Long-Term Functional and Clinical Follow-Up of Patients With Heart Failure With Recovered Left Ventricular Ejection Fraction After β-Blocker Therapy

Abstract

Background-Some patients with left ventricular systolic dysfunction (LVSD) have a dramatic improvement in left ventricular ejection fraction (LVEF) after β-blockade. No study has analyzed the long-term echocardiographic and clinical follow-up of this subgroup of patients. Methods and Results-We included in this analysis 174 consecutive patients with LVSD who had an LVEF≥45% after β-blockade. We performed a long-term echocardiographic follow-up (median 7.7 [4-9.9] years) and clinical follow-up (median 9.2 [7.2-10.8] years). LVEF improved from 33±8% to 54±6% after β-blockade (P<0.0001). At the last echocardiographic evaluation, 26% of the patients had an LVEF<45% (mean±SD: 34±6%), whereas 74% still had an LVEF≥45% (mean±SD: 54±6%). Independent predictors of LVEF deterioration were a low LVEF, a high left ventricular end-diastolic diameter and a low heart rate after β-blockade, and the presence of a complete left bundle-branch block. In the overall study population, survival rates were 90% at 5 years and 75% at 10 years. Cardiovascular death rate was 9%, noncardiovascular death rate was 11%, and unknown death rate was 3%. Patients with subsequent LVEF deterioration had a higher cardiovascular mortality compared with patients with sustained recovered LVEF (22% versus 4%). Conclusions-The long-term survival of patients with LVSD and with near-normal LVEF after β-blockade is good.However, a quarter of these patients may experience a subsequent degradation of LVEF. These patients are at higher risk of cardiovascular mortality. (Circ Heart Fail. 2014;7:434-439.)

Heart Failure With Improved Ejection Fraction: Clinical Characteristics, Correlates of Recovery, and Survival

“…3 In contrast to other reports, 2,3 our subjects with HFiEF had a similar symptom profile compared with subjects with HFrEF and were more likely to be treated with a β-blocker, an agent known to improve EF and long-term survival in HFiEF. 17 New in this study are the findings that patients randomized to valsartan treatment had greater odds of being in the HFiEF group.…”

“…Several available publications have defined the subset of patients with HFpEF who previously had HFrEF as heart failure with recovered ejection fraction 2,3,17 or heart failure with better ejection fraction 4,23 and have been using different EF cut-off points for defining this HF category (≥40%, 2 ≥45%, 17 and ≥50%…”

Improved Long-Term Prognosis of Dilated Cardiomyopathy With Implementation of Evidenced-Based Medication – Report From the CHART Studies –

“…The novel findings of the present study are that (1) 3-year mortality of Japanese DCM patients has recently improved; (2) evidence-based medication for CHF has been implemented in Japan; (3) prevalence of lifestyle comorbidities (eg, hypertension, hyperlipidemia and diabetes mellitus) has been increasing in Japanese DCM patients; and (4) improvement in 25 Furthermore, the present study also showed that the improvement was noted in the subgroup with BNP <220 pg/ml and that with aldosterone antagonist use. Interestingly, β-blocker use was associated with improved mortality in these subgroups, but not in those with BNP ≥220 pg/ml or those without aldosterone antagonist use, although the P-values for interaction were not significant.…”

Heart Failure and Midrange Ejection Fraction

“…However, substantial heterogeneity may exist within HF patients with mid-range LVEF. In particular, this group may include both patients with de novo HF and HF patients with previously reduced LVEF who have recovered their systolic function (3, 8, 9). This fact is clinically relevant because subjects with recovered LVEF have been reported to have more favorable prognosis among HF patients (9).…”