Key result
Non-ischaemic aetiology in new-onset HFrEF is linked to ~11-point greater LVEF improvement versus ischaemic HF.
Why the study?
The study aimed to evaluate left ventricular remodelling and long-term prognosis after discharge in pharmacologically managed patients with new-onset acute heart failure with reduced ejection fraction, comparing ischaemic versus non-ischaemic aetiologies.
Does heart failure aetiology (non-ischaemic vs. ischaemic) influence left ventricular remodelling and long-term prognosis in patients with new-onset acute HFrEF discharged on optimal medical therapy?
Cohort (n=111)
No
Does heart failure aetiology (non-ischaemic vs. ischaemic) influence left ventricular remodelling and long-term prognosis in patients with new-onset acute HFrEF discharged on optimal medical therapy?
Patients with severe new-onset acute HFrEF who can be weaned from acute support and discharged on optimal medical therapy have a favourable long-term prognosis (88% LVAD/transplant-free survival at median 4.6 years) and substantial early LV reverse remodelling—particularly in non-ischaemic HF—supporting deferral of early LVAD or heart transplantation.
Answers are grounded in this paper and cite their sources.
Non-ischaemic new-onset acute HFrEF may show greater early remodeling than ischaemic; leaves open whether aetiology should guide therapy selection in prospective studies.
AIMS: This study aimed to investigate the left ventricular (LV) remodelling and long-term prognosis of patients with new-onset acute heart failure (HF) with reduced ejection fraction who were pharmacologically managed and survived until hospital discharge. We compared patients with ischaemic and non-ischaemic aetiology. METHODS AND RESULTS: This cohort study consisted of 111 patients admitted with new-onset acute HF in the period 2008-2016 [62% non-ischaemic aetiology, 48% supported by inotropes, vasopressors, or short-term mechanical circulatory devices, and left ventricular ejection fraction (LVEF) at discharge 28% (interquartile range 22-34)]. LV dimensions, LVEF, and mitral valve regurgitation were used as markers for LV remodelling during up to 3 years of follow-up. Both patients with non-ischaemic and ischaemic HF had significant improvement in LVEF (P < 0.001 and P = 0.004, respectively) with significant higher improvement in those with non-ischaemic HF (17% vs. 6%, P < 0.001). Patients with non-ischaemic HF had reduction in LV end-diastolic and end-systolic diameters (6 and 10 mm, both P < 0.001), but this was not found in those with ischaemic HF [+3 mm (P = 0.09) and +2 mm (P = 0.07), respectively]. During a median follow-up of 4.6 years, 98 patients (88%) did not reach the composite endpoint of LV assist device implantation, heart transplantation, or all-cause mortality, with no difference between with ischaemic and non-ischaemic HF [hazard ratio 0.69 (95% confidence interval 0.19-2.45)]. CONCLUSIONS: Patients with new-onset acute HF with reduced ejection fraction discharged on optimal medical treatment have a good prognosis. We observed a considerable LV remodelling with improvement in LV function and dimensions, starting already at 6 months in patients with non-ischaemic HF but not in their ischaemic counterparts.
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Berge et al. (2021) conducted a cohort in New-onset acute heart failure with reduced ejection fraction (HFrEF) (n=111). Non-ischaemic heart failure aetiology on optimal medical treatment vs. Ischaemic heart failure aetiology on optimal medical treatment was evaluated on Left ventricular remodelling (improvement in LVEF during up to 3 years of follow-up) (p=<0.001). Non-ischaemic aetiology in new-onset acute HFrEF was associated with greater LVEF improvement (17% vs. 6%, P<0.001) and LV diameter reduction compared to ischaemic HF, with similar survival.
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