Heart failure patients with improved ejection fraction: Insights from the MECKI score database
Piergiuseppe Agostoni1,2, Francesca Romana Pluchinotta3, Elisabetta Salvioni1
1Centro Cardiologico Monzino, IRCCS, Milan, Italy.
European Journal of Heart Failure
|September 13, 2023
Summary
Patients with heart failure who improved ejection fraction (HFimpEF) show distinct clinical traits and better exercise capacity than those with persistently reduced ejection fraction (pHFrEF). While HFimpEF patients have a better prognosis, they still face risks for adverse outcomes.
Area of Science:
- Cardiology
- Heart Failure Research
- Clinical Phenotyping
Background:
- Left ventricular ejection fraction improvement is a key heart failure (HF) treatment goal.
- Limited data exists on the characteristics and prognosis of HF patients with improved ejection fraction (HFimpEF).
- Understanding HFimpEF distinctiveness from persistently reduced ejection fraction (pHFrEF) is crucial.
Purpose of the Study:
- To determine if HFimpEF patients exhibit a unique clinical phenotype, biological profile, and prognosis compared to pHFrEF patients.
- To analyze clinical, laboratory, echocardiographic, and exercise data in both HF groups.
Main Methods:
- Analysis of 7948 patients from the Metabolic Exercise Cardiac Kidney Indexes (MECKI) score database.
- Comparison of clinical, laboratory, ECG, echocardiographic, exercise, and survival data between HFimpEF (n=1504) and pHFrEF (n=6017) groups.
- Primary endpoint: composite of cardiovascular death, LVAD implantation, or urgent heart transplantation; median follow-up: 1490 days.
Main Results:
- HFimpEF patients demonstrated significantly lower HF severity markers, including higher ejection fraction (44.0% vs 29.7%), lower BNP (122 vs 373 pg/ml), and better peak oxygen uptake (62.2% vs 52.6% predicted).
- Cardiovascular mortality rates were lower in HFimpEF (26.6 per 1000 person-years) compared to pHFrEF (46.9 per 1000 person-years).
- Kaplan-Meier analysis indicated a better long-term prognosis for HFimpEF, though this diminished after adjusting for all variables except echocardiographic parameters.
Conclusions:
- Heart failure with improved ejection fraction (HFimpEF) patients represent a distinct group with characteristics mirroring systolic function recovery.
- Despite improved metrics, HFimpEF patients remain susceptible to adverse cardiovascular events.
- Further research is needed to fully elucidate the long-term risks and management strategies for HFimpEF.
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