Clinical features and prognosis of heart failure of ischemic and non-ischemic etiology: a comparative study
M Gutierrez Munoz, A Fraile Sanz, N Gil Mancebo, P Rodriguez Montes, M De La Serna Real De Asua, S Humanes Ybanez, A Vilchez Alcocer, E F Parrales Sanchez, C Utrilla Perez, I Miralles Gil, R Mata Caballero, B Izquierdo Coronel, J A Perea Egido, J J Alonso Martin, M Martin MunozAbstract
Introduction
Heart failure (HF) is a leading cause of morbidity and mortality worldwide, with a growing prevalence. Among the different etiologies, the most common are ischemic and non-ischemic, including valvular disease, cardiomyopathies and hypertension. Although both forms of HF share similar clinical manifestations, their pathophysiology, prognosis and treatment response may differ. This study aims to compare the characteristics of both groups, in order to identify key differences that may support more personalized and effective management, ultimately optimizing long-term clinical outcomes.
Methods
We conducted an observational, prospective and analytic study, including 446 patients hospitalized in our hospital with acute decompensated heart failure (ADHF) between 2020 and 2025, with a median follow-up of 9 months (4-18). Patients were classified into two groups (ischemic and non-ischemic), and clinical, laboratory, pharmacological, demographic and echocardiographic variables were systematically analized. Survival analysis was performed using the Kaplan–Meier method.
Results
Ischemic etiology was present in 27.3% of patients (122), while 72.7% (324) had non-ischemic HF. Ischemic HF was more frequent in men with cardiovascular risk factors such as diabetes mellitus, dyslipemia and smoking. These patients had lower systolic and diastolic blood pressure, more conduction abnormalities and a higher prevalence of cardiac devices (ICD and CRT). Non-ischemic HF was more commonly associated with right sided HF, diuretic resistance and atrial fibrillation, with no differences in length of hospital stay. Charlson index score was higher in ischemic patients (median 7), suggesting a worse long-term prognosis. Regarding echocardiographic parameters, the ischemic group presents greater left ventricular dilatation and worse systolic function with a median LVEF of 36% compared to the other arm (47.5%). Following these findings, ischemic patients also showed a lower prevalence of pulmonary hypertension and right ventricular dilatation. Beta blockers, ARNIs and SGLT2i were more prescribed in the ischemic group, likely reflecting more severe systolic dysfunction. Significant differences were also found in the levels of NT-proBNP, creatinine and high-sensivity troponin T (hs-TnT), which were higher in the ischemic etiology arm. During follow-up, there were no significant differences in mortality, HF readmission or AMI.
Conclusion
Ischemic heart failure is more frequent in men with cardiovascular risk factors. It is also associated with lower blood pressure levels and predominantly left-sided heart failure, with higher Charlson index score. It should be noted that they have worse left ventricular systolic function and larger left ventricular diameter, which may explain the higher use of disease-modifying therapies. Despite higher biomarkers of severity, no differences were observed in mortality, AMI or HF rehospitalization between both groups.Analized variablesFor image description, please refer to the figure legend and surrounding text.Kaplan-Meier curveFor image description, please refer to the figure legend and surrounding text.