Heart failure with mildly reduced ejection fraction: retrospective study of ejection fraction trajectory risk
Abstract Aims Heart failure with mildly reduced ejection fraction (HFmrEF) is associated with a favourable prognosis compared with heart failure (HF) with reduced ejection fraction (EF). We assessed whether left ventricular ejection fraction (LVEF) trajectory can be used to identify groups of patien...
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Wiley
2022-06-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.13869 |
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| author | Robert J.H. Miller Majid Nabipoor Erik Youngson Gynter Kotrri Nowell M. Fine Jonathan G. Howlett Ian D. Paterson Justin Ezekowitz Finlay A. McAlister |
| author_facet | Robert J.H. Miller Majid Nabipoor Erik Youngson Gynter Kotrri Nowell M. Fine Jonathan G. Howlett Ian D. Paterson Justin Ezekowitz Finlay A. McAlister |
| author_sort | Robert J.H. Miller |
| collection | DOAJ |
| description | Abstract Aims Heart failure with mildly reduced ejection fraction (HFmrEF) is associated with a favourable prognosis compared with heart failure (HF) with reduced ejection fraction (EF). We assessed whether left ventricular ejection fraction (LVEF) trajectory can be used to identify groups of patients with HFmrEF who have different clinical outcomes in a large retrospective study of patients with serial imaging. Methods and results Patients with HF and ≥2 echocardiograms performed ≥6 months apart were included if the LVEF measured 40–49% on the second study. Patients were classified as HFmrEF‐Increasing if LVEF had increased ≥10% (n = 450), HFmrEF‐Decreasing if LVEF had decreased ≥10% (n = 512), or HFmrEF‐Stable if they did not meet other criteria (n = 389). The primary outcome was all‐cause mortality or cardiovascular hospitalization after the second echocardiogram. Associations with time to first event were assessed with multivariable Cox analyses adjusted for age, co‐morbidities, and medications. In total, 1351 patients with HFmrEF (median age 74, 64.2% male) were included with 28.8% exhibiting stable LVEF. During median follow‐up of 15.3 months, the composite outcome occurred in 811 patients. During follow‐up, patients with HFmrEF‐Increasing were less likely to experience the primary outcome [adjusted hazard ratio (HR) 0.72, 95% confidence interval (CI) 0.60–0.88, P < 0.001] compared with HFmrEF‐Stable. Patients with HFmrEF‐Decreasing were more likely to experience the composite outcome in unadjusted analyses (unadjusted HR 1.19, 95% CI 1.01–1.40, P = 0.040) but not adjusted analyses (adjusted HR 1.16, 95% CI 0.98–1.37, P = 0.092). Associations with death or HF hospitalizations were similar (HFmrEF‐Increasing: adjusted HR 0.72, 95% CI 0.59–0.88, P = 0.005; HFmrEF‐Decreasing: adjusted HR 1.20, 95% CI 1.01–1.44, P = 0.044). Patients with HFmrEF‐Decreasing had a similar risk of the composite outcome as patients with HF with reduced EF (adjusted HR 1.03, 95% CI 0.89–1.20, P = 0.670). Patients with HFmrEF‐Increasing were less likely to experience the composite outcome compared with patients with HF with preserved EF (adjusted HR 0.73, 95% CI 0.62–0.87, P < 0.001). Conclusions Amongst patients with HFmrEF, those exhibiting positive LVEF trajectory were less likely to experience adverse outcomes after correcting for important confounders including medical therapy. Categorizing HFmrEF patients based on LVEF trajectory provides meaningful clinical information and may assist clinicians with management decisions. |
| format | Article |
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| institution | Kabale University |
| issn | 2055-5822 |
| language | English |
| publishDate | 2022-06-01 |
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| series | ESC Heart Failure |
| spelling | doaj-art-2e021f95c12148db88015b98931eedfe2025-02-05T05:22:10ZengWileyESC Heart Failure2055-58222022-06-01931564157310.1002/ehf2.13869Heart failure with mildly reduced ejection fraction: retrospective study of ejection fraction trajectory riskRobert J.H. Miller0Majid Nabipoor1Erik Youngson2Gynter Kotrri3Nowell M. Fine4Jonathan G. Howlett5Ian D. Paterson6Justin Ezekowitz7Finlay A. McAlister8Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine University of Calgary Calgary AB CanadaData and Research Services, Alberta SPOR Support Unit and Provincial Research Data Services Alberta Health Services Edmonton AB CanadaData and Research Services, Alberta SPOR Support Unit and Provincial Research Data Services Alberta Health Services Edmonton AB CanadaDivision of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine University of Calgary Calgary AB