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Prognostic significance of subsequent decline in LVEF in heart failure with improved ejection fraction - A report

Takuya Takigahira1, Kotaro Nochioka2, Satoshi Miyata1

  • 1Teikyo University Graduate School of Public Health, Japan.

International Journal of Cardiology. Heart & Vasculature
|February 3, 2026
PubMed

Insights

Some heart failure patients who improve their ejection fraction may experience a decline, facing risks similar to persistent heart failure with reduced ejection fraction. Prognosis for this group requires careful monitoring.

Area of Science:

  • Cardiology
  • Heart Failure Research
  • Clinical Prognostics

Background:

  • A subset of heart failure patients with improved ejection fraction (HFimpEF) can experience a subsequent decline in left ventricular ejection fraction (LVEF).
  • The long-term prognosis for these patients with HFimpEF experiencing LVEF decline remains uncertain, necessitating further investigation.

Purpose of the Study:

  • To investigate the clinical characteristics of patients with heart failure who experience a temporary improvement in ejection fraction but later decline.
  • To evaluate the long-term prognosis and identify risk factors associated with LVEF decline in the HFimpEF population.

Main Methods:

  • Analysis of 399 patients with heart failure with reduced ejection fraction (HFrEF) from the CHART-2 Study, with LVEF data at baseline and follow-up.
  • Classification into persistent HFrEF, temporary HFimpEF (improved then declined), and persistent HFimpEF groups based on 1-year and 2-year LVEF measurements.
  • Statistical analysis including hazard ratios and odds ratios to assess risks and identify predictors of LVEF decline.

Main Results:

  • The temporary HFimpEF group (HR: 2.95) and persistent HFrEF group (HR: 2.53) showed significantly increased risks for cardiovascular death and HF hospitalization.
  • Key risk factors for LVEF decline at 1-year follow-up included lower LVEF, larger LV end-diastolic dimension (LVDd), elevated B-type natriuretic peptide (BNP), lower estimated glomerular filtration rate (eGFR), and lower serum sodium levels.

Conclusions:

  • Patients experiencing a temporary improvement in ejection fraction (HFrecEF) constitute 23% of HFrEF patients, with 12% showing subsequent LVEF decline.
  • This subgroup with temporary HFimpEF and subsequent decline shares a worse prognosis comparable to those with persistent HFrEF, highlighting the need for vigilant management.
Abstract

Keywords:
EpidemiologyHeart failureLeft ventricular ejection fractionPrognosis

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