Phenotyping Heart Failure According to the Longitudinal Ejection Fraction Change: Myocardial Strain, Predictors, and Outcomes
Background Many patients with heart failure (HF) experience changes in left ventricular ejection fraction (LVEF) during follow‐up. We sought to evaluate the predictors and outcomes of different HF phenotypes according to longitudinal changes in EF. Methods and Results A total of 2104 patients with a...
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| Format: | Article |
| Language: | English |
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Wiley
2020-06-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.119.015009 |
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| author | Jin Joo Park Alexandre Mebazaa In‐Chang Hwang Jun‐Bean Park Jae‐Hyeong Park Goo‐Yeong Cho |
| author_facet | Jin Joo Park Alexandre Mebazaa In‐Chang Hwang Jun‐Bean Park Jae‐Hyeong Park Goo‐Yeong Cho |
| author_sort | Jin Joo Park |
| collection | DOAJ |
| description | Background Many patients with heart failure (HF) experience changes in left ventricular ejection fraction (LVEF) during follow‐up. We sought to evaluate the predictors and outcomes of different HF phenotypes according to longitudinal changes in EF. Methods and Results A total of 2104 patients with acute HF underwent echocardiography at baseline and follow‐up. Global longitudinal strain was measured at index admission. HF phenotypes were defined as persistent HF with reduced EF (persistent HFrEF, LVEF ≤40% at baseline and follow‐up), heart failure with improved ejection fraction (LVEF≤40% at baseline and improved to >40% at follow‐up), heart failure with declined ejection fraction (LVEF>40% at baseline and declined to ≤40% at follow up), and persistent HF with preserved EF (persistent HFpEF, LVEF>40% at baseline and follow‐up). Overall, 1130 patients had HFrEF at baseline; during follow‐up, 54.2% and 46.8% had persistent HFrEF and heart failure with improved ejection fraction, respectively. Among 975 patients with HFpEF at baseline, 89.5% and 10.5% had persistent HFpEF and heart failure with declined ejection fraction at follow‐up, respectively. The 5‐year all‐cause mortality rates were 43.1%, 33.1%, 24%, and 17% for heart failure with declined ejection fraction, persistent HFrEF, persistent HFpEF, and heart failure with improved ejection fraction, respectively (global log‐rank P<0.001). In multivariable analyses, each 1% increase in global longitudinal strain (greater contractility) was associated with 10% increased odds for heart failure with improved ejection fraction among patients with HFrEF at baseline and 7% reduced odds for heart failure with declined ejection fraction among patients with HFpEF at baseline. Conclusions LVEF changed during follow‐up. Each HF phenotype according to longitudinal LVEF changes has a distinct prognosis. Global longitudinal strain can be used to predict the HF phenotype. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03513653. |
| first_indexed | 2024-12-22T21:47:41Z |
| format | Article |
| id | doaj.art-f5e0054bf62d4f6a95385bab2b5f58a8 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-22T21:47:41Z |
| publishDate | 2020-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-f5e0054bf62d4f6a95385bab2b5f58a82022-12-21T18:11:27ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802020-06-0191210.1161/JAHA.119.015009Phenotyping Heart Failure According to the Longitudinal Ejection Fraction Change: Myocardial Strain, Predictors, and OutcomesJin Joo Park0Alexandre Mebazaa1In‐Chang Hwang2Jun‐Bean Park3Jae‐Hyeong Park4Goo‐Yeong Cho5Cardiovascular Center & Department of Internal Medicine Seoul National University Bundang Hospital Seongnam KoreaDepartment of Anesthesiology and Intensive Care Medicine Hôpitaux Universitaires Saint Louis Lariboisière APHP University Paris Diderot UMR 942 Inserm Paris FranceCardiovascular Center & Department of Internal Medicine Seoul National University Bundang Hospital Seongnam KoreaDepartment of Internal Medicine Seoul National University College of Medicine Seoul National University Hospital Seoul KoreaDepartment of Internal Medicine Chungnam National University Hospital Daejeon KoreaCardiovascular Center & Department of Internal Medicine Seoul National University Bundang Hospital Seongnam KoreaBackground Many patients with heart failure (HF) experience changes in left ventricular ejection fraction (LVEF) during follow‐up. We sought to evaluate the predictors and outcomes of different HF phenotypes according to longitudinal changes in EF. Methods and Results A total of 2104 patients with acute HF underwent echocardiography at baseline and follow‐up. Global longitudinal strain was measured at index admission. HF phenotypes were defined as persistent HF with reduced EF (persistent HFrEF, LVEF ≤40% at baseline and follow‐up), heart failure with improved ejection fraction (LVEF≤40% at baseline and improved to >40% at follow‐up), heart failure with declined ejection fraction (LVEF>40% at baseline and declined to ≤40% at follow up), and persistent HF with preserved EF (persistent HFpEF, LVEF>40% at baseline and follow‐up). Overall, 1130 patients had HFrEF at baseline; during follow‐up, 54.2% and 46.8% had persistent HFrEF and heart failure with improved ejection fraction, respectively. Among 975 patients with HFpEF at baseline, 89.5% and 10.5% had persistent HFpEF and heart failure with declined ejection fraction at follow‐up, respectively. The 5‐year all‐cause mortality rates were 43.1%, 33.1%, 24%, and 17% for heart failure with declined ejection fraction, persistent HFrEF, persistent HFpEF, and heart failure with improved ejection fraction, respectively (global log‐rank P<0.001). In multivariable analyses, each 1% increase in global longitudinal strain (greater contractility) was associated with 10% increased odds for heart failure with improved ejection fraction among patients with HFrEF at baseline and 7% reduced odds for heart failure with declined ejection fraction among patients with HFpEF at baseline. Conclusions LVEF changed during follow‐up. Each HF phenotype according to longitudinal LVEF changes has a distinct prognosis. Global longitudinal strain can be used to predict the HF phenotype. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03513653.https://www.ahajournals.org/doi/10.1161/JAHA.119.015009ejection fraction changeheart failureHFdEFHFiEFmyocardial strain |
| spellingShingle | Jin Joo Park Alexandre Mebazaa In‐Chang Hwang Jun‐Bean Park Jae‐Hyeong Park Goo‐Yeong Cho Phenotyping Heart Failure According to the Longitudinal Ejection Fraction Change: Myocardial Strain, Predictors, and Outcomes Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease ejection fraction change heart failure HFdEF HFiEF myocardial strain |
| title | Phenotyping Heart Failure According to the Longitudinal Ejection Fraction Change: Myocardial Strain, Predictors, and Outcomes |
| title_full | Phenotyping Heart Failure According to the Longitudinal Ejection Fraction Change: Myocardial Strain, Predictors, and Outcomes |
| title_fullStr | Phenotyping Heart Failure According to the Longitudinal Ejection Fraction Change: Myocardial Strain, Predictors, and Outcomes |
| title_full_unstemmed | Phenotyping Heart Failure According to the Longitudinal Ejection Fraction Change: Myocardial Strain, Predictors, and Outcomes |
| title_short | Phenotyping Heart Failure According to the Longitudinal Ejection Fraction Change: Myocardial Strain, Predictors, and Outcomes |
| title_sort | phenotyping heart failure according to the longitudinal ejection fraction change myocardial strain predictors and outcomes |
| topic | ejection fraction change heart failure HFdEF HFiEF myocardial strain |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.119.015009 |
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