A054 Age-Related Differences in Ventricular Remodeling and Long-Term Heart Failure Outcomes Following Acute Coronary Syndrome

Abstract

Older patients are at increased risk of heart failure following acute coronary syndrome (ACS). We investigated whether this hazard related to differing patterns in left ventricular (LV) remodeling. In a prospective multi-centre observational study, 2,140 patients with ACS underwent echocardiography at 1, 4, and 12 months following the index event with long-term heart failure hospitalisations captured for a median 4.8 (IQR 3.4-6.5) years. Individuals ≤65 years and those >65 years were compared using multivariable Cox models adjusted for baseline clinical (sex, blood pressure, revascularisation) and echocardiographic (LV end-diastolic/end-systolic volumes, LV ejection fraction, septal wall thickness, and E/e') variables recorded at 1 and 12 months. The 1177 (55%) participants who were >65 years were more likely to be women, had higher blood pressure, demonstrated smaller increases in cardiac biomarkers and were less likely to undergo coronary revascularisation (p<0.001 for all). At the 1-month visit, after indexing, older patients had similar LV end-diastolic but larger end-systolic volumes (p=0.029), lower LV ejection fractions, and greater LV mass and diastolic filling pressure estimates (E/e' 14 versus 10; p<0.001 for all). Systolic volumes appeared to further diverge at 12 months (p=0.064) however LV mass did not change in either group. In both unadjusted and adjusted analyses older patients were at increased risk of future heart failure hospitalisation (unadjusted HR 4.1, 95%CI 3.2-5.3; adjusted HR 2.4, 95%CI 1.5-3.9). Older patients experience more eccentric remodeling following ACS although remain at increased risk of heart failure hospitalisation after accounting for clinical and echocardiographic characteristics.Tabled 1≤65 years (n=963)>65 years (n=1177)p-valueLV end systolic volume, indexed to BSA28.64 (15.57)30.62 (19.23)0.029% change from 1 to 12 months2.60 (35.36)6.70 (41.09)0.064 Open table in a new tab