Cioffi Giovanni, Tarantini Luigi, De Feo Stefania, Pulignano Giovanni, Del Sindaco Donatella, Stefenelli Carlo, Opasich Cristina
Department of Cardiology, Villa Bianca Hospital, Trento, Italy.
Eur J Heart Fail. 2005 Oct;7(6):1040-8. doi: 10.1016/j.ejheart.2004.11.003.
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.
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.
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).
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.
近年来，在接受血管紧张素转换酶（ACE）抑制剂和/或β受体阻滞剂治疗的中年扩张型心肌病患者中，已确立的左心室（LV）扩张的逆转越来越受到认可。我们进行了这项前瞻性研究，以评估心力衰竭的优化治疗是否也能在老年患者中诱导左心室逆向重构。
124例年龄>70岁、左心室射血分数<40%的患者在基线和1年后接受了临床和超声心动图评估。在随访早期，优化了药物治疗。左心室逆向重构定义为从基线到最终评估左心室舒张末期容积减少>25%。
32例患者（26%）出现左心室逆向重构。与左心室几何形状未改善的受试者相比，逆向重构患者在基线时具有更高的动脉血压、更低的血清肌酐水平、更短的心力衰竭症状持续时间、更频繁接受β受体阻滞剂治疗且主要为非缺血性病因。多变量分析中与逆向重构发生相关的变量是心力衰竭症状持续时间较短（优势比：7.7；可信区间：2.5 - 23.3，p = 0.0001）和β受体阻滞剂治疗（优势比：6.0；可信区间：1.6 - 23.3，p = 0.01）。
左心室逆向重构在老年和年轻心力衰竭患者中均会发生。相当一部分老年患者经历了这一有利过程，该过程在接受β受体阻滞剂治疗且心脏病史较短的患者中更为普遍。
