Understanding Ejection Fraction Improvement in Newly Diagnosed HFrEF
F Rodrigues Santos, G Ferreira, J Gouveia Fiuza, M Duarte Almeida, O Kungel, L Afonso Santos, A Costa, I Fiuza PiresAbstract
Introduction
Patients with heart failure with reduced ejection fraction (HFrEF) have heterogeneous prognosis, and while some have persistently reduced left ventricular ejection fraction (LVEF), others have improvement in ejection fraction (HFimpEF). HFimpEF includes patients with a baseline LVEF≤40%, that have a ≥10 percentage points increase from baseline LVEF, and a second measurement of LVEF>40%. The aim of this study is to identify predictors of HFimprEF, in patients newly diagnosed with HFrEF.
Methods
This retrospective, single-center study included all patients referred to Cardiology consultation due to recently diagnosed HFrEF. Follow up was at least one year. Demographic variables, comorbidities, etiology, medical therapy, blood analysis, electrocardiogram and echocardiogram were analyzed. Statistical analysis used chi-square and Mann-Whitney U tests, and binary logistic regressions.
Results
89 patients were studied: 64 (71.9%) had HFimpEF; 21(23.6%) had persistent HFrEF; 4 (4.5%) had improvement in LVEF that didn’t fulfil criteria for HFimpEF. 69.4% of patients were male; mean age was 63±12 years old; mean LVEF was 30.3±5.4%. HFimpEF was associated with non-ischemic etiology (p=0.09), history of excessive alcoholic ingestion (p=0.019), lower frequency of chronic kidney disease (p=0.05), non-dilated LV (p=0.016), higher prescription of betablockers during follow-up (p=0.03), absence of transmural late gadolinium enhancement in cardiac magnetic resonance (p=0.012), lower NTproBNP levels (p=0.038). There were no differences between HFimpEF and persistent HFrEF regarding age, sex, QRS duration or other medical therapy, namely RAAS inhibitors and SGLT2 receptor–targeting drugs. During follow-up, HFimpEF was associated with fewer HF hospitalizations (p=0.013). Univariate logistic regression analysis showed that history of excessive alcoholic ingestion (OR 3.627; 95% CI 1.186-11.090; p=0.024), non-ischemic etiology (OR 4.308; 95% CI 1.363-13.616; p=0.013), lower LV telediastolic volume (OR 0.977; 95% CI 0.955-0.999; p=0.045) and prescription of betablockers during follow-up (OR 9.687; 95% CI 1.718-54.615; p=0.010) were predictors of HFimpEF. In multivariate analysis, only history of excessive alcoholic ingestion (OR 26.244; p=0.043), non-ischemic etiology (OR 21.826; p=0.036) and lower LV telediastolic volume (OR 0.971; p=0.05) were independent predictors of HFimpEF.
Discussion/conclusion
In patients with newly diagnosed HFrEF, 71.9% fulfilled criteria for HFimpEF during follow-up. Patients with HFimpEF had fewer HF hospitalizations. The only independent predictors of HFimpEF were history of excessive alcoholic ingestion, non-ischemic etiology and lower LV telediastolic volume. This might allow better risk stratification and prognostic evaluation in patients recently diagnosed with HFrEF.