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Temporal left ventricular ejection fraction variations and outcomes in wide population of cardiovascular patients
Radosław Szczerba1,2, Wiktoria Żelazna1,2, Jakub Sokołowski1,2
1First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
Insights
Improved left ventricular ejection fraction (LVEF) in heart failure (HF) patients predicts better outcomes. However, LVEF increase in non-HF patients did not show similar prognostic value, highlighting different clinical significance.
Area of Science:
- Cardiology and Cardiovascular Diseases
- Clinical Prognostics and Outcomes Research
Background:
- Heart failure with improved ejection fraction (HFimpEF) is linked to better prognosis.
- The clinical significance of left ventricular ejection fraction (LVEF) improvement in patients without heart failure is less understood.
- Understanding temporal LVEF variations is crucial for assessing long-term prognosis across cardiovascular conditions.
Purpose of the Study:
- To evaluate the long-term prognosis of patients with various cardiovascular disorders.
- To analyze the impact of temporal LVEF variations on prognosis in both heart failure (HF) and non-HF populations.
- To determine the clinical significance of LVEF improvement in patients with and without HF.
Main Methods:
- Retrospective analysis of 31,920 patients with at least two LVEF measurements separated by ≥1 month.
- HFimpEF defined as LVEF increase ≥10% in HF patients. Endpoints included all-cause mortality and Major Adverse Cardiac and Cerebrovascular Event (MACCE).
- Kaplan-Meier survival analysis and Cox proportional hazards models were used to assess prognosis.
Main Results:
- MACCE occurrence was higher in HF patients (12.78%/year) compared to non-HF patients (6.07%/year).
- In HF patients, improved or stable LVEF correlated with lower MACCE rates compared to decreased LVEF; HFimpEF was an independent predictor of MACCE.
- In non-HF patients, LVEF improvement was associated with higher MACCE occurrence than stable LVEF, and lower than deteriorating LVEF.
Conclusions:
- Temporal increase in LVEF is associated with improved survival in heart failure patients.
- LVEF improvement in patients without heart failure does not confer a survival benefit and may indicate increased risk.
- These findings underscore the differential prognostic implications of LVEF changes based on the presence or absence of heart failure.
Introduction:
Heart failure (HF) with improved ejection fraction (HFimpEF) was shown to be related with improved outcome but increase of left ventricular ejection fraction (LVEF) in patients without HF is of less known clinical significance. The aim of the study was to evaluate long-term prognosis in patients with different cardiovascular disorders, with and without HF, depending on temporal variations of LVEF.
Methods:
The study covered 31 920 patients (median age 71 years, 37.7% females) with different cardiovascular disorders and at least two measurements of LVEF separated by ≥1 month. Clinical parameters were acquired from database of Academic Repository of Clinical Cases of Medical University of Silesia. HFimpEF was defined by LVEF increase ≥10% in HF patients in relation to baseline value. The endpoints were all-cause mortality and Major Adverse Cardiac and Cerebrovascular Event (MACCE).
Results:
The median follow-up time was 51.5 months and LVEF was measured median 2 times. HF was diagnosed in 12 152 patients (38.1%), of which 2 843 (23.4%) experienced HFimpEF. MACCE occurrence was greater in HF than non-HF patients (12.78%/year vs. 6.07%/year, p < 0.001). In patients with HF, Kaplan-Meier survival curves showed significantly lower MACCE occurrence in HFimpEF and stable LVEF than in decreased LVEF (11.46%/year vs. 12.5%/year vs. 21.6%/year; log-rank p = 0.199 and p < 0.001) and HFimpEF constituted one of independent predictors of MACCE (HR = 0.84, 95% CI: 0.76-0.93). Conversely, in non-HF population patients with LVEF improvement had higher MACCE occurrence than patients with stable LVEF and lower than deteriorating LVEF (6.97%/year vs. 5.72%/year vs. 14.55%/year respectively; log-rank p = 0.001 and p < 0.001).
Conclusions:
Temporal increase of LVEF corresponds with improved survival in patients with HF but not among non-HF patients.
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