Heart Failure Unit, Cardiology, Reina Sofia University Hospital, Cordoba, Spain; Institute of Biomedical Research of Cordoba, IMIBIC, Cordoba, Spain.
Heart Failure Unit, Cardiology, Reina Sofia University Hospital, Cordoba, Spain; Institute of Biomedical Research of Cordoba, IMIBIC, Cordoba, Spain.
Med Clin (Barc). 2023 Jul 7;161(1):1-10. doi: 10.1016/j.medcli.2023.02.009. Epub 2023 Apr 3.
A percentage of patients with heart failure with reduced ejection fraction (HFrEF) improve left ventricular ejection fraction (LVEF) in the evolution. This entity, defined for the first time in an international consensus as heart failure with improved ejection fraction (HFimpEF), could have a different clinical profile and prognosis than HFrEF. Our main aim was to analyze the differential clinical profile between the two entities, as well as the mid-term prognosis.
MATERIAL-METHODS: Prospective study of a cohort of patients with HFrEF who had echocardiographic data at baseline and follow-up. A comparative analysis of patients who improved LVEF with those who did not was made. Clinical, echocardiographic and therapeutic variables were analyzed, and the mid-term impact in terms of mortality and hospital readmissions for HF was assessed.
Ninety patients were analyzed. Mean age was 66.5(10.4) years, with a male predominance (72.2%). Forty five patients (50%) improved LVEF (Group-1,HFimpEF) and forty five patients (50%) sustained reduced LVEF (Group-2,HFsrEF). The mean time to LVEF improvement in Group-1 was 12.6(5.7) months. Group-1 had a more favorable clinical profile: lower prevalence of cardiovascular risk factors, higher prevalence of de novo HF (75.6% vs. 42.2%; p<0.05), lower prevalence of ischemic etiology (22.2% vs. 42.2%; p<0.05), with less basal dilatation of the left ventricle. At the end of follow-up (mean 19(1) months) Group-1 had a lower hospital readmission rate (3.1% vs. 26.7%; p<0.01), as well as lower mortality (0% vs. 24.4%; p<0.01).
Patients with HFimpEF seem to have a better mid-term prognosis in terms of reduced mortality and hospital admissions. This improvement could be conditioned by the clinical profile of patients HFimpEF.
有一部分射血分数降低的心力衰竭（HFrEF）患者的左心室射血分数（LVEF）会在病程中得到改善。这种在国际共识中首次被定义为射血分数改善的心力衰竭（HFimpEF）的实体，可能与 HFrEF 具有不同的临床特征和预后。我们的主要目的是分析这两种实体之间的差异临床特征，以及中期预后。
材料-方法：前瞻性研究了一组 HFrEF 患者，这些患者在基线和随访时有超声心动图数据。对 LVEF 改善的患者和未改善的患者进行了比较分析。分析了临床、超声心动图和治疗变量，并评估了中期死亡率和因心力衰竭再次住院的情况。
分析了 90 例患者。平均年龄为 66.5(10.4)岁，男性居多（72.2%）。45 例（50%）患者 LVEF 得到改善（第 1 组，HFimpEF），45 例（50%）患者 LVEF 持续降低（第 2 组，HFsrEF）。第 1 组 LVEF 改善的平均时间为 12.6(5.7)个月。第 1 组具有更有利的临床特征：心血管危险因素的患病率较低，新发心力衰竭的患病率较高（75.6% vs. 42.2%；p<0.05），缺血性病因的患病率较低（22.2% vs. 42.2%；p<0.05），左心室扩张程度较低。在随访结束时（平均 19(1)个月），第 1 组的再住院率较低（3.1% vs. 26.7%；p<0.01），死亡率也较低（0% vs. 24.4%；p<0.01）。
HFimpEF 患者的中期死亡率和再住院率降低，预后较好。这种改善可能与 HFimpEF 患者的临床特征有关。
