Variability of left ventricular ejection fraction in cardiovascular patients with and without heart failure

Introduction Heart failure (HF) with improved ejection fraction (HFimpEF) was shown to be related with improved outcome but increase of left ventricular ejection fraction (LVEF) in patients without HF is of less known clinical significance. Purpose The aim of the study was to evaluate long-term prognosis in patients with different cardiovascular disorders, with and without HF, depending on temporal variations of LVEF. Methods The study covered 31 920 patients (median age 71 years, 37.7% females) with different cardiovascular disorders and at least two measurements of LVEF separated by ≥1 month. Clinical parameters were acquired from database of Academic Repository of Clinical Cases of Medical University of Silesia. HFimpEF was defined by LVEF increase ≥10% in HF patients in relation to baseline value. The primary endpoint was all-cause mortality. Results The median follow-up time was 51.5 months and LVEF was measured median 2 times. HF was diagnosed in 12 152 patients (38.1%), of which 2 843 (23.4%) experienced HFimpEF. Mortality was greater in HF than non-HF patients (11.4% vs. 3.6%, p<0.001). In patients with HF, Kaplan-Meier survival curves showed significantly lower mortality in HFimpEF than in stable and decreased LVEF (Figure; 9.1% vs. 11.0% vs. 24.5%; log-rank p=0.029 and p<0.001) and HFimpEF constituted one of independent predictors of mortality (HR=0.72, 95% CI:0.63-0.82). Conversely, in non-HF population patients with LVEF improvement had higher mortality than patients with stable LVEF and lower than deteriorating LVEF (Figure; 4.8% vs. 3.2% vs. 15.0%; log-rank p=0.001 and p<0.001) and LVEF improvement was not associated with survival. Conclusions Temporal increase of LVEF corresponds with improved survival in patients with HF but not among non-HF patients.