Beyond initial recovery: Heart failure with transient vs sustained improvement in left ventricular ejection fraction

Abstract

BACKGROUND There is no available data about the trajectory of heart failure (HF) with improved ejection fraction (EF) and patient clinical outcomes in Qatar. AIM To explore the difference in characteristics and outcomes between patients with transient and sustained improvement in left ventricular ejection fraction (LVEF) and to determine the independent predictors for sustained improvement in LVEF. METHODS This is a retrospective cohort study that was conducted at the advanced HF clinic of a tertiary care hospital in Qatar between January 2017 and December 2018. This study included adult patients with improved LVEF and had at least three echocardiographic studies. The patients were divided into two groups: HF with transient improvement in EF (HFtimpEF) and HF with sustained improvement in EF (HFsimpEF). RESULTS A total of 175 patients with HF and improved EF were included. Among them 136 (77.7%) patients showed sustained improvement in LVEF. The remaining patients with HFtimpEF were predominantly males [37 (94.9%) vs 101 (74.3%), P = 0.005] with a higher incidence of ischemic cardiomyopathy [32 (82.1%) vs 68 (50.4%), P = 0.002], dyslipidemia [24 (61.5%) vs 54 (39.7%), P = 0.03], and hypertension [34 (87.2%) vs 93 (68.4%), P = 0.03] than those with HFsimpEF. The latter experienced significantly lower rates of hospitalization [39 (28.7%) vs 20 (51.3%), P = 0.01] and diagnosis of new cardiovascular conditions during the follow-up (e.g., acute coronary syndrome, stroke, decompensated HF, and atrial fibrillation) [14 (10.3%) vs 10 (25.6%), P = 0.03] without a difference in emergency department visits or in-hospital death. Sustained improvement in LVEF was positively associated with being female [adjusted odds ratio (aOR) = 6.8, 95% confidence interval (CI): 1.4-32.3, P = 0.02], having non-ischemic etiology of HF (aOR = 3.1, 95%CI: 1.03-9.3, P = 0.04), and using a mineralocorticoid receptor antagonist (aOR = 7.0, 95%CI: 1.50-31.8, P = 0.01). CONCLUSION Patients with HFsimpEF experienced significantly lower rates of hospitalization and diagnosis of new cardiovascular conditions than patients with HFtimpEF. Sustained improvement in LVEF was positively associated with being a female, having non-ischemic etiology of HF, and using a mineralocorticoid receptor antagonist.