Key result
LVEF improvement in HFrEF is linked to ~75% lower mortality.
Why the study?
Does integrated atrial mechanics and biomarker profiling predict left ventricular ejection fraction improvement in patients with heart failure with reduced ejection fraction?
Cohort (n=175)
Does integrated atrial mechanics and biomarker profiling predict left ventricular ejection fraction improvement in patients with heart failure with reduced ejection fraction?
In HFrEF patients, LVEF improvement occurs in nearly half of patients, is strongly associated with reduced mortality and heart failure hospitalizations, and can be predicted by an integrated clinical, echocardiographic, and biomarker model.
Improvement of left ventricular ejection fraction (LVEF) is a relevant phenotype in heart failure with reduced ejection fraction (HFrEF), but its substrate remains unclear. In 175 HFrEF patients followed prospectively for 24 months with serial echocardiography, left atrial (LA) strain and 16 biomarkers, LVEF improvement (increase ≥ 10 points to > 40%) occurred in 80 patients (45.7%). Improvers were more often women and non-ischaemic, with smaller LV volumes, better LV longitudinal strain, shorter atrial conduction time and lower ANP, relaxin-2 and COL4A1; baseline LA volume and strain did not differ. An exploratory eight-variable model had apparent and optimism-corrected AUCs of 0.93 and 0.84. NT-proBNP and LA reservoir strain diverged progressively between groups. Improvement was associated with lower mortality (HR 0.25; 95% CI 0.08-0.75) and fewer heart failure hospitalisations (HR 0.38; 95% CI 0.18-0.78). LVEF improvement reflects progressive atrial and neurohormonal reverse remodelling rather than favourable baseline atrial mechanics.
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Arias et al. (2026) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=175). LVEF improvement (increase ≥10 points to >40%) / Integrated atrial mechanics-biomarker profiling vs. Non-improvers (no LVEF improvement) was evaluated on Mortality (and LVEF improvement of ≥10 points to >40%, occurring in 45.7%) (HR 0.25, 95% CI 0.08-0.75). LVEF improvement (45.7% of HFrEF patients) was predicted by an 8-variable model (AUC 0.84) and associated with lower mortality (HR 0.25; 95% CI 0.08-0.75) and HF hospitalisations (HR 0.38).
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