Changes in left ventricular systolic function for 1 year in patients with acute heart failure <50 years of age

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Though old age is an important risk factor for cardiovascular disease including heart failure (HF), HF can develop in young patients and can have a greater impact on a quality of life because they are active individuals. Purpose We evaluated the clinical characteristics and prognosis according to change of left ventricular (LV) function in younger patients with acute HF. Methods Study data were obtained from a multicenter cohort that included patients hospitalized for acute HF. Patients who were under 50 years of age and had available data regarding baseline and one-year follow-up left ventricular ejection fraction (LVEF) were included in this analysis. Patient were classified into two groups according changes in LVEF: the improved or stationary group whose LVEF improved or maintained at one-year follow-up; the aggravated LVEF group whose LVEF deteriorated at one-year follow-up. Results Among 437 patients, 14.6% of patients had experienced worsening of LVEF at the one-year follow-up. The patients in aggravated LVEF group had a worse clinical profile than patients with improved or stationary LVEF. During follow-up (median 1946 days), a total of 56 patients (12.8%) died. Among them, the aggravated LVEF group had higher incidence of all-cause death (32.8% vs. 9.4%, p < 0.001). The aggravated LVEF group showed significant lower cumulative all-cause death free survival rate than improved or stationary LVEF group (Figure). In addition, the aggravated LVEF group had significantly higher incidence of cardiac death (14.1% vs. 2.9%, p < 0.001), readmission (76.6% vs. 55.5%, p = 0.002), readmission due to cardiac cause (57.8% vs.30.8%, p < 0.001), and HF readmission (51.6% vs. 26.0%, p < 0.001). After adjusting for confounding factors, Cox regression analysis showed that use of angiotensin converting enzyme inhibitors at discharge was independently associated with 63% reduced risk of aggravated LVEF (Odds ratio 0.37, 95% confidence interval 0.168–0.791, p = 0.001). Conclusions Poor clinical prognosis is expected if LVEF worsens after 1 year in young patients with HF. Clinicians need to be aware of the deteriorating characteristics of young HF patients and provide delicate treatment.