Graded Associations Between Left Ventricular Ejection Fraction Improvement and Cardiorenal Outcomes in Heart Failure...

Improvement in left ventricular ejection fraction (LVEF) aligns with better outcomes in patients with heart failure with reduced EF. Nonetheless, detailed relationship between the extent of LVEF improvement and the risks of adverse cardiorenal events remains unclear.

From 2011 to 2021, a retrospective cohort of 601 patients with heart failure with reduced EF who underwent follow-up echocardiography within 6 months was enrolled and followed until March 31, 2022. Patients were classified as nonimprovement (follow-up LVEF ≤40% or <10% absolute LVEF improvement), partial improvement (follow-up LVEF >40% with 10% to <20% improvement), or full improvement (follow-up LVEF >40% and ≥20% improvement). Multivariable Cox regression was used to estimate associations between LVEF improvement and the composite and individual risks of all-cause mortality, major adverse cardiovascular events, and major adverse kidney events.

Over a median follow-up of 2.62 years, 67 deaths, 121 major adverse cardiovascular events, and 100 major adverse kidney events occurred. Compared with the nonimprovement group, only the full-improvement group was independently associated with lower risks of the composite outcome (adjusted hazard ratio [aHR], 0.36 [95% CI, 0.20-0.63]), major adverse cardiovascular events (aHR, 0.33 [95% CI, 0.18-0.61]), and major adverse kidney events (aHR, 0.39 [95% CI, 0.19-0.82]). Graded associations between LVEF improvement and decreased cardiorenal risks were confirmed in spline analyses and consistent across subgroup and sensitivity analyses. Maintenance of improved LVEF for 1 year was further associated with lower risks for the adverse cardiorenal outcomes.

Greater and sustained LVEF improvement is linked to lower risks of cardiorenal events in heart failure with reduced EF, emphasizing the value of incorporating improvement magnitude into risk assessment.