Recovered vs remission heart failure among patients with LVEF improvement in non-Ischaemic HFrEF
T Nabeta, S Ishii, Y Haruki, S Nakahara, Y Watanabe, S Iikura, Y Takigami, Y Eda, Y Iida, Y Ikeda, J AkoAbstract
Background
Improvement in left ventricular ejection fraction (LVEF) is associated with favorable outcomes in patients with heart failure reduced EF (HFrEF), yet some patients remain symptomatic or have residual structural abnormalities. A recent European Journal of Heart Failure consensus document introduced novel phenotypic subgroups with improved HF (impHF), including remission HF (remHF) and recovered HF (recHF), representing more advanced stages of myocardial recovery and clinical stability. However, their prevalence and clinical outcomes are unknown.
Purpose
We aimed to evaluate the prevalence and clinical outcomes of recHF, remHF, and conventional impHF among patients with recent-onset non-ischaemic HFrEF.
Methods
We retrospectively enrolled patients with recent-onset non-iscaemic HFrEF and at least 1 year of follow-up between 2005 to 2022. Patients were categorized according to LVEF trajectory within 2 years. impHF was defined as an absolute LVEF increase ≥10% without reaching 50%. remHF was defined as ≥10% increase with follow-up LVEF ≥50%. recHF required ≥10% increase in LVEF with sustained LVEF ≥50% and normalization of BNP or NT-proBNP maintained for ≥12 months. Patients with <10% LVEF improvement were classified as non-improving HF. (Figure) Clinical Outcomes were assessed from 12 months after baseline and included all-cause mortality and HF hospitalization.
Results
A total of 348 patients were included (mean age 57 years, 70% male, baseline LVEF 29 ± 6.8%). Of these, 50 (14%) were classified as non-improving HF, 71 (20%) as impHF, 115 (33%) as remHF, and 112 (32%) as recHF. Baseline age and BNP levels were lower in recHF, whereas baseline LVEF was lower in impHF compared with the other groups, with no differences observed among the remaining phenotypes. During a median follow-up of 6.5 years, 63 deaths and 56 HF hospitalizations occurred. Kaplan–Meier analysis demonstrated that the recHF had the lowest event rates among the phenotypes (p < 0.001; Figure). In multivariable Cox regression analysis, recHF was associated with a lower risk of all-cause mortality compared with remHF and non-improving HF. Regarding heart failure hospitalization, recHF was associated with a lower risk compared with impHF and non-improving HF, while showing a comparable risk to remHF.
Conclusion
In patients with recent-onset non-ischaemic HFrEF, recHF and remHF were observed in 32% and 33% of patients, respectively. recHF was associated with the most favorable long-term outcomes, whereas remHF showed an intermediate risk profile. These findings highlight the prognostic heterogeneity within improved LVEF phenotypes.Figure