Prognosis and diastolic dysfunction predictors in patients with heart failure and recovered ejection fraction

Abstract

There is limited data on whether diastolic dysfunction in patients with heart failure (HF) and recovered ejection fraction (HFrecEF) is associated with worse prognosis. We retrospectively assessed 96 patients diagnosed with HFrecEF and created ROC curve of their diastolic function at the 1-year follow-up for the composite endpoint of cardiovascular death and HF readmission after the follow-up. Eligible patients were divided into two groups according to the cutoff value of E/e′ ratio (12.1) with the highest AUC (0.70). Kaplan–Meier analysis showed that HFrecEF with high E/e′ group had a significantly poorer prognosis than the low E/e′ group (log-rank, p = 0.01). Multivariate Cox regression analysis revealed that the high E/e′ group was significantly related to the composite endpoint (hazard ratio 5.45, 95% confidence interval [CI] 1.23–24.1). The independent predictors at discharge for high E/e′ ratio at the 1-year follow-up were older age and female sex after adjustment for covariates (odds ratio [OR] 1.07, 95% CI 1.01–1.13 and OR 4.70, 95% CI 1.08–20.5). In conclusion, HFrecEF with high E/e′ ratio might be associated with a poor prognosis. Older age and female sex were independent predictors for a sustained high E/e′ ratio in patients with HFrecEF.

Incremental prognostic value of speckle tracking echocardiography and early follow‐up echo assessment in predicting left ventricular recovery after reperfusion for ST‐segment elevation myocardial infarction (STEMI)

“…51,52 Others categorize E/e' as a powerful predictor of prognosis in patients with HF and recovered EF, poorer survival, and HF hospitalization after acute MI. [53][54][55] In the current study, MACE was mainly driven by heart failure hospitalisation, which is directly related to elevated E/e' that reflects raised LV filling pressures and diastolic dysfunction thus explaining the high propensity for HF hospitalisation in the non-recovery group.…”

Factors Associated With Maintenance of an Improved Ejection Fraction: An Echocardiogram‐Based Registry Study

“…First, prior studies required a single demonstration of improvement in EF with minimal follow up to confirm the patients continued to stay in the HFimpEF category. 6 , 7 , 9 , 11 , 12 , 16 , 19 , 20 , 21 , 22 Those more likely to originally improve the LV function have a growing body of research identifying the unique demographic and medical profile associated with HFimpEF. 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 16 , 17 , 18 , 19 , 20 , 21 , 22 We assessed longitudinally if those predictive factors remained the same over time or if certain prior comorbidities may be particularly harmful after the demonstration of reverse cardiac remodeling.…”

“… 6 , 7 , 9 , 11 , 12 , 16 , 19 , 20 , 21 , 22 Those more likely to originally improve the LV function have a growing body of research identifying the unique demographic and medical profile associated with HFimpEF. 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 16 , 17 , 18 , 19 , 20 , 21 , 22 We assessed longitudinally if those predictive factors remained the same over time or if certain prior comorbidities may be particularly harmful after the demonstration of reverse cardiac remodeling. Similar to others, we identified specific patient characteristics associated with a HFimpEF, including sex, race, and indicators of ischemic damage.…”

“… 9 , 10 , 11 Evidence to date suggests that younger age, female sex, and the lack of history of ischemic heart disease have all been associated with initial improvement in EF. 12 , 13 However, factors associated with maintenance of an improved LVEF remain largely unknown.…”

Your Heart Function Has Normalized—What Next After TRED-HF?

“…A recent retrospective study in 699 patients reported that left atrial reverse remodeling, defined as > 15% reduction in the left atrial end-systolic volume, was observed in ~ 60% of patients with improved LVEF and was associated with a lower risk of cardiovascular death and hospitalization [ 51 ]. In a small study of 96 patients with HFimpEF, diastolic dysfunction, defined as an elevated E/E′ (> 12.1), was associated with a higher risk of a similar endpoint [ 52 ].…”