Different Impact of Changes in Left Ventricular Ejection Fraction Between Heart Failure Classifications in Patients With Acute Decompensated Heart Failure

  • Yamamoto Masayoshi
    Department of Cardiology, Faculty of Medicine, University of Tsukuba
  • Seo Yoshihiro
    Department of Cardiology, Faculty of Medicine, University of Tsukuba
  • Ishizu Tomoko
    Department of Cardiology, Faculty of Medicine, University of Tsukuba
  • Nishi Isao
    Department of Cardiology, Tsuchiura Clinical Education and Training Center
  • Hamada-Harimura Yoshie
    Department of Cardiology, Graduate School of Comprehensive Human Sciences, University of Tsukuba
  • Machino-Ohtsuka Tomoko
    Department of Cardiology, Faculty of Medicine, University of Tsukuba
  • Sato Kimi
    Department of Cardiology, Faculty of Medicine, University of Tsukuba
  • Sai Seika
    Department of Cardiology, Graduate School of Comprehensive Human Sciences, University of Tsukuba
  • Nakatsukasa Tomofumi
    Department of Cardiology, Faculty of Medicine, University of Tsukuba
  • Sugano Akinori
    Cardiovascular Center, Tsuchiura Kyodo Hospital
  • Baba Masako
    Department of Cardiology, Ibaraki Prefectural Central Hospital
  • Obara Kenichi
    Division of Cardiology, Ryugasaki Saiseikai General Hospital
  • Aonuma Kazutaka
    Department of Cardiology, Faculty of Medicine, University of Tsukuba
  • Ieda Masaki
    Department of Cardiology, Faculty of Medicine, University of Tsukuba

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Abstract

<p>Background: Left ventricular ejection fraction (LVEF) can dramatically change when the patient has acute decompensated heart failure (ADHF). We investigated the impact of LVEF and subsequent changes on prognosis in patients with ADHF through a prospective study.</p><p>Methods and Results: A total of 516 hospitalized patients with ADHF were evaluated. Echocardiography was performed on admission, prior to discharge, and 1 year after discharge. The primary endpoint was a composite of cardiovascular death and hospitalization. In heart failure with reduced EF (HFrEF; LVEF <40%), LVEF did not significantly improve during hospitalization (P=0.348); however, it improved after discharge (P<0.001). In contrast, LVEF improved during hospitalization (P<0.001) in HF with preserved EF (HFpEF; LVEF ≥50%). In HF with mid-range EF (HFmrEF; LVEF 40–49%), LVEF consistently improved throughout the observation period (P<0.001). A multivariable Cox model showed that improved LVEF after discharge was associated with a better outcome in HFrEF (hazard ratio [HR]: 0.951; 95% confidence interval [CI]: 0.928–0.974; P<0.001), while improved LVEF during hospitalization was associated with a better outcome in HFpEF (HR: 0.969; 95% CI: 0.940–0.998; P=0.038). </p><p>Conclusions: Improved LVEF after discharge in HFrEF and during hospitalization in HFpEF was associated with a better prognosis in patients with ADHF. Longitudinal improvements in LVEF had different prognostic impact, depending on the HF type by LVEF measurement. </p>

Journal

  • Circulation Journal

    Circulation Journal 83 (3), 584-594, 2019-02-25

    The Japanese Circulation Society

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