February 28, 2026Open Access

Relationship Between Baseline Ejection Fraction, Pharmacotherapy Initiation, and Subsequent Natriuretic Peptide Levels in Heart Failure With Recovered Ejection Fraction

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure with recovered ejection fraction (HFrecEF) (n=1500). Intervention: Higher baseline LVEF (Tertile 3: 39-40%) vs. Lower baseline LVEF (Tertile 1: 5-30%). Primary outcome: NT-proBNP levels measured at the time of LVEF recovery (Percent difference 80.1%, 95% CI 52.5-112.7).

Key Result

Higher baseline LVEF (39-40%) at HFrEF diagnosis was independently associated with an 80.1% higher NT-proBNP level at LVEF recovery compared to lower baseline LVEF (5-30%).

Study Design

Type

Cohort (n=1,500)

Multicenter

Structured PICO

Population

1,500 patients with HFrEF (LVEF ≤40%) from 2009 to 2024 who achieved LVEF recovery (LVEF ≥50%) and had available NT-proBNP data at the time of LVEF recovery, median age 67, 47.7% female, US-based (Cleveland Clinic).

Outcome

NT-proBNP levels measured at the time of LVEF recoverysurrogate

Patients with a higher baseline LVEF at HFrEF diagnosis paradoxically have higher NT-proBNP levels at the time of LVEF recovery, potentially due to lower initiation and utilization of guideline-directed medical therapy.

Main Result

Effect estimate: Percent difference 80.1% (95% CI 52.5-112.7)

Limitations

Selection bias due to exclusion of patients who did not have complete data for baseline covariates
Ascertainment bias due to irregularly spaced measurements
Lack of etiology data precluding adjustment for this variable
Lack of data regarding heart failure stage or class
Lack of dosage data for GDMT
Relatively long study period which may introduce heterogeneity given advances in GDMT over time

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Cite This Study

Kodur et al. (Sun,) conducted a cohort in Heart failure with recovered ejection fraction (HFrecEF) (n=1,500). Higher baseline LVEF (Tertile 3: 39-40%) vs. Lower baseline LVEF (Tertile 1: 5-30%) was evaluated on NT-proBNP levels measured at the time of LVEF recovery (Percent difference 80.1%, 95% CI 52.5-112.7). Higher baseline LVEF (39-40%) at HFrEF diagnosis was independently associated with an 80.1% higher NT-proBNP level at LVEF recovery compared to lower baseline LVEF (5-30%).

synapsesocial.com/papers/6a025a859cddff7633412d0f https://doi.org/https://doi.org/10.1016/j.yjcafi.2026.02.011