Heart failure with recovered ejection fraction: Clinical characteristics, determinants and prognosis. CARDIOCHUS-CHOP registry

Bermejo, Rosa Agra; Babarro, Eva González; Canoa, J Nicolás López; Román, Alfonso Varela; Otero, Iago; Oro‐Ayude, Marcos; Vazquez, Pablo Parada; Rodríguez, Isabel Gómez; Castro, Olalla; González-Juanatey, José Ramón

doi:10.5603/cj.a2017.0103

Cited by 47 publications

(51 citation statements)

References 29 publications

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“…In the multivariate analysis, carrying an ICD was the only independent variable significantly associated with a lower probability of LVEF recovery (HR 0.25, 95% CI 0.13-0.47, p < 0.0001). This finding has already been observed in previous studies [10,11,20] and may be related to the fact that an ICD is recommended to reduce the risk of sudden death and all-cause mortality in patients with symptomatic HF (NYHA classes II-III) and an LVEF ≤35% despite ≥3 months of optimal medical therapy [5]. Consequently, patients with an ICD in our cohort were more likely to have a diagnosis of chronic HF much earlier in time to the others, thus entailing a lower probability of LVEF recovery.…”

Section: Discussionsupporting

confidence: 89%

“…With respect to the etiology of ventricular dysfunction, previous ischemic heart disease has been associated with a lower probability of ventricular function recovery [7,9,10,20]. In our study, this condition was more common among patients in group NR (57.2 vs. 46.8%), although the difference was not statistically significant.…”

Section: Discussioncontrasting

confidence: 56%

“…Although the benefit of these treatments is unambiguous, the reported rates of LVEF recovery vary (between 19 and 50% depending on the series), in part because of lack of unique criteria. Consequently, the predictors of recovery do not seem to be clearly established [7][8][9][10][11][12], though patients with LVEF recovery have a better prognosis [20]. SV is recommended in patients with LVEF ≤35% and symptomatic HF despite optimized medical treatment in order to reduce morbimortality [5,6].…”

Section: Discussionmentioning

confidence: 99%

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Left Ventricular Ejection Fraction Recovery in Patients with Heart Failure and Reduced Ejection Fraction Treated with Sacubitril/Valsartan

et al. 2020

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Background: A significant number of heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF) experience ventricular function recovery during follow-up. We studied the variables associated with LVEF recovery in patients treated with sacubitril/valsartan (SV) in clinical practice. Methods: We analyzed data from a prospective and multicenter registry including 249 HF outpatients with reduced LVEF who started SV between October 2016 and March 2017. The patients were classified into 2 groups according to LVEF at the end of follow-up (> 35%: group R, or ≤35%: group NR). Results: After a mean follow-up of 7 ± 0.1 months, 62 patients (24.8%) had LVEF > 35%. They were older (71.3 ± 10.8 vs. 67.5 ± 12.1 years, p = 0.025), and suffered more often from hypertension (83.9 vs. 73.8%, p = 0.096) and higher blood pressure before and after SV (both, p < 0.01). They took more often high doses of beta-blockers (30.6 vs. 27.8%, p = 0.002), with a smaller proportion undergoing cardiac resynchronization therapy (14.8 vs. 29.0%, p = 0.028) and fewer implanted cardioverter defibrillators (ICD; 32.8 vs. 67.9%, p < 0.001), this being the only predictive variable of NR in the multivariate analysis (OR 0.26, 95% CI 0.13-0.47, p < 0.0001). At the end of follow-up, the mean LVEF in group R was 41.9 ± 8.1% (vs. 26.3 ± 4.7% in group NR, p < 0.001), with an improvement compared with the initial LVEF of 14.6 ± 10.8% (vs. 0.8 ± 4.5% in group NR, p < 0.0001). Functional class improved in both groups, mainly in group R (p = 0.035), Díez-Villanueva et al. with fewer visits to the emergency department (11.5 vs. 21.6%, p = 0.07). Conclusions: In patients with LVEF ≤35% treated with SV, not carrying an ICD was independently associated with LVEF recovery, which was related to greater improvement in functional class.

