Left ventricular ejection fraction changes after an episode of decompensated acute heart failure: a three-year follow-up

Aim. To study the incidence and clinical prognostic significance of changes in heart failure (HF) phenotype based on left ventricular ejection fraction (LVEF) changes over 3 years.

Material and methods. This retrospective study included 157 patients hospitalized with acute decompensated heart failure (ADHF). The results of baseline echocardiography and repeat examinations at 3, 6, 12, 24, and 36 months were assessed. Patients were divided into subgroups based on baseline LVEF as follows: HF with reduced LVEF (HFrEF) (<40%), HF with mildly reduced LVEF (HFmrEF) (40-49%), and HF with preserved LVEF (HFpEF) (≥50%).

Results. Among patients with baseline HFrEF, transition to the HFpEF subgroup was observed in 14%, and transition to the HFmrEF in 20%, while an increase in LVEF >10% was noted in 31% of patients. In the HFmrEF subgroup, LVEF normalized in 48% of patients, and decreased to <40% in 22%. In the HFpEF subgroup, a decrease in LVEF <40% was recorded in 10% of cases. According to the Cox model, the transition from the HFrEF subgroup to the HF with improved EF subgroup was associated with higher overall survival (HR (hazard ratio) 4,57; 95% confidence interval (CI): 1,039-20,177; p=0,04). The risk of cardiovascular death in patients who transitioned from the HFrEF subgroup to any other subgroup (HFmrEF, HFpEF) was also associated with improved survival (HR 8,852; 95% CI: 1,139-68,805, p=0,04). In the HFpEF subgroup, a decrease in LVEF <40% was associated with an increased risk of cardiovascular mortality (HR 4,906; 95% CI: 1,08622,153; p=0,039).

Conclusion. Clinically significant improvement in cardiac function is observed in almost half of patients with a baseline reduced LVEF and is associated with a better prognosis. A decrease in LVEF in the HFpEF subgroup is a predictor of unfavorable outcome.

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