Key result
Full LVEF improvement is linked to ~64% lower cardiorenal event risk vs nonimprovement.
Why the study?
The detailed relationship between the extent of LVEF improvement and the risks of adverse cardiorenal events in heart failure with reduced EF remained unclear.
Does the magnitude of LVEF improvement reduce the risk of adverse cardiorenal events in patients with HFrEF?
Cohort (n=601)
No
Does the magnitude of LVEF improvement reduce the risk of adverse cardiorenal events in patients with HFrEF?
Hazard Ratio: 0.36 (95% CI 0.2–0.63)
Absolute Event Rate: 20.2% vs 37.5%
p-value: p=<0.001
In patients with HFrEF, full LVEF improvement (>40% and ≥20% absolute increase) is associated with significantly lower risks of mortality, MACE, and MAKE compared to nonimprovement.
Full LVEF improvement was associated with lower cardiorenal risk; extends prior observations but leaves open causal confirmation in trials.
BACKGROUND: Improvement in left ventricular ejection fraction (LVEF) aligns with better outcomes in patients with heart failure with reduced EF. Nonetheless, detailed relationship between the extent of LVEF improvement and the risks of adverse cardiorenal events remains unclear. METHODS: From 2011 to 2021, a retrospective cohort of 601 patients with heart failure with reduced EF who underwent follow-up echocardiography within 6 months was enrolled and followed until March 31, 2022. Patients were classified as nonimprovement (follow-up LVEF ≤40% or <10% absolute LVEF improvement), partial improvement (follow-up LVEF >40% with 10% to <20% improvement), or full improvement (follow-up LVEF >40% and ≥20% improvement). Multivariable Cox regression was used to estimate associations between LVEF improvement and the composite and individual risks of all-cause mortality, major adverse cardiovascular events, and major adverse kidney events. RESULTS: Over a median follow-up of 2.62 years, 67 deaths, 121 major adverse cardiovascular events, and 100 major adverse kidney events occurred. Compared with the nonimprovement group, only the full-improvement group was independently associated with lower risks of the composite outcome (adjusted hazard ratio [aHR], 0.36 [95% CI, 0.20-0.63]), major adverse cardiovascular events (aHR, 0.33 [95% CI, 0.18-0.61]), and major adverse kidney events (aHR, 0.39 [95% CI, 0.19-0.82]). Graded associations between LVEF improvement and decreased cardiorenal risks were confirmed in spline analyses and consistent across subgroup and sensitivity analyses. Maintenance of improved LVEF for 1 year was further associated with lower risks for the adverse cardiorenal outcomes. CONCLUSIONS: Greater and sustained LVEF improvement is linked to lower risks of cardiorenal events in heart failure with reduced EF, emphasizing the value of incorporating improvement magnitude into risk assessment.
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Lai et al. (2026) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=601). Full improvement in left ventricular ejection fraction (≥20% absolute improvement) vs. Nonimprovement in left ventricular ejection fraction (≤40% or <10% absolute improvement) was evaluated on Composite of all-cause mortality, major adverse cardiovascular events (MACE), and major adverse kidney events (MAKE) (HR 0.36, 95% CI 0.20-0.63, p=<0.001). Full improvement in left ventricular ejection fraction (≥20% absolute increase) was associated with a 64% lower risk of composite adverse cardiorenal events compared to nonimprovement (HR 0.36).
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