Myocardial Recovery and Relapse in Heart Failure With Improved Ejection Fraction

Abstract

Purpose of review: The purpose of this review is to discuss myocardial recovery in heart failure with reduced ejection fraction (HFrEF) and to summarize the contemporary insights regarding heart failure with improved ejection fraction (HFimpEF).

Recent findings: Improvement in left ventricular ejection fraction (LVEF ≥ 40%) with improved prognosis can be achieved in one out of three (10-40%) patients with HFrEF treated with guideline-directed medical therapy. Clinical predictors include non-ischemic etiology of HFrEF, less abnormal blood or imaging biomarkers, and lack of specific pathogenic genetic variants. However, a subset of patients may ultimately relapse, suggesting that many patients are merely in remission rather than having fully recovered.

Summary: Patients with HFimpEF have improved prognosis but nonetheless remain at risk of relapse and long-term adverse events. Future studies will hopefully chart the natural history of HFimpEF and identify clinical predictors such as blood or novel imaging biomarkers that distinguish subgroups of patients based on differential trajectory and prognosis.

Keywords: HFimpEF; Heart failure with improved ejection fraction; Myocardial recovery; Myocardial relapse.

Fig. 1

Clinical predictors favoring achievement of heart failure with improved ejection fraction Figure created using Servier Medical Art (licensed under CC BY 4.0, https://creativecommons.org/licenses/by/4.0/), based on papers by Wilcox et al. [11•] and Aimo et al. [35]. Abbreviations: HFimpEF, heart failure with improved ejection fraction; LVEF, left ventricular ejection fraction; HF, heart failure; LBBB, left bundle branch block; CRT, cardiac resynchronization therapy; NT-proBNP, aminoterminal pro-B-type natriuretic peptide; sST2, soluble suppression of tumorigenicity 2; LV, left ventricular; TTN, titin; DCM, dilated cardiomyopathy.