The Relationship between LVEF and Cardiovascular Outcomes Following Hospitalization for Heart failure: Insights from the RELAX-AHF-2 Trial

Abstract

Background Although left ventricular ejection fraction (LVEF) is routinely used to categorize heart failure (HF) patients, whether this variable predicts outcomes across the full spectrum of patients with acute heart failure (AHF) is uncertain. We assessed the relationship between LVEF and cardiovascular outcomes in a large cohort of patients hospitalized with AHF. Methods 6128 AHF patients from the RELAX-AHF-2 trial who had LVEF measured during AHF hospitalization were separated into quartiles: Q1, LVEF 7-29%; Q2, LVEF >29-38%; Q3, LVEF >38-50% and Q4, LVEF >50-87% in order to determine the relationship between LVEF and a composite of cardiovascular (CV) mortality and rehospitalization for HF or renal failure (RF) through 180 days, the individual components of this composite and all-cause mortality. Results Patients in the lowest LVEF quartile had the highest risk for the composite of CV mortality and HF or RF hospitalization. When LVEF was assessed as a continuous variable, risk for the composite outcome, its components and all-cause mortality became progressively lower as EF increased (HR 0.95, 95% CI 0.93-0.98 per 5% LVEF increase for composite endpoint, P Conclusions In patients hospitalized with AHF, cardiovascular events occurred more frequently at 180 days in patients in the lowest LVEF quartile, especially in patients with an ischemic etiology and pre-existing HF.