Trajectories of Left Ventricular Ejection Fraction After Acute Decompensation for Systolic Heart Failure: Concomitant Echocardiographic and Systemic Changes, Predictors, and Impact on Clinical Outcomes.

Abstract

Background Prospective longitudinal follow-up of left ventricular ejection fraction (LVEF) trajectories after acute cardiac decompensation of heart failure is lacking. We investigated changes in LVEF and covariates at 6-months' follow-up in patients with a predischarge LVEF ≤40%, and determined predictors and prognostic implications of LVEF changes through 18-months' follow-up. Methods and Results Interdisciplinary Network Heart Failure program participants (n=633) were categorized into subgroups based on LVEF at 6-months' follow-up: normalized LVEF (>50%; heart failure with normalized ejection fraction, n=147); midrange LVEF (41%-50%; heart failure with midrange ejection fraction, n=195), or persistently reduced LVEF (≤40%; heart failure with persistently reduced LVEF , n=291). All received guideline-directed medical therapies. At 6-months' follow-up, compared with patients with heart failure with persistently reduced LVEF, heart failure with normalized LVEF or heart failure with midrange LVEF subgroups showed greater reductions in LV end-diastolic/end-systolic diameters (both P<0.001), and left atrial systolic diameter (P=0.002), more increased septal/posterior end-diastolic wall-thickness (both P<0.001), and significantly greater improvement in diastolic function, biomarkers, symptoms, and health status. Heart failure duration <1 year, female sex, higher predischarge blood pressure, and baseline LVEF were independent predictors of LVEF improvement. Mortality and event-free survival rates were lower in patients with heart failure with normalized LVEF (P=0.002). Overall, LVEF increased further at 18-months' follow-up (P<0.001), while LV end-diastolic diameter decreased (P=0.048). However, LVEF worsened (P=0.002) and LV end-diastolic diameter increased (P=0.047) in patients with heart failure with normalized LVEF hospitalized between 6-months' follow-up and 18-months' follow-up. Conclusions Six-month survivors of acute cardiac decompensation for systolic heart failure showed variable LVEF trajectories, with >50% showing improvements by ≥1 LVEF category. LVEF changes correlated with various parameters, suggesting multilevel reverse remodeling, were predictable from several baseline characteristics, and were associated with clinical outcomes at 18-months' follow-up. Repeat hospitalizations were associated with attenuation of reverse remodeling. Registration URL: https://www.controlled-trials.com; Unique identifier: ISRCTN23325295.

• Authors: Judith Albert, Susanne Lezius, Stefan Störk, Caroline Morbach, Gülmisal Güder, Stefan Frantz, Karl Wegscheider, Georg Ertl, Christiane E Angermann
• Journal: Journal of the American Heart Association (J Am Heart Assoc) Vol. 10 Issue 3 Pg. e017822 (02 02 2021) ISSN: 2047-9980 [Electronic] England
• PMID: 33496189 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Acute Disease
• Aged
• Echocardiography (methods)
• Female
• Follow-Up Studies
• Germany (epidemiology)
• Heart Failure, Systolic (diagnosis, epidemiology, physiopathology)
• Heart Ventricles (diagnostic imaging, physiopathology)
• Hospitalization (trends)
• Humans
• Male
• Middle Aged
• Morbidity (trends)
• Prognosis
• Prospective Studies
• Stroke Volume (physiology)
• Survival Rate (trends)
• Time Factors
• Ventricular Function, Left (physiology)
• Ventricular Remodeling