Transient improved ejection fraction in NICM was associated with a higher risk of death, heart transplantation, or LVAD compared to persistent improvement (HR 2.54; 95% CI 1.60-4.04).
Cohort (n=800)
Does transient improved ejection fraction increase the risk of adverse outcomes compared to persistent improved ejection fraction in patients with non-ischaemic dilated cardiomyopathy?
In patients with non-ischaemic dilated cardiomyopathy and improved ejection fraction, a subsequent decline in LVEF occurs in about 40% of patients and is associated with a 2.5-fold increased risk of death, heart transplantation, or LVAD.
Effect estimate: HR 2.54 (95% CI 1.60-4.04)
AIMS: The recent definition of heart failure with improved ejection fraction outlined the importance of the longitudinal assessment of left ventricular ejection fraction (LVEF). However, long-term progression and outcomes of this subgroup are poorly explored. We sought to assess the LVEF trajectories and their correlations with outcome in non-ischaemic dilated cardiomyopathy (NICM) with improved ejection fraction (impEF). METHODS AND RESULTS: Consecutive NICM patients with baseline LVEF ≤40% enrolled in the Trieste Heart Muscle Disease Registry with ≥1 LVEF assessment after baseline were included. ImpEF was defined as a baseline LVEF ≤40%, and second evaluation showing both a ≥10% point increase from baseline LVEF and LVEF >40%. Transient impEF was defined by the documentation of recurrent LVEF ≤40% during follow-up. The primary endpoint was a composite of all-cause death, heart transplantation and left ventricular assist device (D/HT/LVAD). Among 800 patients, 460 (57%) had impEF (median time to improvement 13 months). Transient impEF was observed in 189 patients (41% of the overall impEF group) and was associated with higher risk of D/HT/LVAD compared with persistent impEF at multivariable analysis (hazard ratio 2.54; 95% confidence interval 1.60-4.04). The association of declining LVEF with the risk of D/HT/LVAD was non-linear, with a steep increase up to 8% points reduction, then remaining stable. CONCLUSIONS: In NICM, a 57% rate of impEF was observed. However, recurrent decline in LVEF was observed in ≈40% of impEF patients and it was associated with an increased risk of D/HT/LVAD.
Manca et al. (Fri,) conducted a cohort in Non-ischaemic dilated cardiomyopathy (n=800). Transient improved ejection fraction vs. Persistent improved ejection fraction was evaluated on Composite of all-cause death, heart transplantation and left ventricular assist device (D/HT/LVAD) (HR 2.54, 95% CI 1.60-4.04). Transient improved ejection fraction in NICM was associated with a higher risk of death, heart transplantation, or LVAD compared to persistent improvement (HR 2.54; 95% CI 1.60-4.04).