Key result
Recovered ejection fraction (EF ≥ 50%) independently predicted a lower risk of all-cause mortality (HR 0.655) and cardiac events compared to persistently reduced ejection fraction in hospitalized HFrEF patients.
Why the study?
Recovery of left ventricular EF occurs in some HFrEF patients and is linked to better outcomes, but its clinical characteristics have not been fully examined.
Does recovered EF to >50% improve cardiac event rate and all-cause mortality in hospitalized HFrEF patients compared to those who remain EF <40%?
Observational (n=567)
No
Does recovered EF to >50% improve cardiac event rate and all-cause mortality in hospitalized HFrEF patients compared to those who remain EF <40%?
Hazard Ratio: 0.655 (95% CI 0.459–0.934)
p-value: p=0.019
In hospitalized HFrEF patients, recovery of EF to >50% within half a year is associated with significantly lower risks of cardiac events and all-cause mortality compared to persistent HFrEF.
Recovered EF identifies lower-risk hospitalized HFrEF patients; supports prognostic stratification yet leaves open whether targeted interventions improve outcomes.
It has been recently recognized that recovery of left ventricular ejection fraction (EF), termed "recovered EF", occurs in a proportion of heart failure patients with reduced EF (HFrEF), and is associated with better prognosis. However, the clinical characteristics of "recovered EF" have not been fully examined.Consecutive 567 patients hospitalized due to HFrEF (EF < 40% at 1st assessment at hospital discharge) were enrolled, and EF was re-assessed within half a year in an outpatient setting (2nd assessment). Among these HFrEF patients, 235 remained EF < 40% (reduced, rEF group), 82 changed to EF 40-49% (midrange, mrEF group), and 250 recovered to EF > 50% (preserved, pEF group "recovered EF" ) at the 2nd examination. Age was lower and body mass index and systolic blood pressure were higher in pEF than in rEF. The prevalence of atrial fibrillation (AF) and usage of an implantable cardiac defibrillator and cardiac resynchronization therapy were highest in pEF. Left ventricular end diastolic dimension (LVDd) was the smallest in the pEF group. Multivariable logistic regression analysis revealed that younger age, presence of AF, and lower levels of LVDd were predictors of "recovered EF". Kaplan-Meier analysis found that pEF presented the lowest cardiac event rate (P = 0.003) and all-cause mortality (P = 0.001). In multivariable Cox proportional hazard analyses, pEF (versus rEF) was an independent predictor of both cardiac event rate (HR = 0.668, 95%CI 0.450-0.994, P = 0.046) and all-cause mortality (HR = 0.655, 95%CI 0.459-0.934, P = 0.019).Hospitalized HFrEF patients with recovered EF are associated with younger age, higher presence of AF, and better prognosis.
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Abe et al. (2020) conducted an observational in Heart Failure with Reduced Ejection Fraction (HFrEF) (n=567). Recovered ejection fraction (EF ≥ 50%) vs. Persistently reduced ejection fraction (EF < 40%) was evaluated on All-cause mortality (HR 0.655, 95% CI 0.459-0.934, p=0.019). Recovered ejection fraction (EF ≥ 50%) independently predicted a lower risk of all-cause mortality (HR 0.655) and cardiac events compared to persistently reduced ejection fraction in hospitalized HFrEF patients.
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