 The hypothesis of this study is that patients with dilated nonischemic cardiomyopathy who require support with an implanted left ventricular assist device LVAD for chronic refractory heart failure can, with a specific two-staged medical regimen designed to enhance maximal reverse remodeling an angiotensin converting enzyme inhibitor, beta blocker, angiotensin receptor blocker, aldosterone antagonist and digoxin stage 1 and preventreverse myocardial atrophy the β2 agonist clenbuterol stage 2, recover adequate left ventricular systolic function to allow LVAD explantation and subsequent intermediate-term survival without need for mechanical circulatory support or heart transplantation. 