Prognostic significance of subsequent decline in LVEF in heart failure with improved ejection fraction − A report from the CHART-2 study −

Background: Some patients of heart failure with improved ejection fraction (HFimpEF) have subsequent decline in left ventricular ejection fraction (LVEF) after improvement, and their prognosis is uncertain. Aims: We aimed to examine the clinical characteristics and long-term prognosis of this sub-population of HFimpEF. Methods: We examined 399 consecutive patients with HF with reduced ejection fraction (HFrEF, LVEF ≤ 40 %) with LVEF data at both baseline and follow-up in the CHART-2 Study. We classified them as follows; persistent HFrEF group (LVEF ≤ 40 % at 1-year and 2-year follow-up, n = 238), temporary HFimpEF group (≥10 % increase from baseline with LVEF > 40 % at 1-year follow-up but LVEF ≤ 40 % at 2-year follow-up, n = 22), and persistent HFimpEF group (≥10 % increase from baseline with LVEF > 40 % at 1-year follow-up, and LVEF > 40 % at 2-year follow-up, n = 139). Results: The temporary HFimpEF group (adjusted hazard ratio: 2.95; 95 % CI: 1.55-5.63) and the persistent HFrEF group (2.53; 1.75-3.67) were associated with increased risks for the composite of cardiovascular death and HF hospitalization. The risk factors for decline in LVEF included LVEF (adjusted odds ratio: 0.80; 95 %CI: 0.69-0.90), LV end-diastolic dimension (LVDd) (1.14; 1.05-1.25), B-type natriuretic peptide (BNP) levels (1.04 per 10 pg/mL increase; 1.00-1.08), estimated glomerular filtration rate (eGFR) levels (0.95; 0.92-0.99) and serum sodium levels (0.70; 0.50-0.91) at 1-year follow-up. Conclusions: These results indicate that patients with HFrecEF account for 23% of those with HFrEF and that 12% of them have subsequent decline in LVEF associated with similar worse prognosis as in those with persistent HFrEF.