Cardiac reverse remodelling and health status in patients with chronic heart failure

Wang, Kaiming; Youngson, Erik; Bakal, Jeffrey A.; Thomas, Jissy; McAlister, Finlay A.; Oudit, Gavin Y.

doi:10.1002/ehf2.13417

Cited by 12 publications

(12 citation statements)

References 37 publications

(90 reference statements)

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“…In addition to the effect on mortality and hospitalization outcomes, Peter Wohlfahrt et al confirmed that HFrecEF significantly improved the quality of life in patients with heart failure ( 9 ). However, the prognostic effect of recovered ejection fraction was inconsistent or even non-significant ( 10 , 12 , 16 ). After a systematic review of all relevant reports, we have pooled the quantified impact of HFrecEF on prognosis, which provided explicit evidence that HFrecEF, recently redefined as HFimpEF, is a novel entity in patients with heart failure needing more attention and evaluation.…”

Section: Discussionmentioning

confidence: 99%

“…Reverse left ventricular remodeling with a more favorable neurohormonal profile is probably the main mechanism of HFimpEF or HFrecEF, which was characterized as the reduction of left ventricular end-diastolic and end-systolic volume, left ventricular mass index, and E/e′ ratio ( 5 , 16 ). Kramer et al had reported that reverse left ventricular remodeling is associated with fewer heart failure hospitalizations and reduced cardiovascular mortality, and the degree of reverse left ventricular remodeling is directly related to improved cardiac survival ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

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Prevalence and Prognosis of HFimpEF Developed From Patients With Heart Failure With Reduced Ejection Fraction: Systematic Review and Meta-Analysis

Ling

Guo

et al. 2021

Front. Cardiovasc. Med.

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Background: Heart failure with improved ejection fraction (HFimpEF) is classified as a new type of heart failure, and its prevalence and prognosis are not consistent in previous studies. There is no systematic review and meta-analysis regarding the prevalence and prognosis of the HFimpEF.Method: A systematic search was performed in MEDLINE, EMBASE, and Cochrane Library from inception to May 22, 2021 (PROSPERO registration: CRD42021260422). Studies were included for analysis if the prognosis of mortality or hospitalization were reported in HFimpEF or in patients with heart failure with recovered ejection fraction (HFrecEF). The primary outcome was all-cause mortality. Cardiac hospitalization, all-cause hospitalization, and composite events of mortality and hospitalization were considered as secondary outcomes.Result: Nine studies consisting of 9,491 heart failure patients were eventually included. During an average follow-up of 3.8 years, the pooled prevalence of HFimpEF was 22.64%. HFimpEF had a lower risk of mortality compared with heart failure patients with reduced ejection fraction (HFrEF) (adjusted HR: 0.44, 95% CI: 0.33–0.60). HFimpEF was also associated with a lower risk of cardiac hospitalization (HR: 0.40, 95% CI: 0.20–0.82) and the composite endpoint of mortality and hospitalization (HR: 0.56, 95% CI: 0.44–0.73). Compared with patients with preserved ejection fraction (HFpEF), HFimpEF was associated with a moderately lower risk of mortality (HR: 0.42, 95% CI: 0.32–0.55) and hospitalization (HR: 0.73, 95% CI: 0.58–0.92).Conclusion: Around 22.64% of patients with HFrEF would be treated to become HFimpEF, who would then obtain a 56% decrease in mortality risk. Meanwhile, HFimpEF is associated with lower heart failure hospitalization. Further studies are required to explore how to promote left ventricular ejection fraction improvement and improve the prognosis of persistent HFrEF in patients.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021260422, identifier: CRD42021260422.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prevalence and Prognosis of HFimpEF Developed From Patients With Heart Failure With Reduced Ejection Fraction: Systematic Review and Meta-Analysis

Ling

Guo

et al. 2021

Front. Cardiovasc. Med.

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“…Our second study aim represented a novelty, to our knowledge, and it is probably the most important finding of our results. Previous studies have shown that patients with HFimpEF or ‘recovered’ LVEF had a better prognosis 15–23 ; but that was not the objective of the present study. Moreover, QoL was previously associated with outcomes in patients with HF 25–30 .…”

Section: Discussionmentioning

confidence: 86%

“…The 2021 universal definition of HF specifically describes the criteria for patients with HF that have shown improved LVEF (HFimpEF) as follows: HF with a baseline LVEF ≤40%, a ≥10‐point increase from baseline LVEF, and a second measurement of LVEF >40% 14 . Improvement or recovery in LVEF has been associated with better clinical outcomes, including HF‐related hospitalizations and survival 15–23 . However, the influence of LVEF improvement (or LVEF recovery) on QoL, although reported in a small number of studies, 6,22–24 has not been completely established.…”

