Determinants of ejection fraction improvement in heart failure patients with reduced ejection fraction

Abstract

Abstract Aims This study aimed to investigate the prognostic value of dynamic changes in left ventricular ejection fraction (EF) for cardiovascular (CV) outcomes in an all‐comer heart failure (HF) population with reduced EF (HFrEF, EF 4 vs. ≤4 years, odd ratio [OR] = 0.477, 95% CI 0.305–0.745), no coronary artery disease (CAD vs. no CAD, OR = 0.583, 95% CI 0.396–0.858), and no ICD implantation (ICD vs. no ICD, OR = 0.341, 95% CI 0.228–0.511). Compared with niEF, iEF was significantly and independently associated with lower all‐cause mortality (22.1% vs. 31.1%, P = 0.019; hazard ratio [HR] = 0.674, 95% CI 0.469–0.968), lower CV mortality (8.9% vs. 16.1%, P = 0.015; HR = 0.539, 95% CI 0.317–0.916), and lower CV events risk (27.2% vs. 49.2%, P 1153 pg/mL, HR = 4.372, P < 0.001) were identified as independent risk factors for CV events in the iEF subgroup. ICD implantation (HR = 1.533, P = 0.011), elevated NT‐proBNP (HR = 1.626, P = 0.018), increased left atrial volume index (HR = 1.461, P = 0.021), reduced lateral mitral annular plane systolic excursion (HR = 1.478, P = 0.025), and reduced tricuspid plane systolic excursion (HR = 1.491, P = 0.039) were identified as risk factors for CV events in the niEF subgroup. Conclusions Improvement in EF is independently related to the longer survival and lower CV related mortality and hospitalization rate of HFrEF. Elevated baseline NT‐proBNP is identified as the strongest prognostic factor associated with increased CV events risk in HFrEF patients both with and without improved EF, regardless of age, sex, duration of HF, and other clinical risk factors.

Keywords

• HFrEF
• Improved ejection fraction
• Cardiovascular events
• Hospitalization