Figure 5: Conceptual Framework for Clinical Trial Design Incorporating the U-NOVA Reverse Remodeling Stages.

Reverse left ventricular remodeling is not an all or none phenomenon and as many other biological phenomena manifests as a continuous spectrum. We describe a new framework to characterize stages of reverse remodeling with mechanical unloading. We identified three distinct HF sub-populations and their cardiac functional and structural response to durable mechanical circulatory support. This framework for grading reverse remodeling allows for heart failure clinicians and investigators to readily recognize the stages of reverse remodeling and identify subpopulations for personalized management. This functional/structural reverse cardiac remodeling staging may also facilitate advancing the field of myocardial plasticity by informing the study design of future clinical and translational investigations. GDMT: Guideline directed medical therapy.