Heart Failure With Midrange Ejection Fraction: Prior Left Ventricular Ejection Fraction and Prognosis
Aims: Evidence-based guidelines for heart failure management depend mainly on current left ventricular ejection fraction (LVEF). However, fewer studies have examined the impact of prior LVEF. Patients may enter the heart failure with midrange ejection fraction (HFmrEF) category when heart failure wi...
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| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2021-08-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2021.697221/full |
| _version_ | 1818597154231418880 |
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| author | Xinxin Zhang Yuxi Sun Yanli Zhang Feifei Chen Shuyuan Zhang Hongyan He Shuang Song Gary Tse Gary Tse Ying Liu |
| author_facet | Xinxin Zhang Yuxi Sun Yanli Zhang Feifei Chen Shuyuan Zhang Hongyan He Shuang Song Gary Tse Gary Tse Ying Liu |
| author_sort | Xinxin Zhang |
| collection | DOAJ |
| description | Aims: Evidence-based guidelines for heart failure management depend mainly on current left ventricular ejection fraction (LVEF). However, fewer studies have examined the impact of prior LVEF. Patients may enter the heart failure with midrange ejection fraction (HFmrEF) category when heart failure with preserved ejection fraction (HFpEF) deteriorates or heart failure with reduced ejection fraction (HFrEF) improves. In this study, we examined the association between change in LVEF and adverse outcomes.Methods: HFmrEF patients with at least two or more echocardiograms 3 months apart at the First Affiliated Hospital of Dalian Medical University between September 1, 2015 and November 30, 2019 were identified. According to the prior LVEF, the subjects were divided into improved group (prior LVEF < 40%), stable group (prior LVEF between 40 and 50%), and deteriorated group (prior LVEF ≥ 50%). The primary outcomes were cardiovascular death, all-cause mortality, hospitalization for worsening heart failure, and composite event of all-cause mortality or all-cause hospitalization.Results: A total of 1,168 HFmrEF patients (67.04% male, mean age 63.60 ± 12.18 years) were included. The percentages of improved, stable, and deteriorated group were 310 (26.54%), 334 (28.60%), and 524 (44.86%), respectively. After a period of follow-up, 208 patients (17.81%) died and 500 patients met the composite endpoint. The rates of all-cause mortality were 35 (11.29%), 55 (16.47%), and 118 (22.52%), and the composite outcome was 102 (32.90%), 145 (43.41%), and 253 (48.28%) for the improved, stable, and deteriorated groups, respectively. Cox regression analysis showed that the deterioration group had higher risk of cardiovascular death (HR: 1.707, 95% CI: 1.064–2.739, P = 0.027), all-cause death (HR 1.948, 95% CI 1.335–2.840, P = 0.001), and composite outcome (HR 1.379, 95% CI 1.096–1.736, P = 0.006) compared to the improvement group. The association still remained significant after fully adjusted for both all-cause mortality (HR = 1.899, 95% CI 1.247–2.893, P = 0.003) and composite outcome (HR: 1.324, 95% CI: 1.020–1.718, P = 0.035).Conclusion: HFmrEF patients are heterogeneous with three different subsets identified, each with different outcomes. Strategies for managing HFmrEF should include previously measured LVEF to allow stratification based on direction changes in LVEF to better optimize treatment. |
| first_indexed | 2024-12-16T11:43:17Z |
| format | Article |
| id | doaj.art-38d19cbe309d4f02921b9b5e9b082b86 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-12-16T11:43:17Z |
| publishDate | 2021-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-38d19cbe309d4f02921b9b5e9b082b862022-12-21T22:32:53ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2021-08-01810.3389/fcvm.2021.697221697221Heart Failure With Midrange Ejection Fraction: Prior Left Ventricular Ejection Fraction and PrognosisXinxin Zhang0Yuxi Sun1Yanli Zhang2Feifei Chen3Shuyuan Zhang4Hongyan He5Shuang Song6Gary Tse7Gary Tse8Ying Liu9Heart Failure and Structural Cardiology Ward, The First Affiliated Hospital of Dalian Medical University, Dalian, ChinaHeart Failure and Structural Cardiology Ward, The First Affiliated Hospital of Dalian Medical University, Dalian, ChinaHeart Failure and Structural Cardiology Ward, The First Affiliated Hospital of Dalian Medical University, Dalian, ChinaHeart Failure and Structural Cardiology Ward, The First Affiliated Hospital of Dalian Medical University, Dalian, ChinaHeart Failure