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. 2020 Apr;13(2):142-150.
doi: 10.1007/s12265-019-09919-9. Epub 2019 Nov 13.

Heterogeneous Outcomes of Heart Failure with Better Ejection Fraction

Jenny Van Kirk  1 , Marat Fudim  1 , Cynthia L Green  2 , Ravi Karra  3   4
Affiliations

Heterogeneous Outcomes of Heart Failure with Better Ejection Fraction

Jenny Van Kirk et al. J Cardiovasc Transl Res. 2020 Apr.

Abstract

We evaluated the heterogeneity of outcomes among heart failure patients with ventricular recovery. The BEST trial studied patients with left ventricular ejection fraction (LVEF) ≤ 35%. Serial LVEF assessment was performed at baseline, 3 months, and 12 months. Heart failure with better ejection fraction (HFbEF) was defined as an LVEF > 40% at any point. Of the patients who survived to 1 year, 399 (21.3%) had HFbEF. Among subjects with HFbEF, 173 (43.4%) had "extended" recovery, 161 (40.4%) had "late" recovery, and 65 (16.3%) patients had "transient" recovery. Subjects with HFbEF had an improved event-free survival from death or first HF hospitalization compared to subjects without recovery (HR 0.50, 95% CI, 0.39-0.64, p < 0.001). Compared to "transient" recovery, "late" and "extended" recovery were associated with an improved event-free survival from all-cause death and HF hospitalization (HR 0.55, 95% CI, 0.34-0.90, p = 0.016). Our study shows patients with HFbEF to be a heterogeneous population with differing prognoses.

Keywords: Heart failure with better ejection fraction; Heart failure with reduced ejection fraction; Recovery.

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Conflict of interest statement

Conflict of Interest: MF is supported by AHA Grant 17MCPRP33460225 and the NHLBI T32 postdoctoral training grant 5T32HL007101-42. Consulting for Coridea, AxonTherapies and Galvani. RK is supported by an NIH Mentored Clinical Scientist Award (K08-HL116485), a Duke University School of Medicine Strong Start Award, the Walker P. Inman Endowment, and the Edna and Fred L. Mandel, Jr. Foundation.

Figures

Figure 1.
Figure 1.
Longitudinal trend of left ventricular ejection fraction in patients enrolled to the BEST trial.
Figure 2.
Figure 2.
Change in LVEF by recovery subset. Abbreviations: LV = left ventricular
Figure 3.
Figure 3.
Kaplan-Meier Plot for freedom from death or first heart failure hospitalization by recovery status.
Figure 4.
Figure 4.
Kaplan-Meier plot for freedom from death or first heart failure hospitalization by recovery subtype.
See this image and copyright information in PMC

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