Characteristics and outcomes of heart failure with recovered left ventricular ejection fraction

Journal article


Zhang, Xinxin, Sun, Yuxi, Zhang, Yanli, Chen, Feifei, Dai, Mengyuan, Si, Jinping, Yang, Jing, Li, Xiao, Li, Jiaxin, Xia, Yunlong, Tse, G. and Liu, Ying 2021. Characteristics and outcomes of heart failure with recovered left ventricular ejection fraction. ESC Heart Failure. 8 (6), pp. 5383-5391. https://doi.org/10.1002/ehf2.13630
AuthorsZhang, Xinxin, Sun, Yuxi, Zhang, Yanli, Chen, Feifei, Dai, Mengyuan, Si, Jinping, Yang, Jing, Li, Xiao, Li, Jiaxin, Xia, Yunlong, Tse, G. and Liu, Ying
Abstract

Aims

There is an emerging interest in elucidating the natural history and prognosis for patients with heart failure with reduced ejection fraction (HFrEF) in whom left ventricular ejection fraction (LVEF) subsequently improves. The characteristics and outcomes were compared between heart failure with recovered ejection fraction (HFrecEF) and persistent HFrEF.


Methods and results

This is a retrospective study of adults who underwent at least two echocardiograms 3 months apart between 1 November 2015 and 31 October 2019 with an initial diagnosis of HFrEF. The subjects were divided into HFrecEF group (second LVEF > 40%, ≥10% absolute improvement in LVEF) and persistent HFrEF group (<10% absolute improvement in LVEF) according to the second LVEF. To further study the characteristics of HFrecEF patients, the cohort was further divided into LVEF improvement of 10–20% and >20% subgroups. The primary outcomes were all-cause mortality and rehospitalization. A total of 1160 HFrEF patients were included [70.2% male, mean (standard deviation) age: 62 ± 13 years]. On the second echocardiogram, 284 patients (24.5%) showed HFrecEF and 876 patients (75.5%) showed persistent HFrEF. All-cause mortality was identified in 23 (8.10%) HFrecEF and 165 (18.84%) persistent HFrEF, whilst 76 (26.76%) and 426 (48.63%) showed rehospitalizations, respectively. Survival analysis showed that the persistent HFrEF subgroup experienced a significantly higher mortality at 12 and 24 months and a higher hospitalization at 12, 24, 48, and more than 48 months following discharge. Multivariate Cox regression showed that persistent HFrEF had a higher risk of all-cause mortality [hazard ratio (HR) 2.30, 95% confidence interval (CI) 1.49–3.56, P = 0.000] and rehospitalization (HR 1.85, 95% CI 1.45–2.36, P = 0.000) than the HFrecEF group. Subgroup analysis showed that the LVEF ≥ 20% improvement subgroup had lower rates of adverse outcomes compared with those with less improvement of 10–20%.


Conclusions

Heart failure with recovered ejection fraction is a distinct HF phenotype with better clinical outcomes compared with those with persistent HFrEF. HFrecEF patients have a relatively better short-term mortality at 24 months but not thereafter.

KeywordsHeart failure; Prognosis; Echocardiography; Left ventricular ejection fraction
Year2021
JournalESC Heart Failure
Journal citation8 (6), pp. 5383-5391
PublisherWiley
ISSN2055-5822
Digital Object Identifier (DOI)https://doi.org/10.1002/ehf2.13630
Official URLhttps://onlinelibrary.wiley.com/doi/full/10.1002/ehf2.13630
FunderNational Natural Science Foundation of China
Publication dates
Online27 Sep 2021
Publication process dates
Deposited16 Jun 2022
Publisher's version
License
Output statusPublished
Licensehttp://creativecommons.org/licenses/by-nc-nd/4.0/
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