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Heart failure with mildly reduced ejection fraction: retrospective study of ejection fraction trajectory risk
AIMS: Heart failure with mildly reduced ejection fraction (HFmrEF) is associated with a favourable prognosis compared with heart failure (HF) with reduced ejection fraction (EF). We assessed whether left ventricular ejection fraction (LVEF) trajectory can be used to identify groups of patients with...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9065872/ https://www.ncbi.nlm.nih.gov/pubmed/35261203 http://dx.doi.org/10.1002/ehf2.13869 |
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author | Miller, Robert J.H. Nabipoor, Majid Youngson, Erik Kotrri, Gynter Fine, Nowell M. Howlett, Jonathan G. Paterson, Ian D. Ezekowitz, Justin McAlister, Finlay A. |
author_facet | Miller, Robert J.H. Nabipoor, Majid Youngson, Erik Kotrri, Gynter Fine, Nowell M. Howlett, Jonathan G. Paterson, Ian D. Ezekowitz, Justin McAlister, Finlay A. |
author_sort | Miller, Robert J.H. |
collection | PubMed |
description | AIMS: Heart failure with mildly reduced ejection fraction (HFmrEF) is associated with a favourable prognosis compared with heart failure (HF) with reduced ejection fraction (EF). We assessed whether left ventricular ejection fraction (LVEF) trajectory can be used to identify groups of patients with HFmrEF who have different clinical outcomes in a large retrospective study of patients with serial imaging. METHODS AND RESULTS: Patients with HF and ≥2 echocardiograms performed ≥6 months apart were included if the LVEF measured 40–49% on the second study. Patients were classified as HFmrEF‐Increasing if LVEF had increased ≥10% (n = 450), HFmrEF‐Decreasing if LVEF had decreased ≥10% (n = 512), or HFmrEF‐Stable if they did not meet other criteria (n = 389). The primary outcome was all‐cause mortality or cardiovascular hospitalization after the second echocardiogram. Associations with time to first event were assessed with multivariable Cox analyses adjusted for age, co‐morbidities, and medications. In total, 1351 patients with HFmrEF (median age 74, 64.2% male) were included with 28.8% exhibiting stable LVEF. During median follow‐up of 15.3 months, the composite outcome occurred in 811 patients. During follow‐up, patients with HFmrEF‐Increasing were less likely to experience the primary outcome [adjusted hazard ratio (HR) 0.72, 95% confidence interval (CI) 0.60–0.88, P < 0.001] compared with HFmrEF‐Stable. Patients with HFmrEF‐Decreasing were more likely to experience the composite outcome in unadjusted analyses (unadjusted HR 1.19, 95% CI 1.01–1.40, P = 0.040) but not adjusted analyses (adjusted HR 1.16, 95% CI 0.98–1.37, P = 0.092). Associations with death or HF hospitalizations were similar (HFmrEF‐Increasing: adjusted HR 0.72, 95% CI 0.59–0.88, P = 0.005; HFmrEF‐Decreasing: adjusted HR 1.20, 95% CI 1.01–1.44, P = 0.044). Patients with HFmrEF‐Decreasing had a similar risk of the composite outcome as patients with HF with reduced EF (adjusted HR 1.03, 95% CI 0.89–1.20, P = 0.670). Patients with HFmrEF‐Increasing were less likely to experience the composite outcome compared with patients with HF with preserved EF (adjusted HR 0.73, 95% CI 0.62–0.87, P < 0.001). CONCLUSIONS: Amongst patients with HFmrEF, those exhibiting positive LVEF trajectory were less likely to experience adverse outcomes after correcting for important confounders including medical therapy. Categorizing HFmrEF patients based on LVEF trajectory provides meaningful clinical information and may assist clinicians with management decisions. |
format | Online Article Text |
