A Universal New Definition of Heart Failure With Improved Ejection Fraction for Patients With Coronary Artery Disease.

Haozhang Huang,Min Lei,Kunming Bao,Yong Liu,Bo Wang,Zhou Yang,Yibo He,Jiyan Chen,Qiang Li,Wenguang Lai,Jin Liu,Maimaitiaili Abudukerimu,Shiqun Chen,Ning Tan,Chun-Quan Ou,Yuying Hu

doi:10.3389/fphys.2021.770650

Abstract

Aims: The aims of this study were to describe the characteristics and outcomes of the universal new definition of heart failure with improved ejection fraction (HFimpEF) and to identify predictors for HFimpEF among patients with coronary artery disease (CAD).Methods: CAD subjects with heart failure with reduced ejection fraction (HFrEF) (EF ≤ 40%) at baseline were enrolled from the real-world registry of the Cardiorenal ImprovemeNt study from January 2007 to December 2018. The new definition of HFimpEF was defined as left ventricular EF (LVEF) of≤40% at baseline and with improvement of up to 40% and at least a ≥ 10% increase during 1 month to 1 year after discharge.Results: Of the 747 CAD patients with HFrEF (86.7% males, mean age: 61.4 ± 11 years), 267 (35.7%) patients conformed to the new HFimpEF definition. Patients with HFimpEF were younger (adjusted odds ratio [aOR]: 0.98 [0.97–0.99]) and had a higher rate of hypertension (aOR:1.43 [1.04–1.98]), lower rate of percutaneous coronary intervention (PCI) treatment at the time of detection of HFrEF (aOR: 0.48 [0.34–0.69]), history of PCI (aOR: 0.51 [0.28–0.88]), history of acute myocardial infarction (aOR: 0.40 [0.21–0.70]), and lower left ventricular end diastolic diameter (aOR: 0.92 [0.90–0.95]). During 3.3-year follow-up, patients with HFimpEF demonstrated lower rates of long-term all-cause mortality (13.1% vs. 20.8%, aHR: 0.61[0.41–0.90]).Conclusion: In our study, CAD patients with HFimpEF achieved a better prognosis compared to those with persistent HFrEF. Patients with CAD meeting the criteria for the universal definition of HFimpEF tended to be younger, presented fewer clinical comorbidities, and had lower left ventricular end diastolic diameter.

Highlights

Epidemiological data further demonstrate that heart failure (HF) is a global disease with increasing prevalence and burden (Bozkurt et al, 2021)
A total of 747 patients identified from admission records were divided into two groups
Compared to patients with persistent heart failure with reduced ejection fraction (HFrEF), the mean age of patients with HF with improved ejection fraction (HFimpEF) was 61.7 ± 10.8 years and males accounted for 85.8% (n = 229)

Summary

Introduction

Epidemiological data further demonstrate that heart failure (HF) is a global disease with increasing prevalence and burden (Bozkurt et al, 2021). The most common cause of HF is coronary artery disease (CAD) (Conrad et al, 2018). It is extremely important for a physician to use important indexes to evaluate both the measure and efficacy of therapy outcome among CAD patients with HF. A scientific panel has proposed a new working definition of HF with improved ejection fraction (HFimpEF) that includes a baseline left ventricular ejection fraction (LVEF) of ≤ 40%, a ≥ 10% increase from baseline LVEF, and a second measurement of LVEF of>40% (Wilcox et al, 2020; Bozkurt et al, 2021). Differences in the prognosis and clinical management of new patients with HFimpEF and those without improvement have attracted increasing attention, especially among patients with CAD

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Results

Discussion

Conclusion