Prevalence and Prognosis of HFimpEF Developed From Patients With Heart Failure With Reduced Ejection Fraction: Systematic Review and Meta-Analysis

He, Yibo; Ling, Yihui; Guo, Wei; Li, Qiang; Yu, Sijia; Huang, Haozhang; Zhang, Rongting; Gong, Zhijun; Liu, Jiaxuan; Mo, Liyi; Yi, Shixin; Lai, Disheng; Yao, Younan; Liu, Jin; Chen, Jiyan; Liu, Yong

doi:10.3389/fcvm.2021.757596

Cited by 34 publications

(31 citation statements)

References 38 publications

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“…We found that 34.7% of our patients with non‐HFimpEF evolved to HFimpEF. In the meta‐analysis performed by He et al ., 37 the pooled prevalence of HFimpEF was only 22.64%, although it ranged from 10 to 52%.…”

Section: Discussionmentioning

confidence: 97%

Quality of life in patients with heart failure and improved ejection fraction: one‐year changes and prognosis

et al. 2022

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Aims The criteria for patients with heart failure (HF) and improved ejection fraction (HFimpEF) are a baseline left ventricular ejection fraction (LVEF) ≤40%, a ≥10‐point increase from baseline LVEF, and a second LVEF measurement >40%. We aimed to (i) assess patients with HF and reduced LVEF (HFrEF) at baseline and compare quality of life (QoL) changes between those that fulfilled and those that did not fulfil the HFimpEF criteria 1 year later and (ii) assess the prognostic role of QoL in patients with HFimpEF. Methods We reviewed data from a prospective registry of real‐world outpatients with HF that were assessed for LVEF and QoL at a first visit to the HF clinic and 1 year later. QoL was evaluated with the Minnesota Living with Heart Failure Questionnaire (MLWHFQ). The primary prognostic endpoint was the composite of all‐cause death or HF hospitalization. Results Baseline and 1‐year LVEF and MLWFQ scores were available for 1040 patients with an initial LVEF ≤40% (mean age, 65.2 ± 11.7 years; 75.9% men). The main aetiology was ischaemic heart disease (52.9%), and patients were mostly in New York heart Association Classes II (71.1%) and III (21.6%). At baseline, the mean LVEF was 28.5% ± 7.3, and the mean MLWHFQ score was 30.2 ± 19.5. After 1 year, the mean LVEF increased to 38.0% ± 12.2, and the MLWHFQ scores improved to 17.4 ± 16.0. In 361 patients that fulfilled the HFimpEF criteria (34.7%), significant improvements were observed in both LVEF (from 28.7% ± 6.6 to 50.9% ± 7.6, P < 0.001) and QoL (from 32.9 ± 20.6 to 16.9 ± 16.0, P < 0.001). Patients that did not fulfil the HFimpEF criteria also showed significant improvements in LVEF (from 28.4% ± 7.6 to 31.1% ± 7.9, P < 0.001) and QoL (from 28.7 ± 18.8 to 17.6 ± 15.9, P < 0.001). However, the QoL improvement was significantly higher in the HFimpEF group (−16.0 ± 23.8 vs. −11.1 ± 20.3, P = 0.001), despite the worse mean baseline MLWHFQ score, compared with the non‐HFimpEF group (P = 0.001). The 1‐year QoL was similar between groups (P = 0.50). The 1‐year MLWHFQ score was independently associated with outcomes; the hazard ratio for the composite endpoint was 1.02 (95% CI: 1.01–1.03, P = 0.006). In contrast, the QoL improvement (with a cut‐off ≥5 points) was not independently associated with the composite outcome. Conclusions Patients with HFrEF showed improved QoL after 1 year, regardless of whether they met the HFimpEF criteria. The similar 1‐year QoL perception between groups suggested that factors other than LVEF influenced QoL perception. The 1‐year QoL was superior to the QoL change from baseline for predicting prognosis in patients with HFimpEF.

