Comparison of Baseline versus Posttreatment Left Ventricular Ejection Fraction in Patients with Acute Decompensated Heart Failure for Predicting Cardiovascular Outcome: Implications from Single-Center Systolic Heart Failure Cohort

Abstract

AimsThe prognostic values of left ventricular ejection fraction (LVEF) during heart failure (HF) with acute decompensation or after optimal treatment have not been extensively studied. We hypothesized that posttreatment LVEF has superior predictive value for long-term prognosis than LVEF at admission does.Methods and ResultsIn Protocol 1, 428 acute decompensated HF (ADHF) patients with LVEF ≤35% in a tertiary medical center were enrolled and followed for a mean period of 34.7 ± 10.8 months. The primary and secondary end points were all-cause mortality and HF readmission, respectively. In total, 86 deaths and 240 HF readmissions were recorded. The predictive values of baseline LVEF at admission and LVEF 6 months posttreatment were analyzed and compared. The posttreatment LVEFs were predictive for future events (P = 0.01 for all-cause mortality, P < 0.001 for HF readmission), but the baseline LVEFs were not. In Protocol 2, the outcomes of patients with improved LVEF (change of LVEF: ≥+10%), unchanged LVEF (change of LVEF: –10% to +10%), and reduced LVEF (change of LVEF: ≤–10%) were analyzed and compared. Improved LVEF occurred in 171 patients and was associated with a superior long-term prognosis among all groups (P = 0.02 for all-cause mortality, P < 0.001 for HF readmission). In Protocol 3, independent predictors of improved LVEF were analyzed, and baseline LV end-diastolic dimension (LVEDD) was identified as a powerful predictor in ADHF patients (P < 0.001).ConclusionsIn patients with ADHF, posttreatment LVEF but not baseline LVEF had prognostic power. Improved LVEF was associated with superior long-term prognosis, and baseline LVEDD identified patients who were more likely to have improved LVEF. Therefore, baseline LVEF should not be considered a relevant prognosis factor in clinical practice for patients with ADHF.

Determinants of Left Ventricular Systolic Function Improvement Following Coronary Artery Revascularization in Heart Failure Patients With Reduced Ejection Fraction (HFrEF)

“…Improvement of LVEF was defined as [(LVEF during chronic phase) -(LVEF during acute phase)] ≥ 10%. 19,20) At our institution, we usually follow the current guidelines when patients are referred for revascularization. 21,22) Revascularization was considered for angiographically significant stenosis (≥ 75% diameter reduction by visual assessment) and functionally significant stenosis (fractional flow reserve measurement < 0.80).…”

Timing on echocardiography and blood laboratory test is important for future outcome association in hospitalized heart failure patients

“…Therefore, it would be helpful to compare examinations conducted upon admission and before discharge with respect to their prognostication. Recently, Yeh et al [18] reported that post-treatment LVEF (6 months after a hospitalization due to HF) but not baseline LVEF was a useful prognostic marker in patients with HFrEF. Although data on diastolic and strain parameters as well as pre-discharge echo indices were lacking in their study, their results indicated that a disturbed hemodynamic status on admission for HF may make baseline echocardiography less relevant to future adverse events.…”

HbA1c levels in patients of acute decompensated heart failure

“…3 The deteriorating clinical outcomes of patients with HF and reduced Left Ventricular ejection fraction (LVEF) may lead to Acute Decompensated Heart Failure (ADHF), where the prognosis remains poor with mortality exceeding 50% at 5 years with a high rate of rehospitalisation and this leads to increased fi nancial burden. 4 The most prevalent form of Diabetes Mellitus (DM) is type II and its incidence increase with advancing age. Insulin resistance in DM is accompanied by other cardiovascular factors -dyslipidemia, hypertension, pro-thrombotic factors, activators of multiple hormone and cytokine system, autonomic neuropathy, endothelial dysfunction and coronary artery disease (CAD).…”