Heart Failure With Recovered Ejection Fraction: Clinical Description, Biomarkers, and Outcomes
What are the characteristics of heart failure (HF) patients who recover left ventricular function (HF-Recovered) when compared to those with HF with reduced ejection (HF-REF) and HF with preserved ejection fraction (HF-PEF)?
The PHFS (Penn Heart Failure Study) cohort was comprised of 1,821 chronic HF patients recruited from tertiary HF clinics. The study investigators divided these patients into three categories based on echocardiograms: HF-REF if EF <50%, HF-PEF if EF consistently ≥50%, and HF-Recovered if EF on enrollment to PHFS was ≥50% but prior EF<50%.
The investigators found that a significant portion of HF-Recovered patients had an abnormal biomarker profile at baseline, including 44% with detectable troponin I, although in comparison, median levels of B-type natriuretic peptide, soluble fms-like tyrosine kinase receptor-1, troponin I, and creatinine were greater in HF-REF and HF-PEF patients. Using unadjusted Cox models, the investigators found that over a maximum follow-up of 8.9 years, the hazard ratio (HR) for death, transplant, or ventricular assist device in HF-REF was 4.1 (95% confidence interval [CI], 2.4-6.8; p < 0.001) and in HF-PEF was 2.3 (95% CI, 1.2-4.5; p = 0.013), as compared to HF-Recovered. In addition, the unadjusted HR for cardiac hospitalization in HFREF was 2.0 (95% CI, 1.5-2.7; p < 0.001) and in HF-PEF was 1.3 (95% CI, 0.90-2.0; p = 0.15), when compared to HF-Recovered.
The authors concluded that HF-Recovered is associated with a better biomarker profile and event-free survival than HF-REF and HF-PEF. However, these patients were at persistent risk for HF, as evidenced by abnormalities in biomarkers and a significant number of HF hospitalizations.
This is an important study because it gives a snapshot of the natural history of HF after recovery of left ventricular systolic function. The better prognosis of HF-Recovered as compared to HF-PEF patients may in part be due to continued neurohormonal blockade. The next step is to establish a prospective registry of HF-Recovered patients to better define the natural history of this entity.
Keywords: Heart Diseases, Ventricular Function, Left, Troponin I, Heart-Assist Devices, Heart Failure, Vascular Endothelial Growth Factor Receptor-1, Disease-Free Survival, Stroke Volume, Confidence Intervals, Hospitalization, Natriuretic Peptide, Brain
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