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

Kewcharoen, Jakrin; Trongtorsak, Angkawipa; Thangjui, Sittinun; Kanitsoraphan, Chanavuth; Prasitlumkum, Narut

doi:10.3390/medsci10020021

Cited by 7 publications

(6 citation statements)

References 39 publications

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“…In our sensitivity analysis, female gender was associated with a higher increase in EF during follow-up. This is in line with a meta-analysis of 18 studies, in which females had a higher odds of EF recovery ( 41 ). The gender difference may be explained by a higher level of signaling molecules with anti-inflammatory effects and more reparative immune cells in females ( 42 ).…”

Section: Discussionsupporting

confidence: 90%

Trajectories and determinants of left ventricular ejection fraction after the first myocardial infarction in the current era of primary coronary interventions

Wohlfahrt

Jenča

Melenovský

et al. 2022

Front. Cardiovasc. Med.

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BackgroundLeft ventricular ejection fraction (EF) is an independent predictor of adverse outcomes after myocardial infarction (MI). However, current data on trajectories and determinants of EF are scarce. The present study aimed to describe the epidemiology of EF after MI.MethodsData from a single-center prospectively-designed registry of consecutive patients hospitalized at a large tertiary cardiology center were utilized.ResultsOut of 1,593 patients in the registry, 1,065 were hospitalized for MI type I (65.4% STEMI) and had no previous history of heart failure or MI. At discharge, EF < 40% was present in 238 (22.3%), EF 40–50% in 326 (30.6%) and EF > 50% in 501 (47.0%). Patients with EF < 40% were often those who suffered subacute and anterior STEMI, had higher heart rate at admission and higher maximal troponin level, and had more often HF signs requiring intravenous diuretics. Among subjects with EF < 40%, the follow-up EF was available in 166 (80% of eligible). Systolic function recovered to EF > 50% in 39 (23.1%), slightly improved to EF 40–50% in 44 (26.0%) and remained below 40% in 86 (50.9%). Systolic function improvement to EF > 40% was predicted by lower severity of coronary atherosclerosis, lower leukocyte count, and the absence of atrial fibrillation.ConclusionsDespite recent improvements in in-hospital MI care, one in five patients has systolic dysfunction at hospital discharge. Out of these, EF improves in 51%, and full recovery is observed in 23%. The severity of coronary atherosclerosis, inflammatory response to MI, and atrial fibrillation may affect EF recovery.

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Section: Discussionsupporting

confidence: 90%

Trajectories and determinants of left ventricular ejection fraction after the first myocardial infarction in the current era of primary coronary interventions

Wohlfahrt

Jenča

Melenovský

et al. 2022

Front. Cardiovasc. Med.

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“…Although representing only 30% of the population study, women benefited more from the Excellence Program, presenting better EF and NT-proBNP levels at follow-up. These findings resonate with the existing literature, where the female gender has been associated with an increased likelihood of EF recovery [25]. Women, in general, tend to have higher baseline EF compared to men, potentially contributing to better recovery in female HF patients [26].…”

Section: Discussionsupporting

confidence: 88%

Excellence in Heart Failure: A Multidisciplinary Program on Heart Failure Management for Improved Patient Outcome

Sousa,

Ponte,

Caeiro

et al. 2023

Hearts

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Chronic heart failure (HF) is the 21st-century cardiovascular epidemic, marked by recurrent hospitalizations and high mortality rates, and represents a considerable burden on Western societies. The complex care demands of HF patients require multidisciplinary approaches, aligning with contemporary guidelines. Accordingly, the Excellence in Heart Failure Program, implemented in Portuguese tertiary hospitals, aims to establish multidisciplinary HF outpatient clinics in Portugal, improving patients’ clinical outcomes. Herein, the results of its pilot project are presented, showing that the implementation of the multidisciplinary clinic resulted in a minimal number of hospitalizations and emergency visits, with only one rehospitalization reported. In addition, patients in the Program experienced significant improvements in ejection fraction (EF) and NT-proBNP levels. Despite the limited power of the sample, these findings underscore the effectiveness of the Program in the management of Portuguese HF patients, particularly in the early discharge period after heart failure, when patients are most vulnerable.

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“…The study’s subgroups analysis for the composite primary endpoint amazingly addressed female gender (RR 0.73: CI 0.58–0.90) and patients with LVEF ≤ 57% (RR 0.78: CI 0.64–0.95). The benefit size in both subgroups was comparable to that achieved by the HFrEF population investigated in the PARADIGM HF study (RR 0.79: CI 0.71–0.89) [ 20 ], highlighting that a normal LVEF does not address the absence of systolic dysfunction and that the female gender reacts differently to medical therapy, probably due to heart reverse remodeling capability [ 21 , 22 ].…”

Section: Critical Analysis Of Hfpef Trials Based On Lvef Thresholdmentioning

confidence: 72%

Does the Measurement of Ejection Fraction Still Make Sense in the HFpEF Framework? What Recent Trials Suggest

Palazzuoli

Correale²,

Iacoviello³

et al. 2023

JCM

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Left ventricular ejection fraction (LVEF) is universally accepted as a cardiac systolic function index and it provides intuitive interpretation of cardiac performance. Over the last two decades, it has erroneously become the leading feature used by clinicians to characterize the left ventricular function in heart failure (HF). Notably, LVEF sets the basis for structural and functional HF phenotype classification in current guidelines. However, its diagnostic and prognostic role in patients with preserved or mildly reduced contractile function is less clear. This is related to several concerns due to intrinsic technical, methodological and hemodynamic limitations entailed in LVEF measurement that do not describe the chamber’s real contractile performance as expressed by pressure volume loop relationship. In patients with HF and preserved ejection fraction (HFpEF), it does not reflect the effective systolic function because it is prone to preload and afterload variability and it does not account for both longitudinal and torsional contraction. Moreover, a repetitive measurement could be assessed over time to better identify HF progression related to natural evolution of disease and to the treatment response. Current gaps may partially explain the causes of negative or neutral effects of traditional medical agents observed in HFpEF. Nevertheless, recent pooled analysis has evidenced the positive effects of new therapies across the LVEF range, suggesting a potential role irrespective of functional status. Additionally, a more detailed analysis of randomized trials suggests that patients with higher LVEF show a risk reduction strictly related to overall cardiovascular (CV) events; on the other hand, patients experiencing lower LVEF values have a decrease in HF-related events. The current paper reports the main limitations and shortcomings in LVEF assessment, with specific focus on patients affected by HFpEF, and it suggests alternative measurements better reflecting the real hemodynamic status. Future investigations may elucidate whether the development of non-invasive stroke volume and longitudinal function measurements could be extensively applied in clinical trials for better phenotyping and screening of HFpEF patients.

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

Cited by 7 publications

References 39 publications

Trajectories and determinants of left ventricular ejection fraction after the first myocardial infarction in the current era of primary coronary interventions

Trajectories and determinants of left ventricular ejection fraction after the first myocardial infarction in the current era of primary coronary interventions

Excellence in Heart Failure: A Multidisciplinary Program on Heart Failure Management for Improved Patient Outcome

Does the Measurement of Ejection Fraction Still Make Sense in the HFpEF Framework? What Recent Trials Suggest

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