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Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Heart Failure With Improved Ejection Fraction in ACHD With Biventricular Physiology and Systemic Left Ventricle
Ahmed E Ali1, Zeyad Kholeif1, Marwan Ahmed1
1Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA.
Insights
Guideline-directed medical therapy (GDMT) improves left ventricular ejection fraction (LVEF) in adults with congenital heart disease (CHD) and heart failure with reduced ejection fraction (HFrEF). This improvement is linked to better survival and fewer cardiovascular events.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Heart Failure Research
Background:
- Guideline-directed medical therapy (GDMT) improves left ventricular ejection fraction (LVEF) in acquired heart disease, but data are limited for congenital heart disease (CHD).
- Heart failure with improved ejection fraction (HFimpEF) is a recognized outcome in acquired heart disease.
- Understanding HFimpEF in CHD is crucial for optimizing patient management.
Purpose of the Study:
- To determine the prevalence of HFimpEF in adults with CHD and systemic left ventricles.
- To identify factors associated with HFimpEF in this population.
- To evaluate the prognostic impact of HFimpEF on mortality and cardiovascular events.
Main Methods:
- Retrospective analysis of adults with CHD, biventricular physiology, and systemic LV with HFrEF (2003-2023).
- Echocardiograms assessed LVEF at baseline and 1-year follow-up; HFimpEF defined as LVEF increase ≥10% (≤40% to >40%).
- GDMT use and uptitration (ΔGDMT) quantified; Cox regression analyzed outcomes.
Main Results:
- 19% (63/327) of patients achieved HFimpEF.
- Higher GDMT use and ΔGDMT were associated with increased odds of HFimpEF.
- HFimpEF correlated with a 26% reduction in all-cause mortality and 28% in cardiovascular events.
Conclusions:
- GDMT is associated with improved LVEF and outcomes in adults with CHD and HFrEF.
- Optimization and adherence to GDMT are recommended for this patient group.
- Ongoing clinical and imaging surveillance is necessary for patients with CHD-related HFimpEF.
Background:
In patients with heart failure (HF) with reduced ejection fraction (HFrEF) from acquired heart disease, guideline-directed medical therapy (GDMT) for HF is associated with improved left ventricular (LV) ejection fraction (LVEF) (ie, HF with improved EF (HFimpEF), and which in turn is associated with improved survival. Similar data are lacking in patients with congenital heart disease (CHD).
Objectives:
The objective of the study was to describe the prevalence, correlates, and prognostic implications of HFimpEF in adults with CHD, biventricular physiology, and systemic LV.
Methods:
Retrospective study of adults with CHD, biventricular physiology, and systemic LV presenting with HFrEF (2003-2023). Echocardiogram was performed at baseline and 1-year follow-up encounters. GDMT use was assessed at baseline and 1-year follow-up encounters using GDMT score. GDMT uptitration (ΔGDMT) was calculated as the difference between GDMT scores. HFimpEF was defined as HF with baseline LVEF ≤40%, and a subsequent absolute LVEF increase ≥10%, leading to LVEF >40% at follow-up echocardiogram. HFrEF relapse was defined as decline in absolute LVEF >10% leading to LVEF ≤40% in patients with HFimpEF. Cox regression analysis was used to assess the relationship between HFimpEF, GDMT score, and outcomes (death and cardiovascular events).
Results:
Of the 327 patients (age 46 ± 16 years; LVEF 31% ± 6%), 63 (19%) had HFimpEF. GDMT use (higher baseline and ΔGDMT) was associated with great odds of HFimpEF. HFimpEF was associated with a 26% decrease in all-cause mortality, and 28% decrease in cardiovascular events on multivariable analysis compared to patients without improvement in LVEF. Of the 63 patients with HFimpEF, 27% had HFrEF relapse, and HFrEF relapse was associated with higher risk of cardiovascular events.
Conclusions:
These data support the use and optimization of GDMT in this subgroup of CHD patients, and the need for ongoing clinical and imaging surveillance.
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