Journal of the American Heart Association, 2019. 8(6), e011077-, DOI: https://doi.org/10.1161/JAHA.118.011077

Characteristics, Outcomes, and Treatment of Heart Failure With Improved Ejection Fraction

Chan Soon Park, Jin Joo Park;Alexandre Mebazaa;Il-Young Oh;Hyun-Ah Park;Hyun-Jai Cho;Hae-Young Lee;Kye Hun Kim;Byung-Su Yoo;Seok-Min Kang;Sang Hong Baek;Eun-Seok Jeon;Jae-Joong Kim;Myeong-Chan Cho;Shung Chull Chae;Byung-Hee Oh;Dong-Ju Choi

Abstract

Background

Many patients with heart failure (HF) with reduced ejection fraction (HFrEF) experience improvement or recovery ofleft ventricular ejection fraction (LVEF). Data on clinical characteristics, outcomes, and medical therapy in patients with HF withimproved ejection fraction (HFiEF) are scarce.

Methods and Results

Of 5625 consecutive patients hospitalized for acute HF in the KorAHF (Registry [Prospective Cohort]for Heart Failure in Korea) study, 5103 patients had baseline echocardiography and 2302 patients had follow-upechocardiography at 12 months. HF phenotypes were defined as persistent HFrEF (LVEF ≤40% at baseline and at 1-yearfollow-up), HFiEF (LVEF ≤40% at baseline and improved up to 40% at 1-year follow-up), HF with midrange ejection fraction(LVEF between 40% and <50%), and HF with preserved ejection fraction (LVEF ≥50%). The primary outcome was 4-year allcausemortality from the time of HFiEF diagnosis. Among 1509 HFrEF patients who had echocardiography 1 year after indexhospitalization, 720 (31.3%) were diagnosed as having HFiEF. Younger age, female sex, de novo HF, hypertension, atrialfibrillation, and b-blocker use were positive predictors and diabetes mellitus and ischemic heart disease were negativepredictors of HFiEF. During 4-year follow-up, patients with HFiEF showed lower mortality than those with persistent HFrEF inunivariate, multivariate, and propensity-score–matched analyses. b-Blockers, but not renin–angiotensin system inhibitors ormineralocorticoid receptor antagonists, were associated with a reduced all-cause mortality risk (hazard ratio: 0.59; 95% CI,0.40–0.87; P=0.007). Benefits for outcome seemed similar among patients receiving low- or high-dose b-blockers (log-rank,P=0.304).

Conclusions

HFiEF is a distinct HF phenotype with better clinical outcomes than other phenotypes. The use of b-blockers may bebeneficial for these patients.

• DOI: https://doi.org/10.1161/JAHA.118.011077
• ISBN or ISSN: 2047-9980

• 본 연구는 질병관리본부 연구개발과제연구비를 지원받아 수행되었습니다.
• This research was supported by a fund by Research of Korea Centers for Disease Control and Prevention.