Heart failure with improved ejection fraction: Beyond diagnosis to trajectory analysis

Area of Science:

• Cardiology
• Heart Failure Research
• Clinical Classification

Background:

• Left ventricular systolic dysfunction is a treatable cause of heart failure.
• A significant number of patients with heart failure with reduced ejection fraction (HFrEF) can improve their LV systolic function, leading to a new classification: HF with improved EF (HFimpEF).
• HFimpEF is recognized as a distinct clinical entity with improved mortality and adverse event rates compared to sustained HFrEF.

Purpose of the Study:

• To review the contemporary definition, epidemiology, and clinical course of HFimpEF.
• To identify factors associated with improvement in LV systolic function.
• To provide evidence-based recommendations for managing HFimpEF patients and suggest future research directions.

Main Methods:

• Review of contemporary guidelines and existing literature on HFimpEF.
• Analysis of clinical and imaging factors associated with LV systolic function improvement.
• Discussion of patient trajectories and outcomes in HFimpEF.

Main Results:

• Improvement in LVEF is associated with reduced mortality and HF-related outcomes.
• Predictors for HFimpEF and the rate of improvement require further investigation.
• Some patients maintain improved function, while others may experience recurrence, particularly upon discontinuation of guideline-directed medical therapy (GDMT).

Conclusions:

• HFimpEF represents an important clinical development in heart failure management.
• Understanding patient-specific factors influencing improvement and long-term maintenance is crucial.
• Optimized clinical management and continued research are essential for improving outcomes in HFimpEF patients.