title: Improvement in left ventricular ejection fraction and reverse remodeling in elderly heart failure patients on intense NT-proBNP-guided therapy.
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.
  
  
  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.
  
  
  BACKGROUND
  http://isrctn.org Identifier: ISRCTN43596477.
authors.affiliation: Division of Cardiology, University Hospital Basel, Switzerland. Electronic address: beat.kaufmann@usb.ch.
authors.forename: Beat A
authors.initials: BA
authors.lastname: Kaufmann
authors.affiliation: Division of Cardiology, University Hospital Basel, Switzerland; Department of Cardiovascular Diseases, University Hospital Leuven, Belgium.
authors.forename: Kaatje
authors.initials: K
authors.lastname: Goetschalckx
authors.affiliation: Division of Cardiology, University Hospital Basel, Switzerland.
authors.forename: Son Y
authors.initials: SY
authors.lastname: Min
authors.affiliation: Division of Cardiology, University Hospital Basel, Switzerland; Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Micha T
authors.initials: MT
authors.lastname: Maeder
authors.affiliation: Division of Cardiology, University Hospital Basel, Switzerland.
authors.forename: Urs
authors.initials: U
authors.lastname: Bucher
authors.affiliation: Division of Cardiology, University Hospital Basel, Switzerland; Cardiology, University Heart Center, University Hospital Zurich, Switzerland.
authors.forename: Fabian
authors.initials: F
authors.lastname: Nietlispach
authors.affiliation: Division of Cardiology, University Hospital Basel, Switzerland; Department of Cardiology, Triemli Hospital, Zurich, Switzerland.
authors.forename: Alain M
authors.initials: AM
authors.lastname: Bernheim
authors.affiliation: Division of Cardiology, University Hospital Basel, Switzerland.
authors.forename: Matthias E
authors.initials: ME
authors.lastname: Pfisterer
authors.affiliation: Division of Cardiology, University Hospital Basel, Switzerland; Department of Cardiology, Maastricht University Medical Center, The Netherlands.
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Brunner-La Rocca
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000627:therapeutic use*; D010446:Peptide Fragments / Q000627:therapeutic use*; D011446:Prospective Studies; D016037:Single-Blind Method; D013318:Stroke Volume / Q000502:physiology; D014463:Ultrasonography; D020257:Ventricular Remodeling / Q000502:physiology
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Biomarkers; Heart failure; Left ventricular ejection fraction; Outcome