Heart failure & cardiomyopathies
Determinants of Ejection Fraction Improvement in Heart Failure Patients with Reduced Ejection Fraction
Primary result · CV events (primary composite)Result — go to the resultHazard ratio 0.519 95% CI 0.381–0.708Authors' conclusion
Improvement in EF is independently related to the longer survival and lower CV related mortality and hospitalization rate of HFrEF. Elevated baseline NT-proBNP is identified as the strongest prognostic factor associated with increased CV events risk in HFrEF patients both with and without improved EF, regardless of age, sex, duration of HF, and other clinical risk factors.
Study context
- Population
- Consecutive patients with chronic HFrEF (ejection fraction (EF) < 40%) hospitalized July 2009–December 2017, with baseline and follow-up echocardiography (interval ≥12 months)
- Participants
- 573 patients
- Comparison
- Improved EF vs non-improved EF
- Primary endpoint
- Composite of:
- CV death
- CV hospitalization
- Appropriate ICD therapy for ventricular arrhythmia
Methodological detailsretrospective
- Retrospective
Primary result
CV events (primary composite)
Hazard ratio
0.519
95% CI 0.381–0.708
P < 0.001
By group
As reported in the abstract
Further findings
| Outcome | iEF | niEF | Estimate | P value | |
|---|---|---|---|---|---|
| All-cause mortalityAdjusted | 22.1% | 31.1% | HR 0.674 (95% CI 0.469–0.968) | P = 0.019 | |
| CV mortalityAdjusted | 8.9% | 16.1% | HR 0.539 (95% CI 0.317–0.916) | P = 0.015 | |
| Independent determinants of iEFHF duration >4 yearsvs ≤4 years | OR 0.477 (95% CI 0.305–0.745) | ||||
| Independent determinants of iEFCADvs no CAD | OR 0.583 (95% CI 0.396–0.858) | ||||
| Independent determinants of iEFICDvs no ICD | OR 0.341 (95% CI 0.228–0.511) | ||||
| 0.20.5125Ratio (log scale) |
Proportion with EF improvement · median 17 months
- EF improved
- 37.2%
Risk factors for cardiovascular (CV) events in improved EF (iEF) (subgroup)
- Hypertension HR = 2.452
- P = 0.032
- NT-proBNP >1153 pg/mL HR = 4.372
- P < 0.001
Risk factors for CV events in non-improved EF (niEF) (subgroup)
- Implantable cardioverter-defibrillator (ICD) implantation HR = 1.533
- P = 0.011
- Elevated NT-proBNP HR = 1.626
- P = 0.018
- Increased left atrial volume index HR = 1.461
- P = 0.021
- Reduced lateral mitral annular plane systolic excursion HR = 1.478
- P = 0.025
- Reduced tricuspid plane systolic excursion HR = 1.491
- P = 0.039
Original publication
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