Abstract 17200: Evolution of Left Ventricular Ejection Fraction and Left Ventricular Volumes in Elderly Heart Failure Patients Under Modern Heart Failure Therapy: Influence of Bnp-Guided Therapy
BACKGROUND: Left ventricular ejection fraction (LVEF) has an important impact on prognosis in patients with heart failure. The purpose of this substudy of the TIME-CHF trial was to evaluate the evolution of LVEF under a symptom-guided versus a NT-BNP guided heart failure therapy in a cohort of elderly heart failure patients, which are not typically included in large heart failure trials.
METHODS AND RESULTS: TIME-CHF was a multicenter trial comparing NT-BNP versus symptom-guided therapy in patients aged 60 to 74 and ≥75 years. Echocardiography was performed at baseline, 12 months and 18 months. LVEF, left ventricular end diastolic volume index (LVEDVI) and left ventricular end systolic volume index (LVESVI) were assessed at the study core lab. 479 patients of the TIME-CHF trial were eligible for the present substudy. Of those, 98 died during follow-up, and 59 withdrew consent. From the remaining 322 patients, a full echocardiographic dataset in adequate image quality was available for 233 patients (72%) with a mean age of 75±7.6 years. Overall, LVEF increased from 30.3±10.7% at baseline to 38.2±12.5% at 12 months (p<0.001), and to 41.9±13.2% at 18 months (p<0.001 vs 12 months). The increase in LVEF was not influenced by age, but was significantly influenced by NT-BNP guided therapy (p=0.015 in both patients 60 to 74 and ≥75 years). LVEDVI decreased from 87.5±33.5 ml/m2 to 76.8±38.45 ml/m2 at 12 months and further to 70±32.7 5ml/m2 at 18 months (p<0.001 for 0 vs 12 months and 12 vs 18 months). LVESVI decreased from 62.8±30.8 ml/m2 to 49.1±34.0 ml/m2 and further to 43.5±28.8 ml/m2 (p<0.001 for the change from 0 vs 12 months and 12 vs 18 months). The changes in LVEDVI and LVESVI were not influenced by age or assignment to NT-BNP-guided treatment.
CONCLUSIONS: In an elderly heart failure population, state of the art therapy leads to a substantial improvement in LVEF and to reverse remodelling. Assignement to NT-BNP guided therapy leads to a larger improvement in LVEF than symptom guided therapy only, while it has no effect on reverse remoldeling.
- © 2012 by American Heart Association, Inc.