Abstract 15746: Longitudinal Remodeling in Persistent Heart Failure With Reduced Ejection Fraction and Improved Ejection Fraction

Abstract

Background: Among patients with heart failure (HF) with reduced ejection fraction (HFrEF), a subpopulation improves ventricular function, HF with improved ejection fraction (HFimpEF). This study aimed to investigate the longitudinal remodeling trajectories associated with HFimpEF and with HFrEF. Methods: This was a retrospective cohort study, UC Davis Medical Center (2014 to 2022). The inclusion criteria included HF related ICD codes, a left ventricular ejection fraction (LVEF) ≤40%, and a B-type natriuretic peptide (BNP) ≥100 pg/mL. Longitudinal BNP and echocardiographic data were retrieved from electronic medical records. The HFimpEF group was defined as follows: an initial LVEF ≤40% with a subsequent >40% with a minimum 10% improvement after ≥3 months. Those not meeting these criteria were classified as persistent HFrEF. Longitudinal assessments were performed using linear mixed models, adjusted for baseline values. Results: The study included 1307 patients. The cohort median age was 65, 68% male, 57% white, with 39% developing HFimpEF. Compared to persistent HFrEF, the HFimpEF group exhibited evidence of reverse remodeling with increasing trends in LVEF, interventricular septal end diastole (IVSd), and decreasing trends in left ventricular internal dimension in systole (LVIDs) values with a p= <.01 between groups (Figure). However, BNP did not present significant changes over time, presenting sustained initial measurements ( p =0.08). Conclusion: Patients with HFimpEF in this cohort had different longitudinal remodeling patterns compared with persistent HFrEF. The HFimpEF group had increasing trends of LVEF, IVSd and decreasing trends of LVIDs. Suggesting reverse remodeling and lower longitudinal levels of BNP.