An LVESD ≥ 55 mm at discharge was an independent predictor of persistent HFrEF at 1-year follow-up, with an incidence of 81% compared to 55% in patients with an LVESD < 55 mm.
Cohort (n=443)
No
Does left ventricular end-systolic diameter at discharge predict persistent HFrEF at 1-year follow-up in patients hospitalized with HFrEF?
An LVESD ≥ 55 mm at discharge is a strong independent predictor of persistent HFrEF at 1 year, which may aid in risk stratification for advanced HF therapies.
Odds Ratio: 1.07 (95% CI 1.02–1.12)
Absolute Event Rate: 81% vs 55%
p-value: p=<0.001
Patients with persistent heart failure (HF) with reduced ejection fraction (HFrEF) have a poorer prognosis than those with HF with improved ejection fraction (HFimpEF). However, data on the predictive value of echocardiographic parameters for persistent HFrEF are lacking. We retrospectively studied 443 patients who were diagnosed with HFrEF (EF ≤ 40%) during hospitalization and underwent echocardiography at the 1-year follow-up. We divided them into the 2 groups: HFimpEF (EF > 40%) and persistent HFrEF group at 1-year follow-up, and assessed the predictive value of echocardiographic parameters at discharge for persistent HFrEF. In total, 301/443 patients (68%) were diagnosed with persistent HFrEF and 142/443 (32%) with HFimpEF at the 1-year follow-up. Kaplan-Meier analysis revealed that the persistent HFrEF group had a poorer prognosis than the HFimpEF group (log-rank, P < 0.001). Receiver operating characteristic curve analysis revealed that left ventricular end-systolic diameter (LVESD) had the highest area under the curve (AUC) (0.70; 95% confidence interval CI: 0.64-0.75; cutoff value: 55 mm) among various echocardiographic parameters. LVESD was an independent predictor of persistent HFrEF at the 1-year follow-up (odds ratio: 1.07, 95%CI: 1.02-1.12) upon multivariable logistic regression analysis. The incidence of persistent HFrEF was higher in patients with an LVESD ≥ 55 mm than in those with an LVESD < 55 mm (81% versus 55%, Fisher's exact test, P < 0.001). In conclusion, an LVESD (≥ 55 mm) was associated with persistent HFrEF. Focusing on LVESD in daily practice may help clinicians with risk stratification for decision-making regarding management in patients with advanced HF refractory to guideline-directed medical therapy.
Takada et al. (2023) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=443). Left ventricular end-systolic diameter (LVESD) ≥ 55 mm vs. LVESD < 55 mm was evaluated on Persistent HFrEF at 1-year follow-up (OR 1.07, 95% CI 1.02-1.12, p=<0.001). An LVESD ≥ 55 mm at discharge was an independent predictor of persistent HFrEF at 1-year follow-up, with an incidence of 81% compared to 55% in patients with an LVESD < 55 mm.