Heart Failure With Midrange Ejection Fraction: Prior Left Ventricular Ejection Fraction and Prognosis

Area of Science:

• Cardiology
• Heart Failure Research
• Echocardiography

Background:

• Current heart failure management guidelines primarily rely on left ventricular ejection fraction (LVEF).
• Limited research exists on the prognostic impact of prior LVEF in patients with heart failure with midrange ejection fraction (HFmrEF).
• HFmrEF patients can transition from heart failure with preserved ejection fraction (HFpEF) or heart failure with reduced ejection fraction (HFrEF).

Purpose of the Study:

• To investigate the association between changes in LVEF and adverse clinical outcomes in HFmrEF patients.
• To stratify HFmrEF patients based on prior LVEF status (improved, stable, or deteriorated).
• To determine if prior LVEF influences cardiovascular death, all-cause mortality, and hospitalization rates.

Main Methods:

• Retrospective cohort study of 1,168 HFmrEF patients with at least two echocardiograms 3 months apart.
• Patients categorized into improved (prior LVEF < 40%), stable (prior LVEF 40-50%), and deteriorated (prior LVEF ≥ 50%) groups.
• Primary outcomes included cardiovascular death, all-cause mortality, heart failure hospitalization, and a composite endpoint.

Main Results:

• The deteriorated group (44.86%) had significantly higher rates of all-cause mortality and composite outcomes compared to the improved group (26.54%).
• Cox regression analysis revealed that the deteriorated group had a higher risk of cardiovascular death (HR: 1.707), all-cause death (HR: 1.948), and composite outcome (HR: 1.379).
• These associations remained significant after adjusting for potential confounders.

Conclusions:

• HFmrEF patients exhibit heterogeneity, with distinct outcomes based on LVEF trajectory.
• Prior LVEF measurements and their changes are crucial for risk stratification in HFmrEF management.
• Treatment strategies for HFmrEF should incorporate historical LVEF data to optimize patient care.