Improvement in Left Ventricular Ejection Fraction in Outpatients With Heart Failure With Reduced Ejection Fraction

Abstract

Background: Among patients with heart failure (HF) with reduced ejection fraction (EF), improvements in left ventricular EF (LVEF) are associated with better outcomes and remain an important treatment goal. Patient factors associated with LVEF improvement in routine clinical practice have not been clearly defined. Methods: CHAMP-HF (Change the Management of Patients with Heart Failure) is a prospective registry of outpatients with HF with reduced EF. Assessments of LVEF are recorded when performed for routine care. We analyzed patients with both baseline and ≥1 follow-up LVEF assessments to describe factors associated with LVEF improvement. Results: In CHAMP-HF, 2623 patients had a baseline and follow-up LVEF assessment. The median age was 67 (interquartile range, 58–75) years, 40% had an ischemic cardiomyopathy, and median HF duration was 2.8 years (0.7–6.8). Median LVEF was 30% (23–35), and median change on follow-up was 4% (−2 to −13); 19% of patients had a decrease in LVEF, 31% had no change, 49% had a ≥5% increase, and 34% had a ≥10% increase. In a multivariable model, the following factors were associated with ≥5% LVEF increase: shorter HF duration (odds ratio [OR], 1.21 [95% CI, 1.17–1.25]), no implantable cardioverter defibrillator (OR, 1.46 [95% CI, 1.34–1.55]), lower LVEF (OR, 1.15 [95% CI, 1.10–1.19]), nonischemic cardiomyopathy (OR, 1.24 [95% CI, 1.09–1.36]), and no coronary disease (OR, 1.20 [95% CI, 1.03–1.35]). Conclusions: In a large cohort of outpatients with chronic HF with reduced EF, improvements in LVEF were common. Common baseline cardiac characteristics identified a population that was more likely to respond over time. These data may inform clinical decision making and should be the basis for future research on myocardial recovery.

Rate of Recovery of Left Ventricular Ejection Fraction in a Real-World Population of Patients Receiving a Wearable Cardioverter Defibrillator

“…In our study, 39% of patients had recovery of their EF to ≥ 35-40% within 21 - 60 days of placement of the WCD. In two recent large, retrospective analyses of patients with heart failure, 38% and 34% of patients had recovery of their EF (defined as improvement > 10%) after a waiting period of at least 6 months or 9 weeks, respectively, which is similar to the rate of recovery in our population [ 4 , 5 ]. Previous studies have identified several factors associated with EF recovery, including female sex, younger age, nonischemic cardiomyopathy, lower baseline EF, left ventricle end-diastolic volume, and tricuspid annular plane systolic excursion (TAPSE) [ 4 - 6 ].…”

Myocardial viability evaluation using a novel 99mTc SestaMIBI and low dose Dobutamine infusion technique in high risk Ischemic cardiomyopathy patients – A pilot study

“…While discussing the incremental value of revascularization in ICM patients, various studies have demonstrated the beneficial effect of viable myocardium on outcome after revascularization. Improvement is judged by regional and global LV function that is highlighted in a few studies ( 18 , 19 ). In our study, an improvement in global LV function was confirmed at the 3-month followup, especially in patients with a shorter waiting time for revascularization.…”

The association of improvement in left ventricular ejection fraction with outcomes in patients with heart failure with reduced ejection fraction: data from CHAMP‐HF

“…Instead, post‐enrolment clinical data, including LVEF assessments and clinical events, were reported by sites at designated time points: 30 days and 3, 6, 12, 18, and 24 months. Similar to our prior work, the most recent value of LVEF prior to enrolment was considered the LVEF at the time of enrolment, and when more than one LVEF assessment was available after enrolment, the last recorded value was used 13 . LVEF could have been assessed by multiple imaging modalities including echocardiography, cardiac magnetic resonance imaging, nuclear scan, cardiac catheterization, and computed tomography scan.…”

“…As a sensitivity analysis, we repeated our analysis considering an increase in LVEF of ≥5% to be a clinically relevant improvement. This approach was used in prior studies 13,15 . Enrolled participants also completed the KCCQ‐12 at the same time intervals as the designated data abstraction time points during routine clinical encounters or by telephone interviews.…”

“…The current understanding of the association of baseline LVEF and of degree of improvement in LVEF with outcomes is based primarily on long‐term survival data from randomized clinical trials involving participants with HFrEF 4–12 . We previously described that almost 50% of participants in CHAnge the Management of Patients with Heart Failure (CHAMP‐HF), a large multicentre registry of patients with chronic HFrEF, had an improvement in LVEF over time 13 . There are limited data describing the impact of improvements in LVEF and their association with health status in routine practice.…”