Improvement of LVEF in patients with HFrEF with coronary heart disease after revascularization-A real-world study

Area of Science:

• Cardiology
• Interventional Cardiology
• Heart Failure Management

Background:

• Ischemic heart failure with reduced ejection fraction (HFrEF) significantly impacts patient outcomes.
• Revascularization strategies aim to improve cardiac function in patients with HFrEF.
• Predicting left ventricular ejection fraction (LVEF) improvement is crucial for guiding treatment decisions.

Purpose of the Study:

• To identify predictive factors for LVEF improvement following revascularization in patients with ischemic HFrEF.
• To analyze factors influencing the degree of LVEF improvement after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).

Main Methods:

• A real-world study of 993 patients with ischemic HFrEF who underwent revascularization.
• Patients were categorized based on LVEF change post-revascularization (≥10% improvement vs. <10% improvement or deterioration).
• Cox regression and multivariate generalized estimation analyses were employed to identify predictive factors.

Main Results:

• Four hundred fifty-four patients showed ≥10% LVEF improvement, while 539 had <10% improvement or deterioration.
• Independent predictors for ≥10% LVEF improvement included female sex, prior MI, baseline LVEF, digoxin use, loop diuretic use, and triple-vessel disease.
• Factors associated with the degree of LVEF improvement included low LVEF, short LV end-systolic diameter (LVESD), short LV end-diastolic diameter (LVEDD), no prior MI, no hyperuricemia, clopidogrel use, and triple-vessel disease.

Conclusions:

• Revascularization method (PCI vs. CABG) did not influence LVEF improvement.
• Patients with severely impaired baseline LVEFs, triple-vessel disease, or no history of MI showed a tendency for marked LVEF improvement.
• LVESD, LVEDD, hyperuricemia, clopidogrel use, and loop diuretic use affected the degree of LVEF improvement.