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Updated: Jun 27, 2026
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Why and when do patients with heart failure and normal left ventricular ejection fraction die? Analysis of >600
Lilian Grigorian-Shamagian1, Fernando Otero Raviña, Emad Abu Assi
1Cardiology Department and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
Insights
Long-term heart failure (HF) death causes are similar regardless of left ventricular ejection fraction (LVEF). Short-term risks differ, particularly for acute myocardial infarction and non-cardiac deaths in patients with normal LVEF.
Area of Science:
- Cardiology
- Heart Failure Research
- Clinical Outcomes
Background:
- Investigating mortality causes in hospitalized heart failure (HF) patients.
- Comparing death causes between patients with normal and depressed left ventricular ejection fraction (LVEF).
Purpose of the Study:
- To analyze HF patient mortality causes.
- To identify differences in death causes based on LVEF status.
Main Methods:
- Retrospective analysis of 615 hospitalized HF patients (1995-2002).
- LVEF assessed by echocardiography (normal >=50%).
- Mean follow-up of 3.7 years.
Main Results:
- Refractory HF was the leading cause of death (39%) in all groups.
- No significant long-term difference in death distribution by LVEF.
- Depressed LVEF showed higher sudden death incidence (21% vs 16%) and lower refractory HF death (37% vs 47%).
- Short-term mortality dynamics from acute myocardial infarction, vascular, and non-cardiovascular causes differed between LVEF groups.
Conclusions:
- Long-term mortality spectrum in HF patients is independent of LVEF.
- Short-term mortality risk dynamics vary between normal and depressed LVEF groups.
- Findings may guide HF management, especially for normal LVEF patients lacking consensus strategies.
Background:
The aim of the study was to examine the causes of the death of patients with heart failure (HF) and evaluate the differences in this respect between patients with and without depression of left ventricular ejection fraction (LVEF).
Method:
All patients hospitalized with HF between 1995 and 2002 in the cardiology service of a tertiary hospital were assessed. LVEF was evaluated by echocardiography during hospitalization and was considered normal when it was > or =50%. After a mean follow-up time of 3.7 +/- 2.8 years, 615 cases had terminated in death.
Results:
The most common cause was refractory HF, both in the whole group (39%) and in both the subgroups defined with respect to LVEF (normal and depressed). There was no statistically significant difference between the normal and depressed subgroups as regard the distribution of deaths, although the depressed group showed a somewhat greater incidence of sudden death (21% as against 16% in the normal group) and a somewhat smaller incidence of death due to refractory HF (37% as against 47%). However, in the depressed LVEF group, the cumulative risk of death due to acute myocardial infarction in the first 1.5 years first increased rapidly and then more slowly, whereas the reverse pattern was held in the normal left ventricular systolic function group, in which it was the cumulative risks of death from noncardiovascular or vascular noncardiac causes that initially increased more rapidly than later.
Conclusions:
The spectrum of causes of death among patients with HF who have been hospitalized is independent of LVEF in the long term. In the short term, there are differences between patients with normal LVEF and depressed LVEF as regard the dynamics of the risks of death from acute myocardial infarction, noncardiac vascular causes, and noncardiovascular causes. These results may help orient the short-term and long-term management of HF, especially for patients with normal LVEF, for whom there is still no well-established consensus strategy.
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