Key result
Improvement in left ventricular ejection fraction to >40% was associated with a 59% lower risk of all-cause death, LVAD implantation, or heart transplantation compared to remaining in a state of reduced ejection fraction.
Why the study?
The characteristics and long-term outcomes of heart failure patients with improved ejection fraction (HFimpEF) were not well elucidated in real-world settings.
Does improvement in left ventricular ejection fraction (HFimpEF) reduce the composite of all-cause death, LVAD implantation, or heart transplantation compared to remaining in HFrEF?
Cohort (n=635)
No
Does improvement in left ventricular ejection fraction (HFimpEF) reduce the composite of all-cause death, LVAD implantation, or heart transplantation compared to remaining in HFrEF?
Hazard Ratio: 0.41 (95% CI 0.27–0.63)
p-value: p=<0.001
Patients with heart failure who improve their ejection fraction to >40% have excellent long-term survival, with risk largely driven by non-cardiovascular causes.
Aims: This real-world cohort study aims to elucidate the characteristics and long-term outcome of heart failure patients with improved ejection fraction (HFimpEF). Methods: Data from a prospective observational single-center registry were analyzed. Adult patients with reduced left ventricular ejection fraction (LVEF)(≤40%) were classified as HFimpEF if follow-up LVEF improved to >40%. Primary outcome was defined as the composite of all-cause death, left ventricular assist device implantation, or heart transplantation. Results: = 0.021). Conclusions: The cardiovascular long-term outcome of HFimpEF patients was generally favorable, with most deaths due to non-cardiovascular causes. A history of cancer and an elevated E/e' ratio independently predicted the composite of death and advanced HF therapy. Future trials are warranted to determine the optimal long-term pharmacotherapeutic management of this population.
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Luo et al. (2026) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) transitioning to improved ejection fraction (HFimpEF) (n=635). Improvement of LVEF to >40% (HFimpEF) vs. Remaining in HFrEF (no LVEF improvement) was evaluated on Composite of all-cause death, left ventricular assist device (LVAD) implantation, or heart transplantation (aHR 0.41, 95% CI 0.27-0.63, p=<0.001). Improvement in left ventricular ejection fraction to >40% was associated with a 59% lower risk of all-cause death, LVAD implantation, or heart transplantation compared to remaining in a state of reduced ejection fraction.
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