Background:
Heart
failure with reduced ejection fraction (HFrEF) patients who have improved
ejection fraction have a better prognosis than those with persistently reduced
ejection fraction. This study aimed to analyze the predictors for progression of
patients with HFrEF to heart failure with improved ejection fraction (HFimpEF),
as well as their characteristics and analyze predictors for prognosis.
Methods:
A retrospective analysis was conducted on 1251 patients with
HFrEF at baseline, who also had a second echocardiogram
3 months. After
left ventricular ejection fraction (LVEF) reassessment,
patients were separated into the HFimpEF group (n = 408) and the persistent HFrEF
group (n = 611). The primary endpoint was a composite of cardiovascular death or
heart failure hospitalization.
Results:
Multivariate logistic regression
showed that without history of alcohol consumption (OR: 0.47,
95% CI: 0.28–0.78), non-New York Heart
Association (NYHA) class III–IV (OR: 0.28, 95% CI: 0.15–0.52),
without dilated cardiomyopathy (OR: 0.47, 95% CI: 0.26–0.84),
concomitant hypertension (OR: 1.53, 95% CI: 1.02–2.29),
-blockers use
(OR: 2.29, 95% CI: 1.54–3.43), and lower uric acid (OR: 0.999, 95% CI:
0.997–1.000) could predict LVEF improvement. Kaplan-Meier curves demonstrated
that HFimpEF patients had a significantly lower incidence of adverse events than
HFrEF patients (log Rank
p
0.001). Multivariate
Cox regression found that older age (HR: 1.04, 95% CI: 1.02–1.06), NYHA class
III–IV (HR: 2.25, 95% CI: 1.28–3.95), concomitant valvular heart disease (HR:
1.98, 95% CI: 1.01–3.85), and higher creatinine (HR: 1.003, 95% CI:
1.001–1.004) were independent risk factors for the primary endpoint in HFimpEF
patients.
Conclusions:
HFrEF patients without a
history of alcohol consumption, non-NYHA class III–IV, without
dilated cardiomyopathy, concomitant hypertension,
-blockers use, and lower uric acid
were more likely to have LVEF improvement. Although the prognosis of HFimpEF
patients was better than that of HFrEF patients, older age, NYHA class III–IV,
concomitant valvular heart disease, and higher creatinine were
still risk factors for cardiovascular events in HFimpEF patients.
