Left Ventricular Ejection Fraction (EF) of 55% as Cutoff for Late Transition From Heart Failure (HF) With Preserved EF to HF With Mildly Reduced EF

Abstract

Background: Heart failure (HF) with preserved (HFpEF) left ventricular ejection fraction (LVEF) is a syndrome with complex pathophysiology. Little is known about changes in LVEF that occur over time in HFpEF patients. A fundamental clinical question about HFpEF is whether HFpEF is an early manifestation of HF with reduced LVEF (HFrEF). If so, which patients with HFpEF are likely to show a decline in LVEF to less than 50%? The aim of the present study was to examine longitudinal changes in LVEF in patients with HFpEF. Methods and Results:Among 279 consecutive HFpEF patients admitted as emergencies, we examined 100 who underwent echocardiography at least 1 year after discharge. EF >50% was used as the definition of HFpEF. During a mean duration from hospitalization to follow-up echocardiography of 31.5 months, 11% of patients had LVEF ≤50% (mildly reduced LVEF), known as mildly reduced (HFmrEF). The utility of LVEF during hospitalization to predict HFmrEF was assessed with receiver-operating characteristic curve analysis. A cutoff value of 55% had sensitivity of 90.9% and specificity of 97.7%. Logistic regression analysis indicated that LVEF ≤55% and ischemic etiology were strong predictors of progression from HFpEF to HFmrEF (odds ratio [OR] 435, 95% confidence interval [CI] 52.65-10,614, P<0.0001 and OR 10.9, 95% CI 2.60-74.80, P=0.0007, respectively). Conclusions:The present study suggests that HFpEF patients with LVEF ≤55% may progress to HFmrEF in the future. (Circ J 2015; 79: 2209 -2215

The prognostic value of brain natriuretic peptide in patients with heart failure and left ventricular ejection fraction higher than 60%: a sub‐analysis of the J‐MELODIC study

“…This is consistent with the results in our study. In addition, Ueda et al 19. concluded that LVEF ≤ 55% in patients with HFpEF (LVEF > 50%) was significantly associated with a decrease in LVEF to below 50% during a mean follow‐up period of 31.5 ± 17.0 months.…”

“…Specifically, we found that the characteristics of patients in the HFrhEF and HFrEF groups were less similar than the characteristics of the HFrlEF and HFrEF groups. Ueda et al 19 demonstrated that patients with HFpEF and LVEF >55% were significantly less likely to have ischaemic heart disease as an aetiology of HF compared with those with HF and 50% < LVEF ≤ 55%. This is consistent with the results in our study.…”

Impact of Mitral Annular Displacement on Left Ventricular Diastolic Function Improvement After Transcatheter Aortic Valve Implantation

“…We also excluded 33 patients with LV ejection fraction (EF) ≤55% to simply clarify the effect of TAVI on DF. 12 The remaining 98 patients eligible for analysis formed the study group.…”

Diastolic heart failure

“…However, using newer diagnostic techniques of myocardial deformation, several studies have shown subtle changes in systolic function including reduced longitudinal strain, impaired systolic twist, torsional dyssynchrony, and reduced myocardial systolic reserve [11]. Also, there is recent evidence that there is slow but progressive decline in ejection fraction in patients with DHF; therefore, these patients will eventually be diagnosed with heart failure with reduced ejection fraction [12,13]. Dunlay et al showed that in patients with DHF, on an average, ejection fraction decreased by 5.8% over 5 years with greater declines in older individuals and in those with coronary artery disease.…”