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Section: Discussionmentioning

confidence: 97%

Quality of life in patients with heart failure and improved ejection fraction: one‐year changes and prognosis

et al. 2022

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“…In a recent study by Li et al, HFimpEF, defined as an absolute increase in LVEF by 10% (regardless of baseline value), was found in 41.2% of cases [ 23 ]. In a recent meta-analysis by He et al performed on 9491 patients from nine studies, HFimpEF was present in 22.6% of patients [ 24 ]. All in all, the prevalence of HFimpEF varies from roughly 10 to 40% [ 9 ].…”

Section: Definition Of Hfimpefmentioning

confidence: 99%

“…A meta-analysis by Jorgensen et al also delivered evidence that a lower baseline LV end-diastolic diameter (LVEDD) is associated with a greater rate of HFimpEF [ 11 ]. Other studies identified a younger age, beta-blocker use, a valid indication for pulmonary vein isolation or CRT implantation, as well as chemotherapy cardiotoxicity among patients with malignant neoplasm, troponin levels within the reference value and elevated natriuretic peptides as independent predictors of HFimpEF [ 23 , 24 , 25 , 26 ]. In addition, convincing data suggests that baseline GLS accurately predicts future variations in LVEF, indicating that GLS is a more reliable and stable in-time parameter of systolic function [ 16 ].…”

Section: Definition Of Hfimpefmentioning

confidence: 99%

“…Despite numerous predictors of HF outcome, such as LVEF, symptomatic class, frequent hospitalization for decompensated HF or the level of natriuretic peptides, the prognosis of HF remains vastly unfavourable and uncertain. The phenomenon of LVEF improvement identifies a subset of patients with a distinct set of phenotypes from patients with stable or declining LVEF [ 13 ], which is linked to better survival than patients with stable or declining LVEF [ 8 , 11 , 12 , 13 , 22 , 23 , 24 , 26 ].…”

Section: Definition Of Hfimpefmentioning

confidence: 99%

“…These results comply with recent observational studies from Asia, which also showed a lower all-cause mortality and risk of hospitalization for HF among patients with HFimpEF [ 22 , 23 ]. These findings were also summarized in the meta-analysis by He et al comprising nine studies with 9491 participants, which delivered evidence for a significantly lower risk of hospitalization for HF and death among HFimpEF patients in comparison to both HFrEF (mortality: HR: 0.44, 95% CI: 0.33–0.60; hospitalization for HF: HR: 0.40, 95% CI: 0.20–0.82) and, surprisingly, HFpEF patients (mortality: HR: 0.42, 95% CI: 0.32–0.55; hospitalization for HF: HR: 0.73, 95% CI: 0.58–0.92) [ 24 ].…”

Section: Definition Of Hfimpefmentioning

confidence: 99%

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Heart Failure with Improved Ejection Fraction: Insight into the Variable Nature of Left Ventricular Systolic Function

Wybraniec

Orszulak

Męcka

et al. 2022

IJERPH

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The progress of contemporary cardiovascular therapy has led to improved survival in patients with myocardial disease. However, the development of heart failure (HF) represents a common clinical challenge, regardless of the underlying myocardial pathology, due to the severely impaired quality of life and increased mortality comparable with malignant neoplasms. Left ventricular ejection fraction (LVEF) is the main index of systolic function and a key predictor of mortality among HF patients, hence its improvement represents the main indicator of response to instituted therapy. The introduction of complex pharmacotherapy for HF, increased availability of cardiac-implantable electronic devices and advances in the management of secondary causes of HF, including arrhythmia-induced cardiomyopathy, have led to significant increase in the proportion of patients with prominent improvement or even normalization of LVEF, paving the way for the identification of a new subgroup of HF with an improved ejection fraction (HFimpEF). Accumulating data has indicated that these patients share far better long-term prognoses than patients with stable or worsening LVEF. Due to diverse HF aetiology, the prevalence of HFimpEF ranges from roughly 10 to 40%, while the search for reliable predictors and genetic associations corresponding with this clinical presentation is under way. As contemporary guidelines focus mainly on the management of HF patients with clearly defined LVEF, the present review aimed to characterize the definition, epidemiology, predictors, clinical significance and principles of therapy of patients with HFimpEF.