id | pubmed-9065872 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-90658722022-05-04 Heart failure with mildly reduced ejection fraction: retrospective study of ejection fraction trajectory risk Miller, Robert J.H. Nabipoor, Majid Youngson, Erik Kotrri, Gynter Fine, Nowell M. Howlett, Jonathan G. Paterson, Ian D. Ezekowitz, Justin McAlister, Finlay A. ESC Heart Fail Original Articles AIMS: Heart failure with mildly reduced ejection fraction (HFmrEF) is associated with a favourable prognosis compared with heart failure (HF) with reduced ejection fraction (EF). We assessed whether left ventricular ejection fraction (LVEF) trajectory can be used to identify groups of patients with HFmrEF who have different clinical outcomes in a large retrospective study of patients with serial imaging. METHODS AND RESULTS: Patients with HF and ≥2 echocardiograms performed ≥6 months apart were included if the LVEF measured 40–49% on the second study. Patients were classified as HFmrEF‐Increasing if LVEF had increased ≥10% (n = 450), HFmrEF‐Decreasing if LVEF had decreased ≥10% (n = 512), or HFmrEF‐Stable if they did not meet other criteria (n = 389). The primary outcome was all‐cause mortality or cardiovascular hospitalization after the second echocardiogram. Associations with time to first event were assessed with multivariable Cox analyses adjusted for age, co‐morbidities, and medications. In total, 1351 patients with HFmrEF (median age 74, 64.2% male) were included with 28.8% exhibiting stable LVEF. During median follow‐up of 15.3 months, the composite outcome occurred in 811 patients. During follow‐up, patients with HFmrEF‐Increasing were less likely to experience the primary outcome [adjusted hazard ratio (HR) 0.72, 95% confidence interval (CI) 0.60–0.88, P < 0.001] compared with HFmrEF‐Stable. Patients with HFmrEF‐Decreasing were more likely to experience the composite outcome in unadjusted analyses (unadjusted HR 1.19, 95% CI 1.01–1.40, P = 0.040) but not adjusted analyses (adjusted HR 1.16, 95% CI 0.98–1.37, P = 0.092). Associations with death or HF hospitalizations were similar (HFmrEF‐Increasing: adjusted HR 0.72, 95% CI 0.59–0.88, P = 0.005; HFmrEF‐Decreasing: adjusted HR 1.20, 95% CI 1.01–1.44, P = 0.044). Patients with HFmrEF‐Decreasing had a similar risk of the composite outcome as patients with HF with reduced EF (adjusted HR 1.03, 95% CI 0.89–1.20, P = 0.670). Patients with HFmrEF‐Increasing were less likely to experience the composite outcome compared with patients with HF with preserved EF (adjusted HR 0.73, 95% CI 0.62–0.87, P < 0.001). CONCLUSIONS: Amongst patients with HFmrEF, those exhibiting positive LVEF trajectory were less likely to experience adverse outcomes after correcting for important confounders including medical therapy. Categorizing HFmrEF patients based on LVEF trajectory provides meaningful clinical information and may assist clinicians with management decisions. John Wiley and Sons Inc. 2022-03-08 /pmc/articles/PMC9065872/ /pubmed/35261203 http://dx.doi.org/10.1002/ehf2.13869 Text en © 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Original Articles Miller, Robert J.H. Nabipoor, Majid Youngson, Erik Kotrri, Gynter Fine, Nowell M. Howlett, Jonathan G. Paterson, Ian D. Ezekowitz, Justin McAlister, Finlay A. Heart failure with mildly reduced ejection fraction: retrospective study of ejection fraction trajectory risk |
title | Heart failure with mildly reduced ejection fraction: retrospective study of ejection fraction trajectory risk |
title_full | Heart failure with mildly reduced ejection fraction: retrospective study of ejection fraction trajectory risk |
title_fullStr | Heart failure with mildly reduced ejection fraction: retrospective study of ejection fraction trajectory risk |
title_full_unstemmed | Heart failure with mildly reduced ejection fraction: retrospective study of ejection fraction trajectory risk |
title_short | Heart failure with mildly reduced ejection fraction: retrospective study of ejection fraction trajectory risk |
title_sort | heart failure with mildly reduced ejection fraction: retrospective study of ejection fraction trajectory risk |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9065872/ https://www.ncbi.nlm.nih.gov/pubmed/35261203 http://dx.doi.org/10.1002/ehf2.13869 |
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