Clinical predictors of preserved left ventricular ejection fraction in decompensated heart failure

Identification and clinical impact of preserved left ventricular ejection fraction (LVEF) on in-hospital outcomes in patients with acute decompensated heart failure (HF) remain poorly defined.

To describe clinical predictors and in-hospital outcomes of acute decompensated HF patients and preserved LVEF, and to develop a clinically-based predictive rule based on data acquired on admission.

Consecutive admissions for HF (n=721) at a tertiary care hospital were followed up to discharge or death. More than 80 clinical variables were evaluated to identify predictors of preserved LVEF upon admission.

Preserved LVEF (>50%) was identified in 224 (31%) hospitalizations. Clinical predictors of preserved LVEF were age > 70 years old (p=0.04), female gender (p<0.001), non-ischemic etiology (p<0.001), atrial fibrillation or flutter (p=0.001), anemia (p=0.001), pulse pressure > 45 mmHg (p<0.01) and absence of EKG conduction abnormalities (p<0.001). A clinical score based on these variables was accurate to predict preserved LVEF upon hospital admission (area under ROC curve of 0.76). No significant differences were observed on in-hospital mortality or clinical complications according to quintiles of LVEF.

Preserved LVEF is a prevalent and morbid condition among hospitalized HF patients. Simple clinical data obtained on admission might be useful for predicting preserved LVEF.