Abstract 13775: Determinants and Prognostic Implications of Improved and Non-Improved Left Ventricular Ejection Fraction in Chronic Heart Failure

Abstract

Introduction: Clinical implications of improvement in left ventricular ejection fraction (LV EF) are not well investigated. Hypothesis: To evaluate determinants and prognostic value of longitudinal changes in ejection fraction among chronic heart failure (HF) patients with reduced EF (HFrEF, EF ≤40%) and to determine risk factors of adverse outcomes among HFrEF patients with or without improve EF Methods: 573 consecutive hospitalized HFrEF patients (aged 66±13years, male 75.6%) with baseline (BL) and follow-up (FUP) echocardiography examinations (interval at least ≥12 months) were included. Patients were divided into improved EF (iEF, ≥5% increase in FUP_EF, n=335) or non-improved EF (niEF, <5% increase in FUP_EF, n=238). Primary endpoints included all-cause death, cardiovascular (CV) death, and CV rehospitalization. Results: Lower BL_EF (≤30%, OR 2.70, P<0.001), smaller LV end-diastolic dimension (<65mm, OR 2.62, P<0.001), and absence of coronary artery disease (CAD, OR 1.73, P=0.006) independently associated with EF improvement in this cohort. During follow-up (median 27 months), overall mortality (20.3% vs. 38.2%), CV mortality (9.0% vs. 19.7%), CV rehospitalization rate (25.4% vs. 45.0%), and HF rehospitalization rate (8.4% vs. 20.6%) were all significantly lower in iEF group than in niEF group (all P<0.001). After adjustment for age, sex, and other confounders associated with CV events, iEF remained independently associated with lower overall mortality (HR 0.50, P<0.001), CV mortality (HR 0.43, P<0.001), CV and HF rehospitalization (HR 0.44 and 0.34, P<0.001). For HFrEF patients with iEF, elevated C-reaction protein and NT-proBNP levels were related to increased risk of CV events. For HFrEF patients with niEF, elevated NT-proBNP, reduced longitudinal systolic function, and enlarged RV were independently related to increased risk of CV events. Conclusions: Improvement in LV EF during follow-up is a powerful determinant of reduced overall mortality, CV mortality, and CV rehospitalization in HFrEF patients independent of age, sex and other identified risk factors.