CanadaDivision of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine University of Calgary Calgary AB CanadaDivision of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine University of Calgary Calgary AB CanadaCanadian VIGOUR Centre, Faculty of Medicine and Dentistry University of Alberta 5‐134 Clinical Sciences Building Edmonton AB T6R 2R3 CanadaCanadian VIGOUR Centre, Faculty of Medicine and Dentistry University of Alberta 5‐134 Clinical Sciences Building Edmonton AB T6R 2R3 CanadaCanadian VIGOUR Centre, Faculty of Medicine and Dentistry University of Alberta 5‐134 Clinical Sciences Building Edmonton AB T6R 2R3 CanadaAbstract Aims Heart failure with mildly reduced ejection fraction (HFmrEF) is associated with a favourable prognosis compared with heart failure (HF) with reduced ejection fraction (EF). We assessed whether left ventricular ejection fraction (LVEF) trajectory can be used to identify groups of patients with HFmrEF who have different clinical outcomes in a large retrospective study of patients with serial imaging. Methods and results Patients with HF and ≥2 echocardiograms performed ≥6 months apart were included if the LVEF measured 40–49% on the second study. Patients were classified as HFmrEF‐Increasing if LVEF had increased ≥10% (n = 450), HFmrEF‐Decreasing if LVEF had decreased ≥10% (n = 512), or HFmrEF‐Stable if they did not meet other criteria (n = 389). The primary outcome was all‐cause mortality or cardiovascular hospitalization after the second echocardiogram. Associations with time to first event were assessed with multivariable Cox analyses adjusted for age, co‐morbidities, and medications. In total, 1351 patients with HFmrEF (median age 74, 64.2% male) were included with 28.8% exhibiting stable LVEF. During median follow‐up of 15.3 months, the composite outcome occurred in 811 patients. During follow‐up, patients with HFmrEF‐Increasing were less likely to experience the primary outcome [adjusted hazard ratio (HR) 0.72, 95% confidence interval (CI) 0.60–0.88, P < 0.001] compared with HFmrEF‐Stable. Patients with HFmrEF‐Decreasing were more likely to experience the composite outcome in unadjusted analyses (unadjusted HR 1.19, 95% CI 1.01–1.40, P = 0.040) but not adjusted analyses (adjusted HR 1.16, 95% CI 0.98–1.37, P = 0.092). Associations with death or HF hospitalizations were similar (HFmrEF‐Increasing: adjusted HR 0.72, 95% CI 0.59–0.88, P = 0.005; HFmrEF‐Decreasing: adjusted HR 1.20, 95% CI 1.01–1.44, P = 0.044). Patients with HFmrEF‐Decreasing had a similar risk of the composite outcome as patients with HF with reduced EF (adjusted HR 1.03, 95% CI 0.89–1.20, P = 0.670). Patients with HFmrEF‐Increasing were less likely to experience the composite outcome compared with patients with HF with preserved EF (adjusted HR 0.73, 95% CI 0.62–0.87, P < 0.001). Conclusions Amongst patients with HFmrEF, those exhibiting positive LVEF trajectory were less likely to experience adverse outcomes after correcting for important confounders including medical therapy. Categorizing HFmrEF patients based on LVEF trajectory provides meaningful clinical information and may assist clinicians with management decisions.https://doi.org/10.1002/ehf2.13869Heart failureLVEFEchocardiogramHeart failure with mildly reduced ejection fractionLVEF trajectory |
| spellingShingle | Robert J.H. Miller Majid Nabipoor Erik Youngson Gynter Kotrri Nowell M. Fine Jonathan G. Howlett Ian D. Paterson Justin Ezekowitz Finlay A. McAlister Heart failure with mildly reduced ejection fraction: retrospective study of ejection fraction trajectory risk ESC Heart Failure Heart failure LVEF Echocardiogram Heart failure with mildly reduced ejection fraction LVEF trajectory |
| title | Heart failure with mildly reduced ejection fraction: retrospective study of ejection fraction trajectory risk |
| title_full | Heart failure with mildly reduced ejection fraction: retrospective study of ejection fraction trajectory risk |
| title_fullStr | Heart failure with mildly reduced ejection fraction: retrospective study of ejection fraction trajectory risk |
| title_full_unstemmed | Heart failure with mildly reduced ejection fraction: retrospective study of ejection fraction trajectory risk |
| title_short | Heart failure with mildly reduced ejection fraction: retrospective study of ejection fraction trajectory risk |
| title_sort | heart failure with mildly reduced ejection fraction retrospective study of ejection fraction trajectory risk |
| topic | Heart failure LVEF Echocardiogram Heart failure with mildly reduced ejection fraction LVEF trajectory |
| url | https://doi.org/10.1002/ehf2.13869 |
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