Josep Lupón1,2,3,4, Giovana Gavidia-Bovadilla5, Elena Ferrer2, Marta de Antonio1,2,4, Alexandre Perera-Lluna6,7,8, Jorge López-Ayerbe2, Mar Domingo1, Julio Núñez4,9,10, Elisabet Zamora1,2,4, Pedro Moliner1,2, Evelyn Santiago-Vacas1,2, Javier Santesmases1, Antoni Bayés-Genis1,2,4. 1. Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain (J.L., M.d.A., M.D., E.Z, P.M., E.S.-V., J.S., A.B.-G.). 2. Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain (J.L., E.F., M.d.A., J.L.-A., E.Z, P.M., E.S.-V., A.B.-G.). 3. Department of Medicine, Universitat Autònoma de Barcelona, Spain (J.L.). 4. CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain (J.L., M.d.A., E.Z., J.N., A.B.-G.). 5. Department of e-Health, Eurecat, Technological Center of Catalonia, Barcelona, Spain (G.G.-B.). 6. Departament d'Enginyeria de Sistemes, Automàtica i Informàtica Industrial, Universitat Politècnica de Catalunya, Barcelona, Spain (A.P.-L.). 7. Networking Biomedical Research Centre in the Subject Area of Bioengineering, Biomaterials and Nanomedicine, Madrid, Spain (A.P.-L.). 8. Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (A.P.-L.). 9. Cardiology Department, Hospital Clínico Universitario, INCLIVA, Valància, Spain (J.N.). 10. Department of Medicine, Universitat de València, Spain (J.N.).
Abstract
BACKGROUND: Long-term trajectories of left ventricular ejection fraction (LVEF) in heart failure (HF) patients with preserved EF (HFpEF) remain unclear. Our objective was to assess long-term longitudinal trajectories in consecutive HFpEF patients and the prognostic impact of LVEF dynamic changes over time. METHODS AND RESULTS: Consecutive ambulatory HFpEF patients admitted to a multidisciplinary HF Unit were prospectively evaluated by 2-dimensional echocardiography at baseline and at 1, 3, 5, 7, 9, and 11 years of follow-up. Exclusion criteria were patients having a previous known LVEF <50%, patients undergoing only 1 echocardiogram study, and those with a diagnosis of dilated, noncompaction, alcoholic, or toxic cardiomyopathy. One hundred twenty-six patients (age, 71±13 years; 63% women) were included. The main pathogeneses were valvular disease (36%) and hypertension (28%). Atrial fibrillation was present in 67 patients (53%). The mean number of echocardiographies performed was 3±1.2 per patient. Locally weighted error sum of squares curves showed a smooth decrease of LVEF during the 11-year follow-up that was statistically significant in linear mixed-effects modeling ( P=0.01). Ischemic patients showed a higher decrease than nonischemics. The great majority (88.9%) of patients remained in the HFpEF category during follow-up; 9.5% evolved toward HF with midrange LVEF, and only 1.6% dropped to HF with reduced LVEF. No significant relationship was found between LVEF dynamics in the immediate preceding period and mortality. CONCLUSIONS: LVEF remained ≥50% in the majority of patients with HFpEF for ≤11 years. Only 1.6% of patients evolved to HF with reduced LVEF. Dynamic LVEF changes were not associated with mortality.
BACKGROUND: Long-term trajectories of left ventricular ejection fraction (LVEF) in heart failure (HF) patients with preserved EF (HFpEF) remain unclear. Our objective was to assess long-term longitudinal trajectories in consecutive HFpEF patients and the prognostic impact of LVEF dynamic changes over time. METHODS AND RESULTS: Consecutive ambulatory HFpEFpatients admitted to a multidisciplinary HF Unit were prospectively evaluated by 2-dimensional echocardiography at baseline and at 1, 3, 5, 7, 9, and 11 years of follow-up. Exclusion criteria were patients having a previous known LVEF <50%, patients undergoing only 1 echocardiogram study, and those with a diagnosis of dilated, noncompaction, alcoholic, or toxic cardiomyopathy. One hundred twenty-six patients (age, 71±13 years; 63% women) were included. The main pathogeneses were valvular disease (36%) and hypertension (28%). Atrial fibrillation was present in 67 patients (53%). The mean number of echocardiographies performed was 3±1.2 per patient. Locally weighted error sum of squares curves showed a smooth decrease of LVEF during the 11-year follow-up that was statistically significant in linear mixed-effects modeling ( P=0.01). Ischemicpatients showed a higher decrease than nonischemics. The great majority (88.9%) of patients remained in the HFpEF category during follow-up; 9.5% evolved toward HF with midrange LVEF, and only 1.6% dropped to HF with reduced LVEF. No significant relationship was found between LVEF dynamics in the immediate preceding period and mortality. CONCLUSIONS: LVEF remained ≥50% in the majority of patients with HFpEF for ≤11 years. Only 1.6% of patients evolved to HF with reduced LVEF. Dynamic LVEF changes were not associated with mortality.
Entities:
Keywords:
ejection fraction; follow-up studies; heart failure; humans; ventricular function
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