Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, University of California, Los Angeles3Associate Editor for Health Care Quality and Guidelines, JAMA Cardiology.
JAMA Cardiol. 2016 Aug 1;1(5):510-8. doi: 10.1001/jamacardio.2016.1325.
Heart failure (HF) guidelines recognize that a subset of patients with HF and preserved left ventricular ejection fraction (LVEF) previously had reduced LVEF but experienced improvement or recovery in LVEF. However, data on these patients are limited.
To investigate the characteristics and outcomes of adult outpatients with HF and improved or recovered ejection fraction (HFrecEF).
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study (inception period, January 1, 2012, to April 30, 2012) with 3-year follow-up at cardiology clinics (including HF subspecialty) in an academic institution. The dates of the analysis were May 21, 2015, to August 10, 2015. Participants were all outpatients 18 years or older who received care for a verified diagnosis of HF not attributed to specific cardiomyopathies or other special causes during the inception period.
Type of HF at baseline, classified as HF with reduced ejection fraction (HFrEF) (defined as current LVEF ≤40%), HF with preserved ejection fraction (HFpEF) (defined as current and all previous LVEF reports >40%), and HF with recovered ejection fraction (HFrecEF) (defined as current LVEF >40% but any previously documented LVEF ≤40%).
Mortality, hospitalization rates, and composite end points.
The study cohort comprised 2166 participants. Their median age was 65 years, 41.4% (896 of 2166) were female, 48.7% (1055 of 2166) were white and 45.2% (1368 of 2166) black, and 63.2% (1368 of 2166) had coronary artery disease. Preserved (>40%) LVEF at inception was present in 816 of 2166 (37.7%) patients. Of these patients, 350 of 2166 (16.2%) had previously reduced (≤40%) LVEF and were classified as having HFrecEF, whereas 466 of 2166 (21.5%) had no previous reduced LVEF and were classified as having HFpEF. The remaining 1350 (62.3%) patients were classified as having HFrEF. After 3 years, age and sex-adjusted mortality was 16.3% in patients with HFrEF, 13.2% in patients with HFpEF, and 4.8% in patients with HFrecEF (P < .001 vs HFrEF or HFpEF). Compared with patients with HFpEF and patients with HFrEF, patients with HFrecEF had fewer all-cause (adjusted rate ratio [RR] vs HFpEF, 0.71; 95% CI, 0.55-0.91; P = .007), cardiovascular (RR, 0.50; 95% CI, 0.35-0.71; P < .001), and HF-related (RR, 0.48; 95% CI, 0.30-0.76; P = .002) hospitalizations and were less likely to experience composite end points commonly used in clinical trials (death or cardiovascular hospitalization and death or HF hospitalization).
Outpatients with HFrecEF have a different clinical course than patients with HFpEF and HFrEF, with lower mortality, less frequent hospitalizations, and fewer composite end points. These patients may need to be investigated separately in outcomes studies and clinical trials.
心力衰竭（HF）指南认识到，先前存在左心室射血分数（LVEF）降低但 LVEF 改善或恢复的部分 HF 并保留左心室射血分数（HFpEF）患者属于此类。然而，这些患者的数据有限。
研究患有射血分数改善或恢复的心力衰竭（HFrecEF）的成年门诊患者的特征和结局。
设计、地点和参与者：回顾性队列研究（起始期为 2012 年 1 月 1 日至 2012 年 4 月 30 日），在学术机构的心脏病学诊所（包括心力衰竭亚专科）进行为期 3 年的随访。分析日期为 2015 年 5 月 21 日至 2015 年 8 月 10 日。所有参与者均为 18 岁或以上的门诊患者，在起始期内接受过经证实的心力衰竭诊断的治疗，但不归因于特定心肌病或其他特殊原因。
基线时的心力衰竭类型，分为射血分数降低型心力衰竭（HFrEF）（定义为当前 LVEF ≤40%）、射血分数保留型心力衰竭（HFpEF）（定义为当前和所有以前的 LVEF 报告 >40%）和射血分数恢复型心力衰竭（HFrecEF）（定义为当前 LVEF >40%，但任何以前记录的 LVEF ≤40%）。
死亡率、住院率和复合终点。
研究队列包括 2166 名参与者。他们的中位年龄为 65 岁，41.4%（896/2166）为女性，48.7%（1055/2166）为白人，45.2%（1368/2166）为黑人，63.2%（1368/2166）患有冠状动脉疾病。2166 名患者中有 816 名（37.7%）在起始时存在 LVEF 保留（>40%）。在这些患者中，350 名（2166 名中的 16.2%）先前存在 LVEF 降低（≤40%），被归类为 HFrecEF，而 466 名（2166 名中的 21.5%）没有以前的 LVEF 降低，被归类为 HFpEF。其余 1350 名（62.3%）患者被归类为 HFrEF。3 年后，HFrEF 患者的年龄和性别调整死亡率为 16.3%，HFpEF 患者为 13.2%，HFrecEF 患者为 4.8%（P < .001 与 HFrEF 或 HFpEF 相比）。与 HFpEF 患者和 HFrEF 患者相比，HFrecEF 患者的全因（调整后的率比[RR]与 HFpEF 相比，0.71；95%CI，0.55-0.91；P = .007）、心血管（RR，0.50；95%CI，0.35-0.71；P < .001）和心力衰竭相关（RR，0.48；95%CI，0.30-0.76；P = .002）住院率较低，且不太可能发生临床试验中常用的复合终点（死亡或心血管住院和死亡或心力衰竭住院）。
HFrecEF 门诊患者的临床过程与 HFpEF 和 HFrEF 患者不同，死亡率较低，住院频率较低，复合终点较少。这些患者可能需要在结局研究和临床试验中单独进行调查。
