Beat A Kaufmann1, Kaatje Goetschalckx2, Son Y Min3, Micha T Maeder4, Urs Bucher3, Fabian Nietlispach5, Alain M Bernheim6, Matthias E Pfisterer3, Hans-Peter Brunner-La Rocca7. 1. Division of Cardiology, University Hospital Basel, Switzerland. Electronic address: beat.kaufmann@usb.ch. 2. Division of Cardiology, University Hospital Basel, Switzerland; Department of Cardiovascular Diseases, University Hospital Leuven, Belgium. 3. Division of Cardiology, University Hospital Basel, Switzerland. 4. Division of Cardiology, University Hospital Basel, Switzerland; Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland. 5. Division of Cardiology, University Hospital Basel, Switzerland; Cardiology, University Heart Center, University Hospital Zurich, Switzerland. 6. Division of Cardiology, University Hospital Basel, Switzerland; Department of Cardiology, Triemli Hospital, Zurich, Switzerland. 7. Division of Cardiology, University Hospital Basel, Switzerland; Department of Cardiology, Maastricht University Medical Center, The Netherlands.
Abstract
BACKGROUND: In chronic heart failure, left ventricular ejection fraction (LVEF) is considered to be stable. Intensified therapy may improve survival, but little is known whether this is associated with reverse remodeling and dependent on age and NT-proBNP guidance. We aimed to define the evolution of LVEF under intensified therapy in relation to age and NT-proBNP guidance. METHODS AND RESULTS: Echocardiography was performed at baseline, 12 and 18months in TIME-CHF, a trial comparing NT-proBNP versus symptom-guided therapy in patients aged 60 to 74 and ≥75 years. LVEF, LV end diastolic volume index (LVEDVI) and end systolic volume index (LVESVI) were assessed. LVEF increased from 31.3 ± 10.7% to 39.1±11.8% at 18 months (p<0.001) in symptom-guided, and from 30.3 ± 11.7% to 44.0 ± 13.2% (p<0.001) in NT-proBNP-guided patients. The increase in LVEF was significantly larger in the NT-proBNP-guided treatment group (p for interaction=0.006), which was true for both age groups (p for interaction in both=0.091). LVEDVI and LVESVI decreased without influence by study group allocation. CONCLUSIONS: In elderly heart failure patients, intensified medical therapy leads to an improvement in LVEF and to reverse remodeling. NT-proBNP guided therapy was associated with a larger improvement in LVEF than symptom guided therapy both in patients aged 60 to 74 and ≥75 years. TRIAL REGISTRATION: http://isrctn.org Identifier: ISRCTN43596477.
RCT Entities:
BACKGROUND: In chronic heart failure, left ventricular ejection fraction (LVEF) is considered to be stable. Intensified therapy may improve survival, but little is known whether this is associated with reverse remodeling and dependent on age and NT-proBNP guidance. We aimed to define the evolution of LVEF under intensified therapy in relation to age and NT-proBNP guidance. METHODS AND RESULTS: Echocardiography was performed at baseline, 12 and 18months in TIME-CHF, a trial comparing NT-proBNP versus symptom-guided therapy in patients aged 60 to 74 and ≥75 years. LVEF, LV end diastolic volume index (LVEDVI) and end systolic volume index (LVESVI) were assessed. LVEF increased from 31.3 ± 10.7% to 39.1±11.8% at 18 months (p<0.001) in symptom-guided, and from 30.3 ± 11.7% to 44.0 ± 13.2% (p<0.001) in NT-proBNP-guided patients. The increase in LVEF was significantly larger in the NT-proBNP-guided treatment group (p for interaction=0.006), which was true for both age groups (p for interaction in both=0.091). LVEDVI and LVESVI decreased without influence by study group allocation. CONCLUSIONS: In elderly heart failurepatients, intensified medical therapy leads to an improvement in LVEF and to reverse remodeling. NT-proBNP guided therapy was associated with a larger improvement in LVEF than symptom guided therapy both in patients aged 60 to 74 and ≥75 years. TRIAL REGISTRATION: http://isrctn.org Identifier: ISRCTN43596477.
Authors: Julie McLellan; Carl J Heneghan; Rafael Perera; Alison M Clements; Paul P Glasziou; Karen E Kearley; Nicola Pidduck; Nia W Roberts; Sally Tyndel; F Lucy Wright; Clare Bankhead Journal: Cochrane Database Syst Rev Date: 2016-12-22