Key result
Improved LVEF in HFrEF is linked to better functional capacity on CPET with prognostic value.
Why the study?
Cardiopulmonary exercise test has prognostic value in heart failure, but its assessment and prognostic impact in patients with improved LVEF required evaluation.
Does improvement in LVEF (HFimpEF) correlate with improved functional capacity measured by CPET parameters in patients with HFrEF?
Cohort (n=105)
No
Does improvement in LVEF (HFimpEF) correlate with improved functional capacity measured by CPET parameters in patients with HFrEF?
Patients with HFrEF who improve their ejection fraction on optimal medical therapy demonstrate significantly improved functional capacity on cardiopulmonary exercise testing.
Answers are grounded in this paper and cite their sources.
Links LVEF recovery to better CPET capacity in HFrEF; extends prognostic observations but leaves open need for prospective trials.
Introduction and Objectives Patients with heart failure and reduced ejection fraction (HFrEF) who improve or normalize LVEF after guideline-directed medical therapy (GDMT) have an improved prognosis with lower event rates during follow-up. Cardiopulmonary exercise test (CPET) has demonstrated its value as a prognostic tool in the different stages of HF. The aim of this study was to perform an CPET assessment in patients with HF and improved LVEF (HFimpEF) to evaluate its prognostic impact. Methods We retrospectively included 105 patients with a diagnosis of HFrEF (EF<40%) after an admission for HF in our center, who had clinical, analytical, echocardiographic, and CPET data at baseline and at least 6 months of follow-up. The analysis was performed according to whether patients improved their LVEF on the second echocardiogram: HFimpEF or HFprEF (HF with persistently reduced EF). Multivariate models adjusted for baseline characteristics, age and sex were used to compare the results of both groups. Results A total of 105 patients were included, 64 of whom presented HFimpEF (60.9%) and 41 HFprEF (39.1%). There were no statistically significant differences between the two groups. Treatment of both groups was similarly optimized at follow-up: beta-blockers (100% vs 95.3%, p=0.279), ACEI (48.8% vs 31.3%) or ARNI (52.1% vs 65.6%, p=0.129), MRA (80.5% vs 84.4%, p=0.606) and SGLT2i (41.5% vs 51. 6%, p=0.312), except in patients with HFprEF, where there was a higher proportion of patients who had physiological pacing or cardiac resynchronization therapy equivalent pacemakers implanted (45.3% vs. 70.7%, p=0.011). The Table shows the differences in the CPET, echocardiographic and analytical parameters between patients with HFimpEF and HFprEF. Conclusions Patients with HFrEF who improve their ejection fraction after optimal medical treatment, improve their functional capacity, measured by a significant improvement in CPET parameters with proven prognostic value.
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Irache et al. (2025) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=105). Improved LVEF (HFimpEF) vs. Persistently reduced LVEF (HFprEF) was evaluated on Functional capacity measured by CPET parameters. Among 105 patients with HFrEF, 60.9% improved their ejection fraction after optimal medical treatment, which was associated with a significant improvement in functional capacity measured by CPET.
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