Key result
Lower QRISK3 score and higher baseline LVEF independently predict LVEF recovery in new-onset HFrEF.
Why the study?
Baseline characteristics predictive of LVEF recovery in patients with HFrEF and presumed non-ischaemic aetiology remained to be determined.
Do baseline QRISK3 score and baseline LVEF predict left ventricular function improvement in patients with new-onset HFrEF of presumed non-ischaemic aetiology?
Cohort (n=407)
Do baseline QRISK3 score and baseline LVEF predict left ventricular function improvement in patients with new-onset HFrEF of presumed non-ischaemic aetiology?
In patients with new-onset HFrEF of presumed non-ischaemic aetiology, a higher QRISK3 score and lower baseline LVEF predict a lower likelihood of left ventricular function recovery.
Answers are grounded in this paper and cite their sources.
May refine recovery expectations in new-onset HFrEF; leaves open prospective validation of QRISK3 integration.
OBJECTIVES: To determine baseline characteristics predictive of left ventricular ejection fraction (LVEF) recovery in patients diagnosed with heart failure with reduced ejection fraction (HFrEF) and presumed non-ischaemic aetiology. METHODS: We prospectively recruited patients who were diagnosed with HFrEF (LVEF ≤40%) on echocardiography and subsequently underwent cardiac MRI. Patients were excluded if they had a known history of coronary artery disease (>70% on invasive coronary angiography), myocardial infarction, coronary revascularisation or anginal symptoms. At cardiac MRI assessment, patients were categorised as either ongoing HFrEF or heart failure with improved ejection fraction (HFimpEF, LVEF >40% with ≥10% of absolute improvement). Clinical characteristics were compared between the groups. Logistic regression was performed to identify variables that were associated with LVEF recovery. Optimal cut-offs in QRISK3 score and baseline LVEF for prediction of LVEF recovery were identified through receiver operating characteristic curve analysis. RESULTS: A total of 407 patients were diagnosed with HFrEF, and 139 (34%) attained HFimpEF at cardiac MRI assessment (median 63 days, IQR 41-119 days). Mean age of the patients was 63±12 years, and 260 (63.9%) were male. At multivariate logistic regression, both QRISK3 score (HR 0.978; 95% CI 0.963 to 0.993, p=0.004) and baseline LVEF (HR 1.044; 95% CI 1.015 to 1.073, p=0.002) were independent predictors of HFimpEF. Among patients with baseline LVEF ≤25%, only 22 (21.8%) recovered. In patients with baseline LVEF 25-40%, QRISK3 score >18% was associated with lack of recovery (HR 2.75; 95% CI 1.70 to 4.48, p<0.001). Additionally, QRISK3 score was associated with the presence of ischaemic late gadolinium enhancement (HR 1.035; 95% CI 1.018 to 1.053, p<0.001). CONCLUSIONS: The QRISK3 score helps identify patients with HFrEF with undiagnosed vascular disease. Patients with either a very low baseline LVEF or a high QRISK3 score have less chance of left ventricular recovery and should be prioritised for early cardiac MRI and close monitoring.
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Goh et al. (2023) conducted a cohort in Heart failure with reduced ejection fraction and presumed non-ischaemic aetiology (n=407). QRISK3 score and baseline LVEF was evaluated on Left ventricular ejection fraction recovery (LVEF >40% with ≥10% absolute improvement) (HR 0.978, 95% CI 0.963-0.993, p=0.004). Lower QRISK3 score and higher baseline LVEF independently predicted left ventricular ejection fraction recovery in patients with new-onset HFrEF (QRISK3 HR 0.978; 95% CI 0.963-0.993; p=0.004).
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