in the corresponding territory. Because of hyperkalemia and impaired renal function, medical treatment was limited, and the patient was discharged on calcium-channel blocker and single antiplatelet therapy. One year later, she was asymptomatic, and echocardiography demonstrated normalized ventricular dimensions without dyskinetic abnormalities and recovery of ejection fraction to 62%. This unexpected improvement highlights the complex and incompletely understood mechanisms underlying reverse cardiac remodeling.