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Section: Discussionsupporting

confidence: 89%

Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

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Left Ventricular Ejection Fraction Recovery in Patients with Heart Failure and Reduced Ejection Fraction Treated with Sacubitril/Valsartan

et al. 2020

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“…In addition, the study demonstrated that not carrying an ICD or cardiac resynchronization therapy predicted LVEF recovery. These results are similar to those published by Agra-Bermejo et al [2]. These data may be important before planning device implantation, and require further research to better stratify those HF-recovered patients that do not necessitate an implantable cardioverter defibrillator.…”

supporting

confidence: 88%

“…However, the predictors of recovery do not seem to be clearly established. Agra-Bermejo et al [2] showed that treatment with ACE inhibitors and beta-blockers was an independent predictor of LVEF recovery. The effects of sacubitril-valsartan on LV remodeling have been uncertain.…”

mentioning

confidence: 99%

Sacubitril-Valsartan, a New Opportunity for Heart Failure with Recovered Ejection Fraction?

2020

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Quality of Life in Patients With Heart Failure With Recovered Ejection Fraction

et al. 2021

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Heart failure with recovered ejection fraction (HFrecEF) is a recently recognized phenotype of patients with a history of reduced left ventricular ejection fraction (LVEF) that has subsequently normalized. It is unknown whether such LVEF improvement is associated with improvements in health status.OBJECTIVE To examine changes in health-related quality of life in patients with heart failure with reduced ejection fraction (HFrEF) whose LVEF normalized, compared with those whose LVEF remains reduced and those with HF with preserved EF (HFpEF). DESIGN, SETTING, AND PARTICIPANTSThis prospective cohort study was conducted at a tertiary care hospital from November 2016 to December 2018. Consecutive patients seen in a heart failure clinic who completed patient-reported outcome assessments were included. Clinical data were abstracted from the electronic health record. Data analysis was completed from February to December 2020. MAIN OUTCOMES AND MEASURESChanges in Kansas City Cardiomyopathy Questionnaire overall summary score, Visual Analog Scale score, and Patient-Reported Outcomes Measurement Information System domain scores on physical function, fatigue, depression, and satisfaction with social roles over 1-year follow-up. RESULTSThe study group included 319 patients (mean [SD] age, 60.4 [15.5] years; 120 women [37.6%]). At baseline, 212 patients (66.5%) had HFrEF and 107 (33.5%) had HFpEF. At a median follow-up of 366 (interquartile range, 310-421) days, LVEF had increased to 50% or more in 35 patients with HFrEF (16.5%). Recovery of systolic function was associated with heart failure-associated quality-of-life improvement, such that for each 10% increase in LVEF, the Kansas City Cardiomyopathy Questionnaire score improved by an mean (SD) of 4.8 (1.6) points (P = .003). Recovery of LVEF was also associated with improvement of physical function, satisfaction with social roles, and a reduction in fatigue.CONCLUSIONS AND RELEVANCE Among patients with HFrEF in this study, normalization of left ventricular systolic function was associated with a significant improvement in health-related quality of life.

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Heart failure with recovered ejection fraction: Clinical characteristics, determinants and prognosis. CARDIOCHUS-CHOP registry

Abstract: Patients with HF and reduced LVEF who were re-evaluated after 1 year, had significant improvement in their LVEF and had a more favourable prognosis than HF with preserved and reduced ejection fraction.

Cited by 47 publications

References 29 publications

Left Ventricular Ejection Fraction Recovery in Patients with Heart Failure and Reduced Ejection Fraction Treated with Sacubitril/Valsartan

Left Ventricular Ejection Fraction Recovery in Patients with Heart Failure and Reduced Ejection Fraction Treated with Sacubitril/Valsartan

Sacubitril-Valsartan, a New Opportunity for Heart Failure with Recovered Ejection Fraction?

Quality of Life in Patients With Heart Failure With Recovered Ejection Fraction

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