Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Nov;5(6):720-6.
doi: 10.1161/CIRCHEARTFAILURE.111.966366. Epub 2012 Aug 30.

Longitudinal changes in ejection fraction in heart failure patients with preserved and reduced ejection fraction

Shannon M Dunlay  1 , Véronique L Roger, Susan A Weston, Ruoxiang Jiang, Margaret M Redfield
Affiliations

Longitudinal changes in ejection fraction in heart failure patients with preserved and reduced ejection fraction

Shannon M Dunlay et al. Circ Heart Fail. 2012 Nov.

Abstract

Background: Heart failure (HF) can occur in patients with preserved (HFpEF, EF≥50%) or reduced (HFrEF, EF<50%) ejection fraction (EF), but changes in EF after HF diagnosis are not well described.

Methods and results: Among a community cohort of incident HF patients diagnosed from 1984 to 2009 in Olmsted County, Minnesota, we obtained all EFs assessed by echocardiography from initial HF diagnosis until death or last follow-up through March 2010. Mixed effects models fit a unique linear regression line for each person using serial EF data. Compiled results allowed estimates of the change in EF over time in HFpEF and HFrEF. Among 1233 HF patients (48.3% male, mean age 75.0 years, mean follow-up 5.1 years), 559 (45.3%) had HFpEF at diagnosis. In HFpEF, on average, EF decreased by 5.8% over 5 years (P<0.001) with greater declines in older individuals and those with coronary disease. Conversely, EF increased in HFrEF (average increase 6.9% over 5 years, P<0.001). Greater increases were noted in women, younger patients, individuals without coronary disease, and those treated with evidence-based medications. Overall, 39% of HFpEF patients had an EF<50% and 39% of HFrEF patients had an EF≥50% at some point after diagnosis. Decreases in EF over time were associated with reduced survival whereas increases in EF were associated with improved survival.

Conclusions: These data suggest that progressive contractile dysfunction may contribute to the pathophysiology of HFpEF. Prospective longitudinal studies are needed to confirm these observations and establish the mechanism and clinical relevance of decline in EF over time in HFpEF.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Distribution of EF at Baseline
The distribution of EF (%) at incident HF diagnosis is shown for the 1233 HF patients.
Figure 2
Figure 2. Number of Echocardiograms Per Person After HF Diagnosis
The number of echocardiograms per individual from HF diagnosis until death or last follow-up are shown.
Figure 3
Figure 3. Change in Ejection Fraction for Patients with Preserved and Reduced Ejection Fraction
The estimated EF (solid line) and 95% CI (dashed lines) for patients who initially had HFpEF and HFrEF are shown.
See this image and copyright information in PMC

Comment in

References

    1. Bursi F, Weston SA, Redfield MM, Jacobsen SJ, Pakhomov S, Nkomo VT, Meverden RA, Roger VL. Systolic and diastolic heart failure in the community. JAMA. 2006;296:2209–2216. - PubMed
    1. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in prevalence and outcome of heart failure with preserved ejection fraction. New Engl J Med. 2006;355:251–259. - PubMed
    1. Massie BM, Carson PE, McMurray JJ, Komajda M, McKelvie R, Zile MR, Anderson S, Donovan M, Iverson E, Staiger C, Ptaszynska A. Irbesartan in patients with heart failure and preserved ejection fraction. New Engl J Med. 2008;359:2456–2467. - PubMed
    1. Lee VC, Rhew DC, Dylan M, Badamgarav E, Braunstein GD, Weingarten SR. Meta-analysis: angiotensin-receptor blockers in chronic heart failure and high-risk acute myocardial infarction. Ann Intern Med. 2004;141:693–704. - PubMed
    1. Packer M, Antonopoulos GV, Berlin JA, Chittams J, Konstam MA, Udelson JE. Comparative effects of carvedilol and metoprolol on left ventricular ejection fraction in heart failure: results of a meta-analysis. Am Heart J. 2001;141:899–907. - PubMed

Publication types