Section: Introductionmentioning

confidence: 99%

Quality of life in patients with heart failure and improved ejection fraction: one‐year changes and prognosis

et al. 2022

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Aims The criteria for patients with heart failure (HF) and improved ejection fraction (HFimpEF) are a baseline left ventricular ejection fraction (LVEF) ≤40%, a ≥10‐point increase from baseline LVEF, and a second LVEF measurement >40%. We aimed to (i) assess patients with HF and reduced LVEF (HFrEF) at baseline and compare quality of life (QoL) changes between those that fulfilled and those that did not fulfil the HFimpEF criteria 1 year later and (ii) assess the prognostic role of QoL in patients with HFimpEF. Methods We reviewed data from a prospective registry of real‐world outpatients with HF that were assessed for LVEF and QoL at a first visit to the HF clinic and 1 year later. QoL was evaluated with the Minnesota Living with Heart Failure Questionnaire (MLWHFQ). The primary prognostic endpoint was the composite of all‐cause death or HF hospitalization. Results Baseline and 1‐year LVEF and MLWFQ scores were available for 1040 patients with an initial LVEF ≤40% (mean age, 65.2 ± 11.7 years; 75.9% men). The main aetiology was ischaemic heart disease (52.9%), and patients were mostly in New York heart Association Classes II (71.1%) and III (21.6%). At baseline, the mean LVEF was 28.5% ± 7.3, and the mean MLWHFQ score was 30.2 ± 19.5. After 1 year, the mean LVEF increased to 38.0% ± 12.2, and the MLWHFQ scores improved to 17.4 ± 16.0. In 361 patients that fulfilled the HFimpEF criteria (34.7%), significant improvements were observed in both LVEF (from 28.7% ± 6.6 to 50.9% ± 7.6, P < 0.001) and QoL (from 32.9 ± 20.6 to 16.9 ± 16.0, P < 0.001). Patients that did not fulfil the HFimpEF criteria also showed significant improvements in LVEF (from 28.4% ± 7.6 to 31.1% ± 7.9, P < 0.001) and QoL (from 28.7 ± 18.8 to 17.6 ± 15.9, P < 0.001). However, the QoL improvement was significantly higher in the HFimpEF group (−16.0 ± 23.8 vs. −11.1 ± 20.3, P = 0.001), despite the worse mean baseline MLWHFQ score, compared with the non‐HFimpEF group (P = 0.001). The 1‐year QoL was similar between groups (P = 0.50). The 1‐year MLWHFQ score was independently associated with outcomes; the hazard ratio for the composite endpoint was 1.02 (95% CI: 1.01–1.03, P = 0.006). In contrast, the QoL improvement (with a cut‐off ≥5 points) was not independently associated with the composite outcome. Conclusions Patients with HFrEF showed improved QoL after 1 year, regardless of whether they met the HFimpEF criteria. The similar 1‐year QoL perception between groups suggested that factors other than LVEF influenced QoL perception. The 1‐year QoL was superior to the QoL change from baseline for predicting prognosis in patients with HFimpEF.

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“…5,30 We also conducted a risk analysis to assess the association between LVEF trajectory and MACE. The utility of serial LVEF evaluation for MACE has been previously demonstrated in traditional HF, 31,32 but never before in MD. We determined that patients with a reduction in LVEF on follow-up TTE were at greater risk of MACE than patients with preserved LVEF, while dimensional changes lacked independent prognostic value.…”

Section: Clinical Variables Hr (95% Ci) P-value Hr (95% Ci) P-valuementioning

confidence: 99%

Trajectory of left ventricular ejection fraction in response to therapies in patients with muscular dystrophy

et al. 2022

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Background: Patients with muscular dystrophy (MD) are at elevated risk of serious cardiac complications and clinical assessment is limited due to inherent physical limitations. We assessed the utility of left ventricular ejection fraction (LVEF) derived from transthoracic echocardiogram (TTE) as a prognostic marker for major adverse cardiac events (MACE) in a mixed adult MD cohort. Methods: One hundred and sixty-five MD patients (median age: 36 (interquartile range [IQR]: 23.0-49.0) years; 65 [39.4%] females) were enrolled in our prospective cohort study. Diagnoses included dystrophinopathies (n = 42), limb-girdle MD (n = 31), type 1 myotonic dystrophy (n = 71), and facioscapulohumeral MD (n = 21). Left ventricular ejection fraction, ventricular dimensions at end-diastole and end-systole, and serial measures (n = 124; follow-up period: 2.19 [IQR: 1.05-3.32] years) stratified patients for MACE risk. Results: Cardiomyopathy was diagnosed in 60 (36.4%) patients of the broader cohort (median LVEF: 45.0 [IQR: 35.0-50.0] %). Ninety-eight MACE occurred over the 7year study period. At baseline, patients with a LVEF < 55.0% had a high risk of MACE (adjusted odds ratio: 8.30; 95% confidence interval [CI]: 3.18-21.7), concordant with the analysis of LV dimensions. Forty-one percent of these patients showed an improvement in LVEF with the optimization of medical and device therapies. Relative to patients with preserved LVEF, patients with reduced LVEF were at an elevated risk of MACE (adjusted hazard ratio [aHR]: 7.21; 95% CI: 1.99-26.1), and improved LVEF resulted in comparable outcomes (aHR: 1.84; 95% CI: .49-6.91) associated with optimization of medical and device therapies. Reduction in QRS duration by CRT therapy was associated with an improvement in LVEF (average improvement: 12.8 [± 2.30] %; p = .04). Conclusions: Reduction in LVEF indicates an increased risk of cardiovascular events in patients with MD. Baseline and serial LVEF obtained by TTE can prognosticate patients for MACE and guide clinical management.

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Cardiac reverse remodelling and health status in patients with chronic heart failure

Cited by 12 publications

References 37 publications

Prevalence and Prognosis of HFimpEF Developed From Patients With Heart Failure With Reduced Ejection Fraction: Systematic Review and Meta-Analysis

Prevalence and Prognosis of HFimpEF Developed From Patients With Heart Failure With Reduced Ejection Fraction: Systematic Review and Meta-Analysis

Quality of life in patients with heart failure and improved ejection fraction: one‐year changes and prognosis

Trajectory of left ventricular ejection fraction in response to therapies in patients with muscular dystrophy

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