Central Illustration.

Biological and physical mechanisms for reverse remodeling. Left ventricular reverse remodeling can target biological pathways that aberrate ventricular loading conditions and cause cavity enlargement and distortion. Alternatively, it can immediately address changes in left ventricular size and shape, as with physical reverse remodeling. ∗Therapies that have combined biological and physical reverse remodeling mechanisms. Courtesy of Alkhunaizi et al.¹⁷ ACE, angiotensin-converting enzyme; ARB, angiotensin receptor blocker; ARNI, angiotensin receptor–neprilysin inhibitor; CRT, cardiac resynchronization therapy; fMR, functional mitral regurgitation; LVAD, left ventricular assist device; MIRTH, Myocardial Intramural Remodeling by Transvenous Tether; MVr, mitral valve repair; MVR, mitral valve replacement.