Transient versus persistent improved ejection fraction in non-ischaemic dilated cardiomyopathy

Area of Science:

• Cardiology
• Heart Failure Research
• Cardiomyopathy Studies

Background:

• The definition of heart failure with improved ejection fraction (HFimpEF) highlights the need for longitudinal left ventricular ejection fraction (LVEF) assessment.
• Long-term progression and outcomes in the HFimpEF subgroup, particularly in non-ischaemic dilated cardiomyopathy (NICM), remain underexplored.

Purpose of the Study:

• To investigate LVEF trajectories in patients with NICM and improved ejection fraction (impEF).
• To correlate these LVEF trajectories with clinical outcomes, including death, heart transplantation, and left ventricular assist device implantation.

Main Methods:

• Analysis of consecutive NICM patients from the Trieste Heart Muscle Disease Registry with baseline LVEF ≤40% and at least one follow-up LVEF assessment.
• ImpEF defined as baseline LVEF ≤40% with a subsequent increase of ≥10% and LVEF >40%. Transient impEF identified by recurrent LVEF ≤40% during follow-up.
• Primary endpoint: composite of all-cause death, heart transplantation, and left ventricular assist device (D/HT/LVAD).

Main Results:

• 57% of 800 NICM patients (460 individuals) achieved impEF, with a median time to improvement of 13 months.
• Transient impEF was observed in 41% of the impEF group (189 patients) and was linked to a 2.54-fold increased risk of D/HT/LVAD compared to persistent impEF.
• The association between declining LVEF and D/HT/LVAD risk was non-linear, showing a sharp increase with up to an 8% point reduction in LVEF.

Conclusions:

• A high rate of impEF (57%) was observed in NICM patients.
• Recurrent LVEF decline occurred in approximately 40% of impEF patients, significantly associated with an increased risk of D/HT/LVAD.
• Longitudinal LVEF monitoring is crucial for risk stratification in NICM patients with impEF.