Huang Liyan, Zhou Ping, Zhai Mei, Feng Jiayu, Huang Yan, Zhou Qiong, He Chunhui, Li Xinqing, Xin Anran, Zhang Yuhui, Zhang Jian
Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, China.
Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, China..
Int J Cardiol. 2025 Feb 1;420:132759. doi: 10.1016/j.ijcard.2024.132759. Epub 2024 Nov 27.
The revised universal definition of heart failure (HF) established a standardized definition for HF with improved ejection fraction (HFimpEF) and emphasized the importance of longitudinally assessing left ventricular EF (LVEF). We aim to investigate the incidence, disease progression, and clinical outcomes of HFimpEF in a longitudinal cohort of hospitalized HF patients.
We retrospectively included HF patients with baseline LVEF ≤40 % and satisfactory echocardiographic follow-ups. HFimpEF was defined as a ≥ 10-point increase in LVEF to >40 %. Transient HFimpEF was defined as a recurrent LVEF ≤40 % after achieving HFimpEF. Clinical outcomes were all-cause death, cardiovascular death, and HF rehospitalization.
During a median follow-up of 47.9 months, 517 of 923 patients met HFimpEF criteria; 65.0 % HFimpEF cases occurred within 12 months. HFimpEF patients had lower risks of all-cause death (hazard ratio [HR] = 0.16, P < 0.001), cardiovascular death (HR = 0.19, P < 0.001), and HF rehospitalization (HR = 0.39, P < 0.001). However, 160 HFimpEF patients experienced LVEF worsening during follow-up; their risks for adverse events were higher (HR = 1.89 for all-cause death, HR = 2.13 for cardiovascular death, HR = 2.13 for HF rehospitalization, P < 0.05 for all) compared to persistent HFimpEF patients, and their capability of LVEF re-improvement was diminished. An inverted U-shaped LVEF profile for HFimpEF-characterized by a slow, modest increase followed by a decline-portended a higher mortality risk.
HFimpEF was observed in 56.0 % of HF patients. Longitudinally assessing LVEF helps identify HFimpEF patients and facilitates disease progression monitoring and risk stratification.
心力衰竭（HF）的修订通用定义为射血分数改善的心力衰竭（HFimpEF）建立了标准化定义，并强调了纵向评估左心室射血分数（LVEF）的重要性。我们旨在调查住院HF患者纵向队列中HFimpEF的发病率、疾病进展和临床结局。
我们回顾性纳入了基线LVEF≤40%且超声心动图随访良好的HF患者。HFimpEF定义为LVEF升高≥10个百分点至>40%。短暂性HFimpEF定义为达到HFimpEF后LVEF复发≤40%。临床结局为全因死亡、心血管死亡和HF再住院。
在中位随访47.9个月期间，923例患者中有517例符合HFimpEF标准；65.0%的HFimpEF病例发生在12个月内。HFimpEF患者全因死亡风险较低（风险比[HR]=0.16，P<0.001）、心血管死亡风险较低（HR=0.19，P<0.001）和HF再住院风险较低（HR=0.39，P<0.001）。然而，160例HFimpEF患者在随访期间LVEF恶化；与持续性HFimpEF患者相比，他们发生不良事件的风险更高（全因死亡HR=1.89，心血管死亡HR=2.13，HF再住院HR=2.13，P均<0.05），且LVEF再次改善的能力下降。HFimpEF的LVEF呈倒U形曲线，其特征是缓慢、适度升高后下降，预示着更高的死亡风险。
56.0%的HF患者观察到HFimpEF。纵向评估LVEF有助于识别HFimpEF患者，并促进疾病进展监测和风险分层。
