Normalized LVEF (>50%) at 6 months after acute decompensation for systolic heart failure was associated with lower mortality compared to persistently reduced LVEF (P=0.002).
Cohort (n=633)
Following acute decompensation for systolic heart failure, over half of patients experience significant LVEF improvement by 6 months, which is associated with better 18-month clinical outcomes.
Background Prospective longitudinal follow‐up of left ventricular ejection fraction (LVEF) trajectories after acute cardiac decompensation of heart failure is lacking. We investigated changes in LVEF and covariates at 6‐months' follow‐up in patients with a predischarge LVEF ≤40%, and determined predictors and prognostic implications of LVEF changes through 18‐months' follow‐up. Methods and Results Interdisciplinary Network Heart Failure program participants (n=633) were categorized into subgroups based on LVEF at 6‐months' follow‐up: normalized LVEF (>50%; heart failure with normalized ejection fraction, n=147); midrange LVEF (41%–50%; heart failure with midrange ejection fraction, n=195), or persistently reduced LVEF (≤40%; heart failure with persistently reduced LVEF , n=291). All received guideline‐directed medical therapies. At 6‐months' follow‐up, compared with patients with heart failure with persistently reduced LVEF, heart failure with normalized LVEF or heart failure with midrange LVEF subgroups showed greater reductions in LV end‐diastolic/end‐systolic diameters (both P 50% showing improvements by ≥1 LVEF category. LVEF changes correlated with various parameters, suggesting multilevel reverse remodeling, were predictable from several baseline characteristics, and were associated with clinical outcomes at 18‐months' follow‐up. Repeat hospitalizations were associated with attenuation of reverse remodeling. Registration URL: https://www.controlled‐trials.com ; Unique identifier: ISRCTN23325295.
Albert et al. (Tue,) conducted a cohort in Acute decompensation for systolic heart failure (n=633). Normalized LVEF (>50%) or midrange LVEF (41%-50%) vs. Persistently reduced LVEF (≤40%) was evaluated on Changes in LVEF and covariates at 6-months' follow-up, and prognostic implications through 18-months' follow-up. Normalized LVEF (>50%) at 6 months after acute decompensation for systolic heart failure was associated with lower mortality compared to persistently reduced LVEF (P=0.002).