Prognostic Implications of Left Ventricular Ejection Fraction Improvement in Patients with Heart Failure with Reduced...

This study aimed to evaluate the prognostic implications and optimal timing for assessing left ventricular ejection fraction (LVEF) trajectory in patients with heart failure (HF) and an LVEF < 50%.

The Taiwan Society of Cardiology HF Registry 2020 is a prospective, multicenter registry of hospitalized HF patients in Taiwan. This study included patients with an LVEF < 50% during their index HF hospitalization, and at least one follow-up echocardiogram within 2 years. HF with improved EF (HFimpEF) was defined as an absolute increase in LVEF > 10% from baseline. The primary endpoints were all-cause mortality and HF hospitalization at 2 years. Predictors of an improvement in LVEF trajectory were also evaluated.

A total of 1478 patients were enrolled, with 873 in the HFimpEF group and 605 in the non-HFimpEF group. HFimpEF was associated with a lower risk of mortality (hazard ratio: 0.41 [0.27-0.62], p < 0.001) and reduced HF hospitalizations (8.6% vs. 24.4%, p < 0.001) at 2 years follow-up. Subgroup analysis showed that survival benefits diverged at an LVEF improvement > 10%, emerging as early as 6 months and persisting beyond 12 months. Lower baseline LVEF was paradoxically associated with better survival. Neither maximal guideline-directed medical therapy (GDMT) score nor revascularization correlated with LVEF trajectory. However, HFimpEF patients received higher doses of renin-angiotensin system inhibitors and beta-blockers in the first year.

LVEF trajectory at 6 months appears to be a valuable prognostic tool, and higher-dose fundamental HF therapy was more important than achieving a higher overall GDMT score.