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. 2020 Oct;7(5):2725-2733.
doi: 10.1002/ehf2.12863. Epub 2020 Jun 27.

Circulating troponin and further left ventricular ejection fraction improvement in patients with previously recovered left ventricular ejection fraction

Jonathan G Howlett  1 , Nakul Sharma  1 , Wendimagegn G Alemayehu  2 , Jason R B Dyck  3 , Todd Anderson  1 , Nowell Fine  1 , Harald Becker  2 , James A White  1 , D Ian Paterson  2 , Richard B Thompson  4 , Gavin Y Oudit  2 , Mark J Haykowsky  5 , Justin A Ezekowitz  2
Affiliations

Circulating troponin and further left ventricular ejection fraction improvement in patients with previously recovered left ventricular ejection fraction

Jonathan G Howlett et al. ESC Heart Fail. 2020 Oct.

Abstract

Aims: The aim of this study is to determine factors associated with long-term recovery of left ventricular ejection fraction (LVEF) in patients with heart failure with reduced EF (HFrEF) and if further recovery also occurs in this group.

Methods and results: Among 621 participants enrolled in the Alberta Heart Failure Etiology and Analysis Team (HEART) Study, 316 with Stage C HF underwent comprehensive imaging and biomarker testing at enrolment and at 1-year follow up. Using pre-enrolment data, HF with recovered EF (HFrecEF) was defined as an absolute improvement ≥5% in LVEF from the prior lowest LVEF value, with a final LVEF value > 35% at or prior to study baseline. Participants with all LVEF > 40% were included for comparison. Hospitalization-free survival to 5 years was performed. The median cohort age was 66 years, and time from diagnosis was 4 years; 82% were male patients. Of the 316 patients, 95 (30%) patients had HFrecEF and 56 (18%) patients pHFrEF. On multivariate analysis, only shorter duration of HF was predictive of HFrecEF status. Over 1 year, LVEF increased in the HFrecEF group 4.0% (0.15-7.90, P = 0.042) as compared with persistent HFrEF, who in turn demonstrated higher baseline serum high sensitivity Troponin-T with further increase at follow up 0.55(0.33-0.86, P = 0.011). No change in any parameter in the HFpEF/HFmrEF group at follow up was observed.

Conclusions: Patients with HFrecEF demonstrate evidence of additional late improvement in LVEF and unchanged troponin levels, in contrast to those with persistent HFrEF, where LVEF does not improve and serum troponin rises over time. These data help to inform mechanisms relating to late LV remodelling.

Keywords: Biomarkers; Heart failure; Left ventricular remodelling; Troponin.

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Conflict of interest statement

None declared.

Figures

FIGURE 1
FIGURE 1
CONSORT diagram of patient disposition. Measurements of left ventricular ejection fraction (LVEF) included all obtained historical data (not evaluated in the core lab) and the study baseline echo (evaluated in the core lab). Participants were included if there were at least two LVEF measurements of adequate quality, measured at least 1 year apart. They were classified as heart failure with recovered ejection fraction (HFrecEF) if at least one historical LVEF measured <35% and a subsequent or study baseline LVEF measured >35% and was at least 5% higher than the lowest previous LVEF. Participants were classified as persistent heart failure with reduced ejection fraction if any prior LVEF measured <35% and they did not experience improvement as previously mentioned and as heart failure with preserved ejection (heart failure with mid‐range ejection fraction) fraction if no prior or baseline LVEF measured <40%.
FIGURE 2
FIGURE 2
Hospitalization free survival at 1 year by response. HFrecEF, heart failure with recovered ejection fraction (responder); HFrEF, persistent heart failure with reduced ejection fraction; HFpEF/HFmrEF, heart failure with preserved ejection fraction. Ref: Reference group,(HFrEF); *adjusted for age per 10 years and split at 65, gender, type of HF (ischaemic vs. non‐ischaemic), duration of heart failure, coronary artery disease, previous coronary artery bypass grafting, or percutaneous coronary intervention.
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