Key result
Early worsening of left ventricular ejection fraction (absolute decline ≥ 5%) in patients with HFpEF was associated with a 2.2-fold increased risk of all-cause mortality (HR 2.18).
Why the study?
Definitions of declined LVEF vary across studies, and results regarding its association with mortality in HFpEF are inconsistent.
Does early worsening LVEF increase mortality in patients with HFpEF?
Cohort (n=1,418)
No
Does early worsening LVEF increase mortality in patients with HFpEF?
Hazard Ratio: 2.18 (95% CI 1.35–3.52)
Absolute Event Rate: 9.2% vs 5.2%
p-value: p=0.001
In patients with HFpEF, an early worsening of LVEF (≥5% absolute decline) occurs in about one-third of patients and is associated with a 2.2-fold increased risk of all-cause mortality.
Early LVEF decline signals higher HFpEF mortality risk; hypothesis-generating for serial monitoring pending prospective trials.
Background: Definitions of declined left ventricular ejection fraction (LVEF) vary across studies and research results concerning the association of mortality with declined LVEF are inconsistent. Thus, this study aimed to assess the impact of early worsening LVEF on mortality in patients with heart failure (HF) with preserved ejection fraction (HFpEF) and to establish independent predictors of early worsening LVEF. Methods and Results: A total of 1,418 consecutive patients with HFpEF with LVEF remeasurement from the Cardiorenal Improvement registry were included in this study. Worsening LVEF was defined as an absolute decline ≥ 5% from baseline LVEF within 3 to 12 months after discharge. The Cox and logistic regression analyses were performed to assess prognostic effects and predictors for worsening LVEF, respectively. Among 1,418 patients with HFpEF, 457 (32.2%) patients exhibited worsening LVEF. During a median follow-up of 3.2 years (interquartile range: 2.3-4.0 years), 92 (6.5%) patients died. Patients with HFpEF with worsening LVEF had higher mortality relative to those with nonworsening LVEF [9.2 vs. 5.2%; adjusted hazard ratio (aHR): 2.18, 95% CI: 1.35-3.52]. In the multivariate binary logistic regression analysis, baseline left ventricular end-diastolic dimension (LVEDD), LVEF, high-density lipoprotein cholesterol (HDL-C), atrial fibrillation (AF), and diabetes mellitus (DM) emerged as predictive factors of worsening LVEF. Conclusion: This study demonstrated that about one out of three patients with HFpEF experiences worsening LVEF during follow-up, which is associated with 2.2-fold increased mortality. Increased LVEDD and LVEF, low HDL-C levels, AF, and DM were predictors of worsening LVEF. Further studies are needed to prospectively assess the efficacy of early active management on prognosis in patients with HF with worsening LVEF. Registration: ClinicalTrials.gov, identifier NCT04407936.
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Chen et al. (2022) conducted a cohort in Heart failure with preserved ejection fraction (HFpEF) (n=1,418). Worsening LVEF (absolute decline ≥ 5% from baseline) vs. Non-worsening LVEF was evaluated on All-cause mortality (HR 2.18, 95% CI 1.35-3.52, p=0.001). Early worsening of left ventricular ejection fraction (absolute decline ≥ 5%) in patients with HFpEF was associated with a 2.2-fold increased risk of all-cause mortality (HR 2.18).
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