Recovered Left Ventricular Ejection Fraction and Its Prognostic Impacts in Hospitalized Heart Failure Patients with Reduced Ejection Fraction

Abstract

It has been recently recognized that recovery of left ventricular ejection fraction (EF), termed "recovered EF", occurs in a proportion of heart failure patients with reduced EF (HFrEF), and is associated with better prognosis. However, the clinical characteristics of "recovered EF" have not been fully examined. Consecutive 567 patients hospitalized due to HFrEF (EF < 40% at 1st assessment at hospital discharge) were enrolled, and EF was reassessed within half a year in an outpatient setting (2nd assessment). Among these HFrEF patients, 235 remained EF < 40% (reduced, rEF group), 82 changed to EF 40-49% (midrange, mrEF group), and 250 recovered to EF > 50% (preserved, pEF group "recovered EF") at the 2nd examination. Age was lower and body mass index and systolic blood pressure were higher in pEF than in rEF. The prevalence of atrial fibrillation (AF) and usage of an implantable cardiac defibrillator and cardiac resynchronization therapy were highest in pEF. Left ventricular end diastolic dimension (LVDd) was the smallest in the pEF group. Multivariable logistic regression analysis revealed that younger age, presence of AF, and lower levels of LVDd were predictors of "recovered EF". Kaplan-Meier analysis found that pEF presented the lowest cardiac event rate (P = 0.003) and all-cause mortality (P = 0.001). In multivariable Cox proportional hazard analyses, pEF (versus rEF) was an independent predictor of both cardiac event rate (HR = 0.668, 95%CI 0.450-0.994, P = 0.046) and all-cause mortality (HR = 0.655, 95%CI 0.459-0.934, P = 0.019). Hospitalized HFrEF patients with recovered EF are associated with younger age, higher presence of AF, and better prognosis.

Body Mass Index: An Effective Predictor of Ejection Fraction Improvement in Heart Failure

“…A meta-analysis of 48 studies found that age, renal function, EF, and BMI are strong predictors of HF mortality ( 30 ). Additionally, it has been shown that BMIs are higher in HFrecEF patients, which is consistent with our observations ( 31 ). However, none of these studies assessed the entire range of BMI values or BMI classifications and how the BMI influenced EF changes.…”

Predictors and Mortality for Worsening Left Ventricular Ejection Fraction in Patients With HFpEF

“…In this study, higher baseline LVEDD is validated as an independent predictor of early worsening LVEF occurring 3 to 12 months after discharge. Recently, Abe et al indicated that LVEDD was an independent predictor of recovered LVEF, defined as LVEF < 40% during hospitalization with progression to > 50% after a mean follow-up of 4 months ( 17 ). This proves finding supports the idea that LVEDD is related to LVEF trajectory in patients with HF.…”

Reverse Remodeling in Human Heart Failure after Cardiac Resynchronization Therapy Is Associated With Reduced RHO-Kinase Activation

“…LV reverse remodeling correlates with long-term prognosis in patients hospitalized with decompensated HFrEF and LVEF <40% at hospital discharge (Abe et al, 2020;Maki and Takeda, 2020). After 4 months of follow-up, LVEF normalizes or recovers to midrange in nearly 60% of patients.…”

“…After 4 months of follow-up, LVEF normalizes or recovers to midrange in nearly 60% of patients. These changes are associated with significantly lower cardiac event rates and all-cause mortality and correlate with younger age, absence of atrial fibrillation, smaller LV diastolic diameter, and higher LVEF at first discharge (Abe et al, 2020). In previous clinical trials of HFrEF, patients receiving betablockers, angiotensin converting enzyme inhibitors (ACEIs), angiotensin II type 1 receptor blockers (ARBs), or ivabradine, LVEF has improved by 2-12% over the course of 5-20 months (Tardif et al, 2011;Sze and Daubert, 2018;Maki and Takeda, 2020).…”