Jin Joo Park1, Chan Soon Park2, Alexandre Mebazaa3, Il-Young Oh1, Hyun-Ah Park4, Hyun-Jai Cho5, Hae-Young Lee5, Kye Hun Kim6, Byung-Su Yoo7, Seok-Min Kang8, Sang Hong Baek9, Eun-Seok Jeon10, Jae-Joong Kim11, Myeong-Chan Cho12, Shung Chull Chae13, Byung-Hee Oh14, Dong-Ju Choi15. 1. Division of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Gumiro 166, Bundang, Seongnam, Gyeonggi-do, Republic of Korea. 2. Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea. 3. Department of Anesthesiology and Intensive Care Medicine, Hôpitaux Universitaires Saint Louis Lariboisière, APHP, University Paris Diderot, UMR 942 Inserm, Paris, France. 4. Department of Family Medicine, Inje University Seoul Paik Hospital, Seoul, Republic of Korea. 5. Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea. 6. Heart Research Center, Chonnam National University, Gwangju, Republic of Korea. 7. Yonsei University Wonju College of Medicine, Wonju, Republic of Korea. 8. Yonsei University College of Medicine, Seoul, Republic of Korea. 9. Department of Internal Medicine, The Catholic University of Korea, Seoul, Republic of Korea. 10. Department of Internal Medicine, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea. 11. Division of Cardiology, Asan Medical Center, Seoul, Republic of Korea. 12. Chungbuk National University College of Medicine, Cheongju, Republic of Korea. 13. Kyungpook National University College of Medicine, Daegu, Republic of Korea. 14. Mediplex Sejong Hospital, Incheon, Republic of Korea. 15. Division of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Gumiro 166, Bundang, Seongnam, Gyeonggi-do, Republic of Korea. djchoi@snubh.org.
Abstract
OBJECTIVE: Some patients with heart failure with preserved ejection fraction (HFpEF) experience declining of left-ventricular ejection fraction (LVEF) during follow-up. We aim to investigate the characteristics and outcomes of patients with HF with declining ejection fraction (HFdEF). METHODS: We analyzed a prospective, nationwide multicenter cohort with consecutive patients with acute HF enrolled from March 2011 to December 2014. HFpEF was defined as LVEF ≥ 50% at index admission. After 1 year, HFpEF patients were further classified as HFdEF (LVEF ≥ 50% at admission and < 50% at 1 year), and persistent HFpEF (LVEF ≥ 50% both at admission and 1 year). Primary outcome was 4-year all-cause mortality according to HF type from HFdEF diagnosis. RESULTS: Of patients with HFpEF, 426 (90.4%) were diagnosed as having persistent HFpEF and 45 (9.6%) as having HFdEF. Natriuretic peptide level was an independent predictor of HFdEF (natriuretic peptide level > median: odds ratio: 3.20, 95% confidence interval [CI]: 1.42-7.25, P = 0.005). During 4-year follow-up, patients with HFdEF had higher mortality than those with persistent HFpEF (Log-rank P < 0.001). After adjustment, HFdEF was associated with an almost twofold increased risk for mortality (hazard ratio 1.82, 95% CI 1.13-2.96, P = 0.015). The use of beta-blockers, renin-angiotensin system inhibitors, and mineralocorticoid receptor antagonists was not associated with improved prognosis of patients with HFdEF. CONCLUSIONS: HFdEF is a distinct HF type with grave outcomes. Further investigations that focus on HFdEF are warranted to better understand and develop treatment strategies for these high-risk patients. CLINICAL TRIAL REGISTRATION: ClinicalTrial.gov identifier: NCT01389843. URL: https://clinicaltrials.gov/ct2/show/NCT01389843 .
OBJECTIVE: Some patients with heart failure with preserved ejection fraction (HFpEF) experience declining of left-ventricular ejection fraction (LVEF) during follow-up. We aim to investigate the characteristics and outcomes of patients with HF with declining ejection fraction (HFdEF). METHODS: We analyzed a prospective, nationwide multicenter cohort with consecutive patients with acute HF enrolled from March 2011 to December 2014. HFpEF was defined as LVEF ≥ 50% at index admission. After 1 year, HFpEF patients were further classified as HFdEF (LVEF ≥ 50% at admission and < 50% at 1 year), and persistent HFpEF (LVEF ≥ 50% both at admission and 1 year). Primary outcome was 4-year all-cause mortality according to HF type from HFdEF diagnosis. RESULTS: Of patients with HFpEF, 426 (90.4%) were diagnosed as having persistent HFpEF and 45 (9.6%) as having HFdEF. Natriuretic peptide level was an independent predictor of HFdEF (natriuretic peptide level > median: odds ratio: 3.20, 95% confidence interval [CI]: 1.42-7.25, P = 0.005). During 4-year follow-up, patients with HFdEF had higher mortality than those with persistent HFpEF (Log-rank P < 0.001). After adjustment, HFdEF was associated with an almost twofold increased risk for mortality (hazard ratio 1.82, 95% CI 1.13-2.96, P = 0.015). The use of beta-blockers, renin-angiotensin system inhibitors, and mineralocorticoid receptor antagonists was not associated with improved prognosis of patients with HFdEF. CONCLUSIONS: HFdEF is a distinct HF type with grave outcomes. Further investigations that focus on HFdEF are warranted to better understand and develop treatment strategies for these high-risk patients. CLINICAL TRIAL REGISTRATION: ClinicalTrial.gov identifier: NCT01389843. URL: https://clinicaltrials.gov/ct2/show/NCT01389843 .
Authors: Alberico Del Torto; Andrea Igoren Guaricci; Francesca Pomarico; Marco Guglielmo; Laura Fusini; Francesco Monitillo; Daniela Santoro; Monica Vannini; Alexia Rossi; Giuseppe Muscogiuri; Andrea Baggiano; Gianluca Pontone Journal: Front Cardiovasc Med Date: 2022-03-09