Heart failure with normal LVEF in BIOSTAT-CHF. (1st October 2022)

• Record Type: Journal Article
• Authors: Baumhove, Lukas; Tromp, Jasper; Figarska, Sylwia; van Essen, Bart J.; Anker, Stefan D.; Dickstein, Kenneth; Cleland, John G.; Lang, Chim C.; Filippatos, Gerasimos; Ng, Leong L.; Samani, Nilesh J.; Metra, Marco; van Veldhuisen, Dirk J.; Lam, Carolyn S.P.; Voors, Adriaan A.; van der Meer, Peter
• Is Part Of: International journal of cardiology. Volume 364(2022)
• Page Start: 85
• Page End: 90
• Publication Date: 2022-10-01
• Subjects: Heart failure -- Women -- LVEF -- Normal LVEF -- BIOSTAT-CHF; ACEi Angiotensin-converting-enzyme inhibitors -- ANOVA One-way analysis of variance -- ARBs Angiotensin II receptor blockers -- BMI Body mass index -- CI Confidence interval -- HF Heart failure -- HFnEF Heart failure with normal ejection fraction -- HFpEF Heart failure with preserved ejection fraction -- HFrEF Heart failure with reduced ejection fraction -- HR Hazard Ratio -- IQR Interquartile range -- IVS Interventricular septum -- LA Left atrial -- LVEDD Left ventricular end diastolic diameter -- LVEDV Left ventricular end diastolic volume -- LVEF Left ventricular ejection fraction -- MRA Mineralocorticoid receptor antagonist -- NYHA New York Heart Association (NYHA) Functional Classification -- SD Standard deviation; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.05.054
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Aims: Several studies have shown that heart failure (HF) drug treatment seems to benefit patients with preserved ejection fraction (HFpEF) and a left ventricular ejection fraction (LVEF) up to 55–60% but not with higher LVEF. Certain HF drugs are now indicated in patients with HFpEF and a LVEF below normal. However, not much is known about patients with a normal LVEF. Therefore, we investigated the prevalence, clinical characteristics and outcome of patients with HF and a normal LVEF. Methods and results: Normal LVEF was defined according to the Recommendations for Cardiac Chamber Quantification from the American Society of Echocardiography as a LVEF ≥62% for men and ≥ 64% for women. Preserved ejection fraction was defined as a LVEF ≥50% and reduced ejection fraction as a LVEF <50%. In the total cohort of 1568 studied patients with heart failure (mean age 73 years; 33.6% female) 57 patients (3.6%) had a normal LVEF. These patients least likely had a previous myocardial infarction ( p < 0.001) or diabetes ( p = 0.045), had the lowest Left Ventricular End Diastolic Diameter ( p < 0.001), the highest rate of previous HF hospitalization in the last year ( p = 0.015), the highest cardiac output ( p < 0.001) and were most frequently women ( p < 0.001). Patients with a normal LVEF had the lowest risk for the primary combined outcome of all-cause mortality and HF hospitalization. Conclusion: Only 3.6% of patients with HF had a sex-adjusted normal LVEF. Despite the sex-adjusted cut-offs they were more frequently female with less ischemic heart disease, higher cardiac output and better clinical outcomes. Highlights: Only 3.6% of patients with HF had a sex-adjusted normal LVEF. Patients with a normal LVEF were most commonly women with less ischemic heart disease and diabetes. They had the lowest risk for the primary combined outcome of all-cause mortality and HF hospitalization.