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Updated: May 26, 2025
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Clinical determinants and long-term survival in heart failure with supra-normal ejection fraction. Insights from
Konrad Stępień1, Karolina Eliasz2, Karol Nowak3
1Department of Coronary Artery Disease and Heart Failure, St. John Paul II Hospital, Kraków, Poland; Department of Thromboembolic Disorders, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland; "Club 30", Polish Cardiac Society, Warsaw, Poland.
Insights
Heart failure with supra-normal ejection fraction (HFsnEF) is a new category of heart failure. HFsnEF patients have higher long-term mortality compared to those with heart failure with preserved ejection fraction (HFpEF).
Area of Science:
- Cardiology
- Heart Failure Research
- Clinical Outcomes
Background:
- Heart failure with supra-normal ejection fraction (HFsnEF), defined as LVEF > 65%, is a novel but understudied category of heart failure.
- Understanding the clinical profile and long-term prognosis of HFsnEF is crucial for patient management.
Purpose of the Study:
- To characterize Polish patients diagnosed with HFsnEF.
- To determine the long-term mortality associated with HFsnEF.
Main Methods:
- Analysis of 1186 patients from the LECRA-HF registry (2009-2019).
- 40 patients classified as HFsnEF and 221 as HFpEF (LVEF ≥50%).
- Collection of baseline characteristics, treatments, and laboratory/echocardiographic data; mortality assessed via National Death Registry.
Main Results:
- HFsnEF patients were less frequently hypertensive and received fewer mineralocorticoid receptor antagonists and loop diuretics compared to HFpEF.
- Kaplan-Meier analysis revealed significantly higher all-cause mortality in HFsnEF (65%) versus HFpEF (55.2%).
- Independent predictors of mortality included age and HFsnEF diagnosis (HR 1.665).
Conclusions:
- Approximately 1 in 7 Polish patients with HFpEF may meet criteria for HFsnEF.
- HFsnEF patients exhibit similar baseline characteristics to HFpEF patients.
- HFsnEF diagnosis is linked to reduced long-term survival in this cohort.
Purpose:
Heart failure with supra-normal ejection fraction (HFsnEF), defined as HF with left ventricular ejection fraction (LVEF) > 65 %, constitutes a novel HF category. However, its clinical characteristics and long-term outcomes remain insufficiently elucidated. We sought to characterize Polish HFsnEF patients and provide their long-term mortality.
Material And Methods:
Of 1186 patients enrolled in the single-center Lesser Poland Cracovian Heart Failure (LECRA-HF) registry between years 2009 and 2019, 261 (22 %) were classified as HF with LVEF ≥50 %. Of them, 40 (15.3 %) were classified as HFsnEF, and the remaining 221 (84.7 %) as HF with preserved EF (HFpEF). Baseline characteristics, prior cardiovascular treatment, laboratory and echocardiographic measurements have been collected during index hospitalization. The long-term follow-up of all-cause mortality was obtained from the National Death Registry.
Results:
HFsnEF patients were less frequently hypertensive (75 vs 88.2 %, P = 0.026) and they were less often treated with mineralocorticoid receptor antagonists (25 vs 46.2 %, P = 0.013) and loop diuretics (60 vs 76 %, P = 0.017). The Kaplan-Meier analysis showed that all-cause mortality is higher in HFsnEF than in HFpEF (65 vs 55.2 %, P = 0.044). The independent predictors of long-term mortality were age and HFsnEF diagnosis (hazard ratio [HR] 1.037, 95 % confidence interval [CI] 1.018-1.056; HR 1.665, 95 % CI 1.063-2.608, respectively).
Conclusions:
Our findings indicate that every 7th Polish patient admitted with HFpEF could be classified as HFsnEF. Baseline characteristics of HFsnEF patients are not significantly different from HFpEF. Simultaneously, in the longest follow-up to date, HFsnEF diagnosis is associated with lower long-term survival.
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