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

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.

Efficacy of guideline‐directed medical treatment in heart failure with mildly reduced ejection fraction

“…Our results supported that the response to medical treatment in HFmrEF was more similar to patients with reduced LVEF and complement our previous analysis in different HF subpopulations. [13][14][15][16][17] Interestingly, in our study, the baseline left ventricular diameter and brain natriuretic peptide level in TT group were higher than that of NTT group, indicating more severe HF in the TT group. It was possible that cardiologists considered patients with greater severity of illness, where the GDMT may be more appropriate.…”

Female Gender Is Associated with an Increased Left Ventricular Ejection Fraction Recovery in Patients with Heart Failure with Reduced Ejection Fraction

“…No additional studies were added through the manual search. Therefore, a total of 18 studies were included in the meta-analysis [ 3 , 8 , 11 , 14 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. The PRISMA flow diagram is demonstrated in Figure 1 .…”

“…A total of 18 cohort studies from 2011 to 2021 were included in our meta-analysis with a total population of 12,270 patients (3460, 28.2% female) [ 3 , 8 , 11 , 14 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. There were 4, 13, and 1 studies that used an LVEF cutoff value of >50%, >40–45%, and >35% for LVEF recovery, respectively.…”

“…Among the 18 included studies, 7 studies found that female gender was significantly associated with an increased chance of LVEF recovery [ 3 , 8 , 11 , 14 , 26 , 28 , 32 ]. In the other 11 studies, 10 studies reported a non-significant correlation between female gender and LVEF recovery [ 22 , 23 , 24 , 25 , 27 , 29 , 30 ] while 1 study found a negative correlation between female gender and LVEF recovery [ 35 ]. As shown in Table 1 , the studies with non-significant results had a relatively lower number of participants.…”

Prognosis and diastolic dysfunction predictors in patients with heart failure and recovered ejection fraction

“…We speculated that sex differences between the two groups might affect the LVEF and LV size at the discharge. In addition, because Zhang et al reported that the degree of LVEF improvement was associated with the prognosis 25 , we created ROC curve and compared the AUC of E/e′ ratio at the 1-year follow-up and LVEF changes from the discharge to the 1-year follow-up for the composite of CV death and rehospitalization for HF. Although there was no significant difference between them, AUC was higher in E/e′ ratio than LVEF change (E/e′ ratio: 0.70 vs. LVEF change: 0.61, p = 0.48, Supplemental Fig.…”