Reversal of heart failure remodeling with age

Since heart failure is a major cause of morbidity in the elderly, we studied the effect of up-titrated heart failure therapy in older vs. younger individuals on symptoms and left ventricular (LV) function over 1 year. Seventy-one patients with heart failure and an LV ejection fraction < or =35% were enrolled and were followed with echocardiography at baseline and at 1 year. Young patients were born in or after 1935 (n=48; 51.7+/-9.1 years); middle-aged were born between 1925-1934 (n=14; 69.7+/-2.8 years); and older patients in or prior to 1924 (n=9; 80.5+/-3.3 years). Baseline LV ejection fraction was 18%+/-7%, LV end-diastolic diameter 6.9+/-0.9 cm, and New York Heart Association class was 2.6+/-1.0, equivalent for all groups. On medical therapy, at 12 months, LV ejection fraction improved only for the young and middle-aged (36%+/-14% and 37%+/-17%; p=0.002), but not for the older patients (22%+/-7%; p=NS). Reductions in LV end-diastolic diameter and mitral regurgitation were significant only for the young. However, New York Heart Association status improved similarly for all groups (1.6+/-0.8; p<0.001), as did heart failure hospitalizations (p<0.0001). Although all groups tolerated intensified heart failure therapy, only the young and middle-aged improved LV remodeling. However, older patients experienced equivalent significant improvements in heart failure symptoms and hospitalizations.