and Structural Cardiology Ward, The First Affiliated Hospital of Dalian Medical University, Dalian, ChinaHeart Failure and Structural Cardiology Ward, The First Affiliated Hospital of Dalian Medical University, Dalian, ChinaHeart Failure and Structural Cardiology Ward, The First Affiliated Hospital of Dalian Medical University, Dalian, ChinaHeart Failure and Structural Cardiology Ward, The First Affiliated Hospital of Dalian Medical University, Dalian, ChinaKent and Medway Medical School, Canterbury, United KingdomHeart Failure and Structural Cardiology Ward, The First Affiliated Hospital of Dalian Medical University, Dalian, ChinaAims: Evidence-based guidelines for heart failure management depend mainly on current left ventricular ejection fraction (LVEF). However, fewer studies have examined the impact of prior LVEF. Patients may enter the heart failure with midrange ejection fraction (HFmrEF) category when heart failure with preserved ejection fraction (HFpEF) deteriorates or heart failure with reduced ejection fraction (HFrEF) improves. In this study, we examined the association between change in LVEF and adverse outcomes.Methods: HFmrEF patients with at least two or more echocardiograms 3 months apart at the First Affiliated Hospital of Dalian Medical University between September 1, 2015 and November 30, 2019 were identified. According to the prior LVEF, the subjects were divided into improved group (prior LVEF < 40%), stable group (prior LVEF between 40 and 50%), and deteriorated group (prior LVEF ≥ 50%). The primary outcomes were cardiovascular death, all-cause mortality, hospitalization for worsening heart failure, and composite event of all-cause mortality or all-cause hospitalization.Results: A total of 1,168 HFmrEF patients (67.04% male, mean age 63.60 ± 12.18 years) were included. The percentages of improved, stable, and deteriorated group were 310 (26.54%), 334 (28.60%), and 524 (44.86%), respectively. After a period of follow-up, 208 patients (17.81%) died and 500 patients met the composite endpoint. The rates of all-cause mortality were 35 (11.29%), 55 (16.47%), and 118 (22.52%), and the composite outcome was 102 (32.90%), 145 (43.41%), and 253 (48.28%) for the improved, stable, and deteriorated groups, respectively. Cox regression analysis showed that the deterioration group had higher risk of cardiovascular death (HR: 1.707, 95% CI: 1.064–2.739, P = 0.027), all-cause death (HR 1.948, 95% CI 1.335–2.840, P = 0.001), and composite outcome (HR 1.379, 95% CI 1.096–1.736, P = 0.006) compared to the improvement group. The association still remained significant after fully adjusted for both all-cause mortality (HR = 1.899, 95% CI 1.247–2.893, P = 0.003) and composite outcome (HR: 1.324, 95% CI: 1.020–1.718, P = 0.035).Conclusion: HFmrEF patients are heterogeneous with three different subsets identified, each with different outcomes. Strategies for managing HFmrEF should include previously measured LVEF to allow stratification based on direction changes in LVEF to better optimize treatment.https://www.frontiersin.org/articles/10.3389/fcvm.2021.697221/fullheart failuremid-range ejection fractionpriorleft ventricular ejection fractionprognosis |
| spellingShingle | Xinxin Zhang Yuxi Sun Yanli Zhang Feifei Chen Shuyuan Zhang Hongyan He Shuang Song Gary Tse Gary Tse Ying Liu Heart Failure With Midrange Ejection Fraction: Prior Left Ventricular Ejection Fraction and Prognosis Frontiers in Cardiovascular Medicine heart failure mid-range ejection fraction prior left ventricular ejection fraction prognosis |
| title | Heart Failure With Midrange Ejection Fraction: Prior Left Ventricular Ejection Fraction and Prognosis |
| title_full | Heart Failure With Midrange Ejection Fraction: Prior Left Ventricular Ejection Fraction and Prognosis |
| title_fullStr | Heart Failure With Midrange Ejection Fraction: Prior Left Ventricular Ejection Fraction and Prognosis |
| title_full_unstemmed | Heart Failure With Midrange Ejection Fraction: Prior Left Ventricular Ejection Fraction and Prognosis |
| title_short | Heart Failure With Midrange Ejection Fraction: Prior Left Ventricular Ejection Fraction and Prognosis |
| title_sort | heart failure with midrange ejection fraction prior left ventricular ejection fraction and prognosis |
| topic | heart failure mid-range ejection fraction prior left ventricular ejection fraction prognosis |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2021.697221/full |
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