Changes in Left Ventricular Ejection Fraction Predict Survival and Hospitalization in Heart Failure With Reduced...

Area of Science:

• Cardiology
• Clinical Outcomes Research
• Heart Failure Management

Background:

• Left ventricular remodeling, assessed by left ventricular ejection fraction (LVEF), impacts patient outcomes.
• Serial LVEF measurements are inconsistently used in observational studies.
• The prognostic value of LVEF change over time requires further characterization.

Purpose of the Study:

• To evaluate the prognostic significance of changes in LVEF over time.
• To determine if serial LVEF measurements improve prediction of clinical outcomes in heart failure.
• To assess the incremental value of LVEF change beyond traditional predictors.

Main Methods:

• Analysis of data from the β-Blocker Evaluation of Survival Trial (2484 patients).
• LVEF measured by radionuclide ventriculography at baseline, 3, and 12 months.
• Multivariable models incorporating 16 clinical parameters and change in LVEF were used to predict clinical endpoints.

Main Results:

• Change in LVEF was the second most significant predictor of all-cause mortality, after baseline creatinine.
• An improvement in LVEF by ≥5% was associated with a 38% reduction in all-cause mortality (HR 0.62).
• LVEF change improved predictive discrimination and was consistent across treatment groups, though sex and race influenced benefit.

Conclusions:

• Serial assessment of LVEF change is a valuable prognostic tool in heart failure with reduced LVEF.
• LVEF change provides a dynamic, real-time measure of prognosis for survival and heart failure hospitalizations.
• LVEF change offers incremental prognostic information beyond established clinical predictors.