Key result
Recovered heart failure phenotype links to the lowest mortality and HF hospitalization rates in non-ischaemic HFrEF.
Why the study?
Although novel phenotypic subgroups of improved HF—including remission HF and recovered HF—were recently introduced to represent more advanced stages of myocardial recovery and clinical stability, their prevalence and clinical outcomes in recent-onset non-ischaemic HFrEF were unknown.
Cohort (n=348)
In recent-onset non-ischaemic HFrEF, achieving recovered HF (sustained LVEF ≥50% and normalized natriuretic peptides for ≥12 months) occurred in 32% of patients and conferred significantly lower long-term mortality risk compared to remission HF and non-improving HF.
Supports prognostic stratification by recovery phenotype in non-ischaemic HFrEF; extends consensus definitions yet leaves open need for prospective trials.
Background Improvement in left ventricular ejection fraction (LVEF) is associated with favorable outcomes in patients with heart failure reduced EF (HFrEF), yet some patients remain symptomatic or have residual structural abnormalities. A recent European Journal of Heart Failure consensus document introduced novel phenotypic subgroups with improved HF (impHF), including remission HF (remHF) and recovered HF (recHF), representing more advanced stages of myocardial recovery and clinical stability. However, their prevalence and clinical outcomes are unknown. Purpose We aimed to evaluate the prevalence and clinical outcomes of recHF, remHF, and conventional impHF among patients with recent-onset non-ischaemic HFrEF. Methods We retrospectively enrolled patients with recent-onset non-iscaemic HFrEF and at least 1 year of follow-up between 2005 to 2022. Patients were categorized according to LVEF trajectory within 2 years. impHF was defined as an absolute LVEF increase ≥10% without reaching 50%. remHF was defined as ≥10% increase with follow-up LVEF ≥50%. recHF required ≥10% increase in LVEF with sustained LVEF ≥50% and normalization of BNP or NT-proBNP maintained for ≥12 months. Patients with <10% LVEF improvement were classified as non-improving HF. (Figure) Clinical Outcomes were assessed from 12 months after baseline and included all-cause mortality and HF hospitalization. Results A total of 348 patients were included (mean age 57 years, 70% male, baseline LVEF 29 ± 6.8%). Of these, 50 (14%) were classified as non-improving HF, 71 (20%) as impHF, 115 (33%) as remHF, and 112 (32%) as recHF. Baseline age and BNP levels were lower in recHF, whereas baseline LVEF was lower in impHF compared with the other groups, with no differences observed among the remaining phenotypes. During a median follow-up of 6.5 years, 63 deaths and 56 HF hospitalizations occurred. Kaplan–Meier analysis demonstrated that the recHF had the lowest event rates among the phenotypes (p < 0.001; Figure). In multivariable Cox regression analysis, recHF was associated with a lower risk of all-cause mortality compared with remHF and non-improving HF. Regarding heart failure hospitalization, recHF was associated with a lower risk compared with impHF and non-improving HF, while showing a comparable risk to remHF. Conclusion In patients with recent-onset non-ischaemic HFrEF, recHF and remHF were observed in 32% and 33% of patients, respectively. recHF was associated with the most favorable long-term outcomes, whereas remHF showed an intermediate risk profile. These findings highlight the prognostic heterogeneity within improved LVEF phenotypes.
No takes yet. Share an insight, caveat, or question.
Nabeta et al. (2026) conducted a cohort in Recent-onset non-ischaemic heart failure with reduced ejection fraction (HFrEF) (n=348). Recovered heart failure (recHF: ≥10% LVEF increase with sustained LVEF ≥50% and normalized BNP/NT-proBNP for ≥12 months) vs. Remission HF (remHF), improved HF (impHF), and non-improving HF was evaluated on All-cause mortality and heart failure hospitalization (p=< 0.001). Recovered heart failure (32% of cohort) had the lowest event rates for all-cause mortality and heart failure hospitalization among non-ischaemic HFrEF phenotypes over 6.5 years (p<0.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: