There has been increasing interest in understanding optimal management of patients with heart failure with recovered rejection fraction (HFrecEF), according to a new consensus document published Aug. 3 in the Journal of the American College of Cardiology.

Jane E. Wilcox, MD, and Douglas L. Mann, MD, FACC, et al., review the biology of reverse left ventricular (LV) remodeling and the clinical course for patients with HFrecEF, as well as provide guidelines for defining, diagnosing and managing these patients. According to the document, there is growing evidence that a significant portion of patients who experience complete normalization of LV ejection fraction (LVEF) will develop recurrent LV dysfunction and recurrent heart failure (HF) events.

Patients with HFrecEF are a subset of patients with HF with reduced EF (HFrEF) whose biological substrate for HF and clinical course are distinct from those with HFrEF and HF with preserved ejection fraction (HFpEF), the document notes. For HFrecEF patients, clinicians should focus on the LVEF "trajectory" in HFrecEF patients, including the nature and extent of myocardial injury, degree and duration of LV remodeling, and the type of therapy that is being initiated, the document notes. A working definition of HFrecEF consistent with the literature includes 1) documentation of decreased LVEF <40% at baseline; 2) ≥10% absolute improvement in LVEF; and 3) a second measurement of LVEF >40%. In addition, the document recommends obtaining measurements of LVEF changes three to six months after the baseline LVEF to confirm HFrecEF.

The document recommends continued guideline-directed medical and device therapy for HFrecEF patients until there is a better understanding of the biology and clinical epidemiology of HFrecEF. In addition, the document recommends close clinical follow up for HFrecEF patients due to the high risk of HF relapse.

The knowledge gap in the biology, natural history and long-term clinical outcomes for HFrecEF patients "represents a significant unmet clinical need, insofar as it is directly relevant to the reemergence of clinical HF in this seemingly stable patient population," the authors write, adding that future research should improve understanding of HFrecEF and optimal treatment. "The goal is to develop new therapeutic targets that will enable patients with HFrecEF to experience a durable remission from HF," they conclude.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Heart Failure, Stroke Volume, Ventricular Remodeling, Recurrence, Ventricular Function, Left

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