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Characteristics, Predictors, and Clinical Outcomes in Heart Failure With Reduced Ejection Fraction According to a

Chan Soon Park1,2, Jiesuck Park2,3, Nan Young Bae1,2

  • 1Cardiovascular Center Seoul National University Hospital Seoul Republic of Korea.

Journal of the American Heart Association
|October 25, 2024
PubMed

Insights

Patients with heart failure with reduced ejection fraction (HFrEF) who improved their left ventricular ejection fraction (LVEF) after ARNI therapy had better outcomes. ARNI treatment showed benefits over RAAS inhibitors for both improved and persistent HFrEF.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Optimal medical treatment can improve left ventricular ejection fraction (LVEF) in patients with heart failure with reduced ejection fraction (HFrEF).
  • Angiotensin receptor-neprilysin inhibitors (ARNI) are a key therapy for HFrEF.
  • Understanding outcomes based on LVEF response to ARNI is crucial.

Purpose of the Study:

  • To investigate the characteristics, predictors, and outcomes of HFrEF based on 1-year LVEF following ARNI therapy.
  • To compare ARNI therapy with renin-angiotensin-aldosterone system (RAAS) inhibitors.

Main Methods:

  • Analysis of the STRATS-HF-ARNI registry (N=1074) with baseline and 1-year echocardiography.
  • Classification of patients into HF with improved ejection fraction (HFimpEF; LVEF >40%) and persistent HFrEF (perHFrEF; LVEF ≤40%).
  • Assessment of all-cause and cardiac mortality as primary and secondary outcomes.

Main Results:

  • 46.4% of patients achieved HFimpEF, while 53.6% had perHFrEF.
  • Older age, male sex, and larger LV end-diastolic volumes predicted perHFrEF.
  • HFimpEF was associated with significantly lower all-cause and cardiac mortality (P<0.001).
  • perHFrEF was an independent predictor of poor outcomes (HR 2.402, P=0.008).
  • Mortality risk decreased with increasing LVEF up to 40%, with no further reduction beyond that.
  • ARNI therapy demonstrated better outcomes than RAAS inhibitors in both HFimpEF and perHFrEF groups.

Conclusions:

  • Patients achieving HFimpEF after ARNI therapy have a better prognosis than those with perHFrEF.
  • ARNI treatment appears more beneficial than RAAS inhibitors for both HFimpEF and perHFrEF patients.
  • LVEF improvement to >40% is associated with improved survival in HFrEF patients on ARNI.
Abstract

Keywords:
ARNIejection fractionheart failuremortality

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