Josep Lupón1, Giovana Gavidia-Bovadilla2, Elena Ferrer3, Marta de Antonio4, Alexandre Perera-Lluna5, Jorge López-Ayerbe3, Mar Domingo6, Julio Núñez7, Elisabet Zamora1, Pedro Moliner4, Patricia Díaz-Ruata8, Javier Santesmases6, Antoni Bayés-Genís9. 1. Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigatión Biomédica en Red (CIBER) Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain. 2. Department of e-Health, Eurecat, Technological Center of Catalonia, Barcelona, Spain; Departament d'Enginyeria de Sistemes, Automàtica i Informàtica Industrial, Universitat Politècnica de Catalunya, Barcelona, Spain. 3. Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. 4. Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. 5. Departament d'Enginyeria de Sistemes, Automàtica i Informàtica Industrial, Universitat Politècnica de Catalunya, Barcelona, Spain; Networking Biomedical Research Centre in Bioengineering, Biomaterials, and Nanomedicine (CIBER-BBN), Madrid, Spain; Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain. 6. Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. 7. Centro de Investigatión Biomédica en Red (CIBER) Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Cardiology Department, Hospital Clínico Universitario, INCLIVA, València, Spain; Department of Medicine, Universitat de València, València, Spain. 8. Departament d'Enginyeria de Sistemes, Automàtica i Informàtica Industrial, Universitat Politècnica de Catalunya, Barcelona, Spain; Networking Biomedical Research Centre in Bioengineering, Biomaterials, and Nanomedicine (CIBER-BBN), Madrid, Spain. 9. Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigatión Biomédica en Red (CIBER) Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain. Electronic address: abayesgenis@gmail.com.
Abstract
BACKGROUND: Long-term trajectories of left ventricular ejection fraction (LVEF) in heart failure (HF) are incompletely characterized. OBJECTIVES: This study sought to examine LVEF trajectories in HF with reduced LVEF (<40%) and mid-range LVEF (40% to 49%) and the prognostic impact of LVEF dynamic changes over 15-year follow-up. METHODS: In this prospective, consecutive, observational registry of real-life HF outpatients, the authors performed 2-dimensional echocardiography at baseline and on a structured schedule after 1 year and then every 2 years up to 15 years. RESULTS: The mean number of LVEF measurements in the 1,160 included patients was 3.6 ± 1.7. As a whole, Loess curves of long-term LVEF trajectories showed an inverted U shape with a marked rise in LVEF during the first year, maintained up to a decade, and a slow LVEF decline thereafter (p for trajectory <0.001). This pattern was more pronounced in HF of nonischemic origin and in women. Patients with new-onset HF (≤12 months) had a higher early increase in LVEF, whereas patients with ischemic HF showed a lower LVEF increase at 1 year; both groups had a relative plateau thereafter. Patients with HF with mid-range LVEF had less of an increase (3 ± 9%) than those with HF with reduced LVEF (9 ± 12%) during the first year (p < 0.001), but the groups overlapped after 15 years. Patients who died had lower final LVEF and worse LVEF dynamics in the immediately preceding period than survivors. CONCLUSIONS: LVEF trajectories vary in HF depending on a number of disease modifiers, but an inverted U-shaped pattern with lower LVEF at both ends of the distribution emerged. A declining LVEF in the preceding period was associated with higher mortality.
BACKGROUND: Long-term trajectories of left ventricular ejection fraction (LVEF) in heart failure (HF) are incompletely characterized. OBJECTIVES: This study sought to examine LVEF trajectories in HF with reduced LVEF (<40%) and mid-range LVEF (40% to 49%) and the prognostic impact of LVEF dynamic changes over 15-year follow-up. METHODS: In this prospective, consecutive, observational registry of real-life HF outpatients, the authors performed 2-dimensional echocardiography at baseline and on a structured schedule after 1 year and then every 2 years up to 15 years. RESULTS: The mean number of LVEF measurements in the 1,160 included patients was 3.6 ± 1.7. As a whole, Loess curves of long-term LVEF trajectories showed an inverted U shape with a marked rise in LVEF during the first year, maintained up to a decade, and a slow LVEF decline thereafter (p for trajectory <0.001). This pattern was more pronounced in HF of nonischemic origin and in women. Patients with new-onset HF (≤12 months) had a higher early increase in LVEF, whereas patients with ischemic HF showed a lower LVEF increase at 1 year; both groups had a relative plateau thereafter. Patients with HF with mid-range LVEF had less of an increase (3 ± 9%) than those with HF with reduced LVEF (9 ± 12%) during the first year (p < 0.001), but the groups overlapped after 15 years. Patients who died had lower final LVEF and worse LVEF dynamics in the immediately preceding period than survivors. CONCLUSIONS: LVEF trajectories vary in HF depending on a number of disease modifiers, but an inverted U-shaped pattern with lower LVEF at both ends of the distribution emerged. A declining LVEF in the preceding period was associated with higher mortality.
Authors: Biniyam G Demissei; Brian S Finkelman; Rebecca A Hubbard; Liyong Zhang; Amanda M Smith; Karyn Sheline; Caitlin McDonald; Hari K Narayan; Vivek Narayan; Adam J Waxman; Susan M Domchek; Angela DeMichele; Payal Shah; Amy S Clark; Angela R Bradbury; Joseph R Carver; Jenica Upshaw; Saro H Armenian; Peter Liu; Bonnie Ky Journal: Cancer Date: 2019-05-01 Impact factor: 6.860
Authors: Tan Panpan; Du Yuchen; Shi Xianyong; Liu Meng; He Ruijuan; Dong Ranran; Zhang Pengyan; Li Mingxi; Xie Rongrong Journal: Cardiovasc Toxicol Date: 2022-07-25 Impact factor: 2.755