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Incidence and predictors of heart failure with improved ejection fraction category in a HFrEF patient population

Solymossi,

Muk,

Sepp

et al. 2023

ESC Heart Failure

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AimsThe aim of the study was to assess the incidence and predictive factors of the development of heart failure with improved ejection fraction (HFimpEF) category during a 1 year follow‐up period in a heart failure with reduced ejection fraction (HFrEF) patient population managed in a heart failure outpatient clinic.Methods and resultsThe study evaluated data from patients enrolled in the Hungarian Heart Failure Registry (HHFR). The incidence and predictive factors of the development of the HFimpEF category after 1 year follow‐up were assessed in the group of patients who had HFrEF at baseline. We evaluated the incidence and predictors of the development of HFimpEF after a 1 year follow‐up in relation to time since diagnosis of HFrEF in patients diagnosed within 3 months, between 3 months and 1 year, and beyond 1 year. The predictive factors of the development of HFimpEF were analysed using univariate and multivariate logistic regression analysis. Of the 833 HFrEF patients enrolled in the HHFR, the development of HFimpEF was observed in 162 patients (19.5%) during 1 year follow‐up. In the whole patient population, independent predictors of the development of HFimpEF were female gender [odds ratio (OR): 1.73; 95% confidence interval (CI): 1.01–2.96; P < 0.05], non‐ischaemic aetiology (OR: 1.95; 95% CI: 1.15–3.30; P < 0.05), and left ventricular end‐diastolic diameter (LVEDD) <60 mm (OR: 2.04; 95% CI: 1.18–3.51; P < 0.05). The 1 year incidence of HFimpEF decreased in relation to time since diagnosis of HFrEF. The incidence of HFimpEF was 27.1% in patients diagnosed within 3 months, 18.4% in patients diagnosed between 3 months and 1 year, and 12.2% in patients diagnosed beyond 1 year. Non‐ischaemic aetiology (OR: 4.76; 95% CI: 1.83–12.4; P < 0.01) and QRS width (OR: 0.81; 95% CI: 0.71–0.94; P < 0.01) for patients diagnosed within 3 months, LVEDD (OR: 0.54; 95% CI: 0.32–0.90; P < 0.05) and left atrial diameter ≤45 mm (OR: 5.44; 95% CI: 1.45–20.4; P < 0.05) for patients diagnosed between 3 months and 1 year, and LVEDD < 67 mm (OR: 2.71; 95% CI: 1.07–6.88; P < 0.05) for patients diagnosed beyond 1 year were found to be independent predictive factors.ConclusionsIn our study, in this HFrEF patient population managed in a heart failure outpatient clinic, the 1 year incidence of HFimpEF was found to be ~20%. The 1 year incidence of HFimpEF decreased in relation to time since diagnosis of HFrEF. The most important predictors of the development of HFimpEF were female sex, non‐ischaemic aetiology, narrower QRS width, and smaller diameter of the left ventricle and left atrium.

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Prevalence and Prognosis of HFimpEF Developed From Patients With Heart Failure With Reduced Ejection Fraction: Systematic Review and Meta-Analysis

Cited by 34 publications

References 38 publications

Quality of life in patients with heart failure and improved ejection fraction: one‐year changes and prognosis

Quality of life in patients with heart failure and improved ejection fraction: one‐year changes and prognosis

Heart Failure with Improved Ejection Fraction: Insight into the Variable Nature of Left Ventricular Systolic Function

Incidence and predictors of heart failure with improved ejection fraction category in a HFrEF patient population

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