**5. Medication management**

LVADs contribute to reverse remodeling through various mechanisms. One of those comes from mechanical unloading resulting in improved cardiac output. Simultaneously, the neurohormonal axis begins to normalize with improvement in beta-adrenergic receptor density and reversal of ryanodine-receptor 2 hyperphosphorylation. Additionally, increasing cross-linking of collagen leads to decreased compliance of the left ventricle [40]. This can be augmented with neurohormonal blockade using: angiotensin-converting enzyme inhibitors, B-blockers, angiotensin-II antagonists, neprilisin inhibitors, and aldosterone antagonists. With improved cardiac function, higher doses of these medications can be tolerated to further augment reverse remodeling [41]. Digoxin is also frequently added to this regimen for its ionotropic and antiangiogenesis effects [42].
