Heart Failure With Improved Ejection Fraction: Clinical Characteristics, Correlates of Recovery, and Survival. (July 2016)

• Record Type: Journal Article
• Authors: Florea, Viorel G.; Rector, Thomas S.; Anand, Inder S.; Cohn, Jay N.
• Is Part Of: Circulation. Volume 9:Number 7(2016)
• Publication Date: 2016-07
• Subjects: biomarker -- blood pressure -- heart failure -- prognosis -- valsartan; Heart failure -- Periodicals; 616.129005
• DOI: 10.1161/CIRCHEARTFAILURE.116.003123
• Languages: English
• ISSNs: 1941-3289

Abstract

Abstract : Background—: Heart failure with recovered or improved ejection fraction (HFiEF) has been proposed as a new category of HF. Whether HFiEF is clinically distinct from HF with persistently reduced ejection fraction remains to be validated. Methods and Results—: Of the 5010 subjects enrolled in the Valsartan Heart Failure Trial (Val-HeFT), 3519 had a baseline left ventricular EF of <35% and a follow-up echocardiographic assessment of EF at 12 months. Of these, 321 (9.1%) patients who had a 12-month EF of >40% constituted the subgroup with HFiEF. EF improved from 28.7±5.6% to 46.5±5.6% in the subgroup with HFiEF and remained reduced (25.2±6.2% and 27.5±7.1%) in the subgroup with HF with reduced ejection fraction. The group with HFiEF had a less severe hemodynamic, biomarker, and neurohormonal profile, and it was treated with a more intense HF medication regimen. Subjects who had higher blood pressure and those treated with a β-blocker or randomized to valsartan had greater odds of being in the HFiEF group, whereas those with an ischemic pathogenesis, a more dilated left ventricle, and a detectable hs-troponin had lower odds of an improvement in EF. Recovery of the EF to >40% was associated with a better survival compared with persistently reduced EF. Conclusions—: Our data support HFiEF as a stratum of HF with reduced ejection fraction with a more favorable outcome, which occurs in a minority of patients with HF with reduced ejection fraction who have a lower prevalence of ischemic heart disease, a less severe hemodynamic, biomarker, and neurohormonal profile, and who are treated with a more intense HF medication regimen. Clinical Trial Registration—: URL:http://www.clinicaltrials.gov . Unique identifier: NCT00336336.