Heart Failure With Improved Ejection Fraction: Clinical Characteristics, Correlates of Recovery, and Survival

Abstract

Background— Heart failure with recovered or improved ejection fraction (HFiEF) has been proposed as a new category of HF. Whether HFiEF is clinically distinct from HF with persistently reduced ejection fraction remains to be validated. Methods and Results— Of the 5010 subjects enrolled in the Valsartan Heart Failure Trial (Val-HeFT), 3519 had a baseline left ventricular EF of <35% and a follow-up echocardiographic assessment of EF at 12 months. Of these, 321 (9.1%) patients who had a 12-month EF of >40% constituted the subgroup with HFiEF. EF improved from 28.7±5.6% to 46.5±5.6% in the subgroup with HFiEF and remained reduced (25.2±6.2% and 27.5±7.1%) in the subgroup with HF with reduced ejection fraction. The group with HFiEF had a less severe hemodynamic, biomarker, and neurohormonal profile, and it was treated with a more intense HF medication regimen. Subjects who had higher blood pressure and those treated with a β-blocker or randomized to valsartan had greater odds of being in the HFiEF group, whereas those with an ischemic pathogenesis, a more dilated left ventricle, and a detectable hs-troponin had lower odds of an improvement in EF. Recovery of the EF to >40% was associated with a better survival compared with persistently reduced EF. Conclusions— Our data support HFiEF as a stratum of HF with reduced ejection fraction with a more favorable outcome, which occurs in a minority of patients with HF with reduced ejection fraction who have a lower prevalence of ischemic heart disease, a less severe hemodynamic, biomarker, and neurohormonal profile, and who are treated with a more intense HF medication regimen. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00336336.

Myocardial remodelling and recovery in dilated cardiomyopathy

“…27 Finally, in the subset of patients with repeat echocardiography imaging in the Valsartan Heart Failure Trial (Val-HeFT), 321 of 3519 (9.1%) patients with initial LVEF <35% (including ischemic aetiologies) improved LVEF to >40% at 1-year follow up, and recovery was associated with improved survival at 2-year short-term follow up (log-rank p -value comparing survival in group with improved LVEF compared to group without improved LVEF = 0.005). 28 …”

Anemia and iron deficiency in heart failure: a review of echocardiographic features

“…Although statistically significant, it is debatable whether this slight increase in LVEF is clinically relevant or whether it can explain the symptomatic improvement in these patients. Nevertheless, many studies have found a survival benefit in patients with HFrEF whose LVEF improved after treatment for HF . Some of these studies found a very significant increase in LVEF .…”

“…Nevertheless, many studies have found a survival benefit in patients with HFrEF whose LVEF improved after treatment for HF. [66][67][68][69][70] Some of these studies found a very significant increase in LVEF. [66][67][68]70 However, any statistically significant improvement in LVEF may be associated with improved survival, independently of the baseline LVEF or the magnitude of the increase.…”

Heart Failure With a Better Ejection Fraction

“…In this issue of Circulation: Heart Failure, Florea et al 11 used data from the Valsartan Heart Failure Trial (Val-HeFT) to identify a subset of patients who entered the study with a reduced LVEF of <35% but went onto improve their ejection fraction (HFiEF) to >40% after 12 months of follow-up. They specifically sought to better characterize this improved LVEF population, determine independent predictors of improvement, and compare prognosis to patients who did not improve.…”