Recovery of Ejection Fraction in Heart Failure: Frequency, Predictors, and Prognosis
Supervisor / Principle Investigator:
MD Class of 2020
Objective: To identify variables predicting ejection-fraction (EF) recovery and to characterize prognosis of heart failure (HF) patients with EF recovery (HFrecEF).
Methods: Retrospective study of adults referred for ≥ 2 echocardiograms separated by ≥ 6 months between 2008 and 2016 at the two largest echocardiography centers in Alberta who also had physician-assigned diagnosis of HF. Patients were classified as HFrEF if EF<40%, HFmEF if EF 41-49%, or HFpEF if EF>50%.
Results: Of 10,641 patients, 3124 had HFrEF at baseline: EF improved ≥10% in 1174 patients (37.6%) and while mean EF declined from 30.2% on initial echocardiogram to 28.6% on the second echocardiogram in those patients with persistent HFrEF, it improved from 26.1% to 46.4% in those with HFrecEF. On multivariate analysis, female sex (aOR 1.55, 95%CI 1.31-1.83), younger age (aOR per decade 1.21, 95%CI 1.14 to 1.28), atrial fibrillation (aOR 1.90, 95%CI 1.61-2.25), chronic kidney disease (aOR 1.25, 95%CI 1.04-1.50), hypertension (aOR 1.27, 95%CI 1.09-1.49), and using an ACE inhibitor (aOR 1.20, 95%CI 1.02-1.42) or a mineralocorticoid receptor antagonist (aOR 1.18, 95%CI 1.00-1.38) were associated with EF improvement. HFrecEF patients demonstrated lower rates per 1000 patient years of mortality (106vs. 164, aHR 0.70 [0.62-0.79]), all-cause hospitalizations (300 vs. 428, aHR 0.87 [0.79-0.95]), all-cause ER visits (569 vs. 799, aHR 0.88 [0.81-0.95]), and cardiac transplantation or LVAD implantation (2 vs. 10, aHR 0.21 [0.10-0.45]) compared to patients with persistent-HFrEF.
Conclusion: HFrecEF patients tended to be younger, female, and were more likely to have used ACE inhibitors or mineralocorticoid receptor antagonists. HFrecEF patients have a substantially better prognosis compared to those with persistent HFrEF, even after multivariate adjustment.