Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
Heart Center Bremen, Electrophysiology Bremen, Senator-Wessling-Str. 1, 28277 Bremen, Germany.
Eur Heart J. 2024 Aug 9;45(30):2771-2781. doi: 10.1093/eurheartj/ehae334.
In patients with de novo heart failure with reduced ejection fraction (HFrEF), improvement of left ventricular ejection fraction (LVEF) is expected to occur when started on guideline-recommended medical therapy. However, improvement may not be completed within 90 days.
Patients with HFrEF and LVEF ≤ 35% prescribed a wearable cardioverter-defibrillator between 2017 and 2022 from 68 sites were enrolled, starting with a registry phase for 3 months and followed by a study phase up to 1 year. The primary endpoints were LVEF improvement > 35% between Days 90 and 180 following guideline-recommended medical therapy initiation and the percentage of target dose reached at Days 90 and 180.
A total of 598 patients with de novo HFrEF [59 years (interquartile range 51-68), 27% female] entered the study phase. During the first 180 days, a significant increase in dosage of beta-blockers, renin-angiotensin system inhibitors, and mineralocorticoid receptor antagonists was observed (P < .001). At Day 90, 46% [95% confidence interval (CI) 41%-50%] of study phase patients had LVEF improvement > 35%; 46% (95% CI 40%-52%) of those with persistently low LVEF at Day 90 had LVEF improvement > 35% by Day 180, increasing the total rate of improvement > 35% to 68% (95% CI 63%-72%). In 392 patients followed for 360 days, improvement > 35% was observed in 77% (95% CI 72%-81%) of the patients. Until Day 90, sustained ventricular tachyarrhythmias were observed in 24 wearable cardioverter-defibrillator carriers (1.8%). After 90 days, no sustained ventricular tachyarrhythmia occurred in wearable cardioverter-defibrillator carriers.
Continuous optimization of guideline-recommended medical therapy for at least 180 days in HFrEF is associated with additional LVEF improvement > 35%, allowing for better decision-making regarding preventive implantable cardioverter-defibrillator therapy.
在射血分数降低的新发心力衰竭（HFrEF）患者中，开始接受指南推荐的医学治疗后，左心室射血分数（LVEF）有望得到改善。然而，改善可能无法在 90 天内完成。
2017 年至 2022 年期间，68 个地点的 HFrEF 且 LVEF≤35%的患者被纳入研究，首先进行为期 3 个月的登记阶段，然后进行长达 1 年的研究阶段。主要终点为指南推荐的医学治疗开始后 90 至 180 天之间 LVEF 改善>35%，以及 90 至 180 天达到目标剂量的百分比。
共有 598 名新发 HFrEF 患者[59 岁（四分位距 51-68），27%为女性]进入研究阶段。在最初的 180 天内，β受体阻滞剂、肾素-血管紧张素系统抑制剂和盐皮质激素受体拮抗剂的剂量显著增加（P<0.001）。在第 90 天，46%[95%置信区间（CI）41%-50%]的研究阶段患者 LVEF 改善>35%；第 90 天 LVEF 持续较低的 46%（95%CI 40%-52%）患者在第 180 天 LVEF 改善>35%，使改善>35%的总比率增加到 68%（95%CI 63%-72%）。在 392 名随访 360 天的患者中，77%（95%CI 72%-81%）的患者观察到 LVEF 改善>35%。直到第 90 天，24 名穿戴式除颤器携带者中观察到持续性室性心律失常（1.8%）。90 天后，穿戴式除颤器携带者中未发生持续性室性心律失常。
HFrEF 患者接受至少 180 天的指南推荐的医学治疗持续优化与额外的 LVEF 改善>35%相关，这有助于更好地决策预防性植入式心脏复律除颤器治疗。
