Prognostic implications of left ventricular ejection fraction trajectory changes in heart failure

Area of Science:

• Cardiology
• Heart Failure Research
• Clinical Outcomes

Background:

• Current heart failure (HF) guidelines emphasize assessing left ventricular ejection fraction (LVEF) trajectory.
• Real-world data on LVEF trajectory in HF patients is limited.
• Understanding LVEF changes is crucial for patient prognostication.

Purpose of the Study:

• To investigate the frequency of LVEF trajectory changes in a real-world HF cohort.
• To determine the prognostic implications of different LVEF trajectories.
• To analyze the association between LVEF changes and patient outcomes.

Main Methods:

• Patients were categorized into intensified, static, or worsening LVEF groups.
• Groups were further subdivided based on the magnitude of LVEF change (mild ≤10% vs. significant >10%).
• Cox regression analysis was used to assess the association between LVEF trajectories and composite endpoints.

Main Results:

• Nearly 40% of HF with reduced ejection fraction (HFrEF) and HF with mildly reduced ejection fraction (HFmrEF) patients showed LVEF improvement.
• A decline in LVEF was noted in 19.3% of HF with preserved ejection fraction (HFpEF) and 34.9% of HFmrEF patients.
• Intensified LVEF trajectories correlated with lower composite endpoint risk, while worsening trajectories showed the opposite.

Conclusions:

• LVEF trajectories are strongly linked to outcomes in HF patients with a history of HF admission.
• Significant LVEF changes have the most pronounced prognostic implications.
• LVEF trajectory and HF type changes are recommended prognostic tools.