Heart failure with midrange ejection fraction: Prior left ventricular ejection fraction and prognosis

Journal article


Zhang, Xinxin, Sun, Yuxi, Zhang, Yanli, Chen, Feifei, Zhang, Shuyuan, He, Hongyan, Song, Shuang, Tse, Gary and Liu, Ying 2021. Heart failure with midrange ejection fraction: Prior left ventricular ejection fraction and prognosis. Frontiers in Cardiovascular Medicine. 8, p. 697221. https://doi.org/10.3389/fcvm.2021.697221
AuthorsZhang, Xinxin, Sun, Yuxi, Zhang, Yanli, Chen, Feifei, Zhang, Shuyuan, He, Hongyan, Song, Shuang, Tse, Gary and Liu, Ying
Abstract Evidence-based guidelines for heart failure management depend mainly on current left ventricular ejection fraction (LVEF). However, fewer studies have examined the impact of prior LVEF. Patients may enter the heart failure with midrange ejection fraction (HFmrEF) category when heart failure with preserved ejection fraction (HFpEF) deteriorates or heart failure with reduced ejection fraction (HFrEF) improves. In this study, we examined the association between change in LVEF and adverse outcomes. HFmrEF patients with at least two or more echocardiograms 3 months apart at the First Affiliated Hospital of Dalian Medical University between September 1, 2015 and November 30, 2019 were identified. According to the prior LVEF, the subjects were divided into improved group (prior LVEF < 40%), stable group (prior LVEF between 40 and 50%), and deteriorated group (prior LVEF ≥ 50%). The primary outcomes were cardiovascular death, all-cause mortality, hospitalization for worsening heart failure, and composite event of all-cause mortality or all-cause hospitalization. A total of 1,168 HFmrEF patients (67.04% male, mean age 63.60 ± 12.18 years) were included. The percentages of improved, stable, and deteriorated group were 310 (26.54%), 334 (28.60%), and 524 (44.86%), respectively. After a period of follow-up, 208 patients (17.81%) died and 500 patients met the composite endpoint. The rates of all-cause mortality were 35 (11.29%), 55 (16.47%), and 118 (22.52%), and the composite outcome was 102 (32.90%), 145 (43.41%), and 253 (48.28%) for the improved, stable, and deteriorated groups, respectively. Cox regression analysis showed that the deterioration group had higher risk of cardiovascular death (HR: 1.707, 95% CI: 1.064-2.739, = 0.027), all-cause death (HR 1.948, 95% CI 1.335-2.840, = 0.001), and composite outcome (HR 1.379, 95% CI 1.096-1.736, = 0.006) compared to the improvement group. The association still remained significant after fully adjusted for both all-cause mortality (HR = 1.899, 95% CI 1.247-2.893, = 0.003) and composite outcome (HR: 1.324, 95% CI: 1.020-1.718, = 0.035). HFmrEF patients are heterogeneous with three different subsets identified, each with different outcomes. Strategies for managing HFmrEF should include previously measured LVEF to allow stratification based on direction changes in LVEF to better optimize treatment. [Abstract copyright: Copyright © 2021 Zhang, Sun, Zhang, Chen, Zhang, He, Song, Tse and Liu.]
KeywordsPrognosis; Heart failure; Mid-range ejection fraction; Left ventricular ejection fraction; Cardiology
Year2021
JournalFrontiers in Cardiovascular Medicine
Journal citation8, p. 697221
PublisherFrontiers Media S.A.
ISSN2297-055X
Digital Object Identifier (DOI)https://doi.org/10.3389/fcvm.2021.697221
Official URLhttps://www.frontiersin.org/articles/10.3389/fcvm.2021.697221/full
Publication dates
Online02 Aug 2021
Publication process dates
Accepted29 Jun 2021
Deposited06 Sep 2021
Publisher's version
License
File Access Level
Open
Output statusPublished
Permalink -

https://repository.canterbury.ac.uk/item/8y6xz/heart-failure-with-midrange-ejection-fraction-prior-left-ventricular-ejection-fraction-and-prognosis

Download files


Publisher's version
fcvm-08-697221.pdf
License: CC BY 4.0
File access level: Open

  • 0
    total views
  • 2
    total downloads
  • 0
    views this month
  • 2
    downloads this month

Export as

Related outputs

Cardiac abnormalities after induction of endoplasmic reticulum stress are associated with mitochondrial dysfunction and connexin43 expression
He, Jinli, Gong, Mengqi, Wang, Zaojia, Liu, Daiqi, Xie, Bingxin, Luo, C., Li, Guangping, Tse, Gary and Liu, T. 2021. Cardiac abnormalities after induction of endoplasmic reticulum stress are associated with mitochondrial dysfunction and connexin43 expression. Clinical and Experimental Pharmacology and Physiology. https://doi.org/10.1111/1440-1681.13541
Ventricular tachyarrhythmia risk in paediatric/young vs. adult Brugada Syndrome patients: A territory-wide study
Lee, Sharen, Wong, Wing Tak, Wong, Ian Chi Kei, Mak, Chloe, Mok, Ngai Shing, Liu, Tong and Tse, Gary 2021. Ventricular tachyarrhythmia risk in paediatric/young vs. adult Brugada Syndrome patients: A territory-wide study. Frontiers in Cardiovascular Medicine. 8, p. 671666. https://doi.org/10.3389/fcvm.2021.671666
The association between blood pressure variability and hip or vertebral fracture risk: A population-based study
Zhou, Jiandong, Li, Helen, Chang, Carlin, Wu, William K.K., Wang, Xiansong, Liu, Tong, Cheung, Bernard Man Yung, Zhang, Qingpeng, Lee, Sharen and Tse, Gary 2021. The association between blood pressure variability and hip or vertebral fracture risk: A population-based study. Bone. 150, p. 1160115. https://doi.org/10.1016/j.bone.2021.116015