Characteristics and prognosis of heart failure with improved compared with persistently reduced ejection fraction: A systematic review and meta-analyses

Abstract

Aims We assessed the clinical characteristics and prognosis of chronic heart failure patients with improved ejection fraction (HFIEF) compared with persistently reduced ejection fraction (HFpREF) after evidence-based therapy. Methods and results We performed a meta-analysis including 24 eligible observational studies comparing 2663 HFIEF (≥5% left ventricular ejection fraction (LVEF) improvement) versus 8355 HFpREF patients who received recommended drug therapy, cardiac resynchronization therapy and/or intracardiac defibrillator. LVEF was assessed at baseline and reassessed after 19 ± 19 months. The primary endpoints were all-cause mortality and appropriate shocks. The mean duration of follow-up was 39 ± 12 months. Among HFIEF patients, LVEF improved 16.3 percentage points (95% confidence interval 15.9-16.6, p < 0.0001). Compared with HFpREF patients, HFIEF patients had a comparable mean age (60.9 years vs. 62.4 years, p = 0.11), were more often women (33% vs. 25%), had a higher prevalence of non-ischaemic heart failure (58% vs. 53%), less diabetes (27% vs. 28%), higher systolic blood pressure (127.5 ± 9 vs. 122 ± 12 mmHg) and lower left ventricle end-diastolic diameter (64.1 ± 3.7 vs. 67.4 ± 4.9 mmHg), all p-values < 0.05. Absolute risk of all-cause mortality was lower in HFIEF (5.8%) compared with HFpREF (17.5%) with a risk ratio of 0.34 (95% confidence interval 0.28-0.41), p < 0.001. Risk of appropriate shocks was significantly lower in HFIEF versus HFpREF (risk ratio 0.58 (95% confidence interval 0.46-0.74), p < 0.001). Conclusion In heart failure patients, we identified several baseline characteristics in favour of an improved LVEF, in response to evidence based therapy. Patients with improved LVEF had significantly lower risks of mortality and appropriate shocks compared with patients with persistently reduced LVEF.

Recovered Left Ventricular Ejection Fraction and Its Prognostic Impacts in Hospitalized Heart Failure Patients with Reduced Ejection Fraction

“…Several reported factors of EF recovery in stable HFrEF patients were as follows: younger age, lower NYHA class, lower prevalence of male gender, CAD, diabetes, CKD, chronic obstructive pulmonary disease and CLBBB, higher prevalence of AF and hypertension, higher levels of baseline EF, body mass index, blood pressure and sodium, and lower levels of LVDd and circulating levels of uric acid, troponin T, BNP and NT-pro BNP. [12][13][14][15]17) Concordant with the previous studies based on stable HFrEF patients, [12][13][14][15][16][17]25) younger age, higher presence of AF, lower levels of LVDd, and higher levels of baseline EF were associated with "recovered EF" in the present study from decompensated and hospitalized HFrEF patients. In addition, although the etiology of HFrEF could be associated with "recovered EF", associations between EF recovery and the etiology of cardiomyopathy or valvular heart disease have not been reported.…”

“…In addition, although the etiology of HFrEF could be associated with "recovered EF", associations between EF recovery and the etiology of cardiomyopathy or valvular heart disease have not been reported. On the contrary, ischemic etiology is reportedly less likely to present EF recovery in stable HFrEF patients, [12][13][14][15]17) and the etiology of HF (e.g. higher prevalence of ischemic etiology in the rEF group, and relative higher prevalence of valvular etiology in the pEF group in the present study) might be associated with "recovered EF" in the hospitalized HFrEF patients.…”

“…In stable HFrEF patients, EF recovery was observed in 9.1 -24.2%. [13][14][15][16][17]25) The relatively higher prevalence of "recovered EF" (44.1%) than those in previous studies [12][13][14][15][16][17]25) may be due to the greater number of patients with acute phase of decompensated HFrEF in the present study compared to the outpatient setting of other studies.…”

Editor’s Presentation

“…Interestingly, indicators related to heart failure status were considered less important despite clinical status being an important predictor of outcomes and quality of life. 5 The importance of the face to face interaction approach between patient and healthcare provider cannot be understated: it is wellknown that compliance and documented changes in positive lifestyle behaviours decrease during and after the unsupervised months following hospitalization. 6 Circulating PCSK9 and lipid lowering drug New approaches have been investigated in order to reduce low-density lipoprotein cholesterol (LDL-C) and cardiovascular risk, including implementation of new drugs belonging to the PCSK9 inhibitor class.…”

Comparison of MAGGIC and MECKI risk scores to predict mortality after cardiac rehabilitation among Dutch heart failure patients

“…4 Risk prediction among cardiovascular patients is an emerging topic of interest. [5][6][7] To gain insight into the prognosis of heart failure, several clinical risk models were developed, such as the Meta-Analysis Global Group in Chronic heart failure (MAGGIC) and Metabolic Exercise data combined with Cardiac and Kidney Indexes (MECKI) score. 8,9 Both MAGGIC and MECKI scores are internally and externally validated, [8][9][10][11] but their clinical use is limited to specific settings.…”