Jang Jeong Yoon, Lee Jae Myoung, Shin Yujin, Kim Yong-Lee, Yu Gain, Bae Jae Seok, Cho Yun-Ho, Kwak Choong Hwan, Kang Min Gyu, Kim Kye-Hwan, Park Jeong Rang, Hwang Jin-Yong, Jeong Young-Hoon, Ahn Jong-Hwa
Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea.
Front Cardiovasc Med. 2025 Jul 17;12:1597947. doi: 10.3389/fcvm.2025.1597947. eCollection 2025.
Acute myocardial infarction (AMI) often leads to heart failure with reduced ejection fraction (HFrEF), with some patients showing recovery of left ventricular ejection fraction (HFrecEF) over time. This study aimed to evaluate the prognostic differences between persistent HFrEF and HFrecEF.
This prospective cohort study included AMI patients with reduced LVEF (<40%) at admission. LVEF was reassessed one month later to classify patients into persistent HFrEF (LVEF <40%) or HFrecEF, defined as follow-up LVEF >40% with an absolute increase of ≥10% from baseline, in accordance with recent consensus definitions. Outcomes included cardiovascular mortality and/or rehospitalization for heart failure. Predictors of LVEF recovery were also analyzed.
Of the 679 patients analyzed, 373 (55%) had persistent HFrEF, while 306 (45%) transitioned to HFrecEF. Patients with HFrecEF were younger, had fewer comorbidities, and were more likely to receive renin-angiotensin system (RAS) inhibitors and β-blockers.Cardiovascular mortality was significantly lower in the HFrecEF group (3.3% vs. 8.3%; adjusted HR 0.37, 95% CI: 0.18-0.77, = 0.007), as was the rate of heart failure rehospitalization (6.2% vs. 10.2%; adjusted HR 0.60, 95% CI: 0.35-1.05, = 0.074). Independent predictors of LVEF recovery included younger age, beta-blocker use, and RAS inhibitor use.
This study emphasizes the critical role of transitioning from persistent HFrEF to HFrecEF in improving clinical outcomes for AMI patients. Tailored management approaches, combined with routine echocardiographic monitoring and adherence to optimal medical therapy, are essential for optimizing patient care and long-term prognosis.
急性心肌梗死（AMI）常导致射血分数降低的心力衰竭（HFrEF），部分患者左心室射血分数（HFrecEF）会随时间恢复。本研究旨在评估持续性HFrEF和HFrecEF之间的预后差异。
这项前瞻性队列研究纳入了入院时左心室射血分数（LVEF）降低（<40%）的AMI患者。1个月后重新评估LVEF，根据最近的共识定义，将患者分为持续性HFrEF（LVEF<40%）或HFrecEF，后者定义为随访LVEF>40%且较基线绝对增加≥10%。结局包括心血管死亡和/或因心力衰竭再次住院。还分析了LVEF恢复的预测因素。
在分析的679例患者中，373例（55%）为持续性HFrEF，而306例（45%）转变为HFrecEF。HFrecEF患者更年轻，合并症更少，更有可能接受肾素-血管紧张素系统（RAS）抑制剂和β受体阻滞剂治疗。HFrecEF组的心血管死亡率显著更低（3.3%对8.3%；校正后风险比0.37，95%置信区间：0.18-0.77，P=0.007），心力衰竭再次住院率也更低（6.2%对10.2%；校正后风险比0.60，95%置信区间：0.35-1.05，P=0.074）。LVEF恢复的独立预测因素包括年轻、使用β受体阻滞剂和使用RAS抑制剂。
本研究强调了从持续性HFrEF转变为HFrecEF对改善AMI患者临床结局的关键作用。量身定制的管理方法，结合常规超声心动图监测和坚持最佳药物治疗，对于优化患者护理和长期预后至关重要。
