© 2005 European Society of Cardiology
Pharmacological left ventricular reverse remodeling in elderly patients receiving optimal therapy for chronic heart failure
a Department of Cardiology, "Villa Bianca" Hospital Trento, Italy
b Department of Cardiology, "S. Martino" Hospital Belluno, Italy
c "Salvatore Maugeri" Foundation, IRCCS, Pavia Medical Center Italy
d Department of Cardiology, "S. Camillo" Hospital Rome, Italy
e Department of Cardiology INRCA IRCCS Rome Italy
* Corresponding author. Division of Cardiology, Villa Bianca Hospital, Trento. via Piave 78, 38100, Trento, Italy. Tel.: +39 461 916 000; fax: +39 461 916874. E-mail address: gcioffi{at}albaclick.com
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Abstract |
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Background and aims: In recent years, reversal of established left ventricular (LV) dilatation has been increasingly recognized in middle-aged patients with dilated cardiomyopathy receiving angiotensin-converting enzyme (ACE) inhibitors and/or beta-blockers. We performed this prospective study to evaluate whether optimized therapy for heart failure also induces LV reverse remodeling in older patients.
Methods: One hundred and twenty-four patients aged >70 years with LV ejection fraction <40% underwent clinical and echocardiographic evaluation at baseline and after 1 year. During the early stage of follow-up, pharmacological therapy was optimized. LV reverse remodeling was defined as a reduction in LV end-diastolic volume >25% from baseline to final evaluation.
Results: LV reverse remodeling was recognized in 32 patients (26%). Compared to the subjects who did not improve LV geometry, those with reverse remodeling had, at baseline, higher arterial blood pressure, lower serum creatinine levels, shorter duration of symptoms of heart failure, more frequently received beta-blocker therapy and had predominantly nonischemic aetiology. The variables associated with the development of reverse remodeling in the multivariate analysis were shorter duration of symptoms of heart failure (Odds ratio: 7.7; CI: 2.5–23.3, p=0.0001) and beta-blocker therapy (Odds ratio: 6.0; CI: 1.6–23.3, p=0.01).
Conclusions: LV reverse remodeling takes place in elderly as well as in younger heart failure patients. A significant proportion of elderly patients undergoes this favourable process which occurs prevalently in patients receiving beta-blocker therapy with a short history of cardiac disease.
Key Words: Chronic heart failure • Left ventricular reverse remodeling • Elderly population • Dilated cardiomyopathy • Left ventricular systolic dysfunction
Received June 11, 2004; Revised October 12, 2004; Accepted November 11, 2004
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