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
. 2023 Feb 17;24(3):293-300.
doi: 10.1093/ehjci/jeac240.

Unfavourable outcomes in patients with heart failure with higher preserved left ventricular ejection fraction

Nobuyuki Ohte  1 , Shohei Kikuchi  1 , Noriaki Iwahashi  2 , Yoshiharu Kinugasa  3 , Kaoru Dohi  4 , Hiroyuki Takase  5 , Kumiko Masai  6 , Katsuji Inoue  7 , Takahiro Okumura  8 , Kenta Hachiya  9 , Shuichi Kitada  1 , Yoshihiro Seo  1 ; EASY HFpEF Investigators
Collaborators, Affiliations

Unfavourable outcomes in patients with heart failure with higher preserved left ventricular ejection fraction

Nobuyuki Ohte et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Aims: Newly introduced drugs for heart failure (HF) have been reported to improve the prognosis of HF with preserved ejection fraction (HFpEF) in the lower range of left ventricular ejection fraction (LVEF). We hypothesized that a higher LVEF is related to an unfavourable prognosis in patients with HFpEF.

Methods and results: We tested this hypothesis by analysing the data from a prospective multicentre cohort study in 255 patients admitted to the hospital due to decompensated HF (LVEF > 40% at discharge). The primary endpoint of this study was a composite outcome of all-cause death and readmission due to HF, and the secondary endpoint was readmission due to HF. LVEF and the mitral E/e' ratio were measured using echocardiography. In multicovariate parametric survival time analysis, LVEF [hazard ratio (HR) = 1.046 per 1% increase, P = 0.001], concurrent atrial fibrillation (AF) (HR = 3.203, P < 0.001), and E/e' (HR = 1.083 per 1.0 increase, P < 0.001) were significantly correlated with the primary endpoint. In addition to these covariates, angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) use was significantly correlated with the secondary endpoint (HR = 0.451, P = 0.008). Diagnostic performance plot analysis demonstrated that the discrimination threshold value for LVEF that could identify patients prone to reaching the primary endpoint was ≥57.2%. The prevalence of AF or E/e' ratio did not differ significantly between patients with LVEF ≥ 58% and with 40% < LVEF < 58%.

Conclusion: A higher LVEF is independently related to poor prognosis in patients with HFpEF, in addition to concurrent AF and an elevated E/e' ratio. ACEI/ARB use, in contrast, was associated with improved prognosis, especially with regard to readmission due to HF.

Clinical trial registration: https://www.umin.ac.jp/ctr/index.htm.

Unique identifier: UMIN000017725.

Keywords: ACEI/ARB; HFpEF; LVEF; prognosis.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: N.O. received lecture fees from Daiichi Sankyo, Otsuka Pharma; Y.K. received scholarship from Abbott Japan, Otsuka Pharma, Biotronik Japan, Japan Lifeline, Medtronic Japan, and Boston Scientific; K.D. received lecture fees from Novartis Pharma, Otsuka Pharma, Daiichi Sankyo, and Nippon Boehringer Ingelheim and research grants from Otsuka Pharma and Daiichi Sankyo; T.O. received lecture fees from Ono Yakuhin, Novartis Pharma, and Otsuka Pharma and research grants from Ono Yakuhin and Amgen Astellas; and S.K., N.I., H.T., K.M., K.I., K.H., S.K., and Y.S. had nothing to declare.

Comment in

Dataset use reported in

Substances