Clinical features and prognosis of patients with heart failure with improved ejection fraction
Objective To analyze the clinical features,predictors and prognosis of patients with heart failure with improved ejection fraction.Methods The clinical data of 327 patients hospitalized for heart failure in the Department of Cardiology,Nanjing Hospital Affiliated to Nanjing Medical University from June 1,2019 to June 1,2022 were retrospectively analyzed.The patients were divided into 2 groups according to the LVEF values in the hospital and at the time of review:the group of persistently heart failure with reduced ejection fraction(pHFrEF group,n=224):LVEF≤40%at admission and LVEF≤40%at review;The group of heart failure with improved ejection fraction(HFimpEF group,n=103):LVEF≤40%at admission and LVEF>40%at review.General data,clinical tests and examination data of enrolled patients were collected through electronic medical records,outpatient system and heart failure follow-up database,recording the occurrence of follow-up endpoint events(heart failure re-hospitalization,all-cause death).Logistic regres-sion model was used to analyze the predictors of HFimpEF.Kaplan-Meier survival curves of the two groups were drawn,and the differ-ence in the occurrence of end-point events between the two groups was tested by Log-rank method.Results Compared with pHFrEF group,patients in HFimpEF group were younger,had a larg-er proportion of newly diagnosed heart failure,a shorter course of dis-ease,higher blood pressure,faster heart rate,better overall cardiac function classification,a larger proportion of dilated cardiomyopathy,better renal function,and lower NT-proBNP.The proportion of ACEI/ARB/ARNI and β-blockers used was higher(P<0.05).Compared with HFimpEF group,pHFrEF group had a higher proportion of cere-brovascular disease,coronary heart disease and myocardial infarction history,and a higher proportion of PCI and CABG history(P<0.05).In terms of echocardiography,compared with pHFrEF group,patients in HFimpEF group had a smaller left heart at admission,better left and right heart function,and more significant improvement in cardiac structure and function after treatment(P<0.05).Multi-variate Logistic regression model analysis showed that heart failure at first diagnosis,shorter course of disease,higher mean arterial pressure,absence of old myocardial infarction,smaller left ventricular end-diastolic diameter and higher tricuspid annulus systolic dis-placement distance were predictive factors of HFimpEF(P<0.05).The rate of heart failure readmission and all-cause death in HFim-pEF group was significantly lower than that in pHFrEF group(P<0.05).The rate of heart failure rehospitalization,all-cause mortality and composite end points in HFimpEF group were significantly lower than those in pHFrEF group(P<0.05).Conclusion HFim-pEF patients have better initial condition and better prognosis.Timely diagnosis and early standard treatment of heart failure can help improve left ventricular ejection fraction,and HFrEF patients with higher blood pressure,no complicated old myocardial infarction,smaller left ventricle and better right ventricular function have more potential to develop HFimpEF.
heart failure with improved ejection fractionclinical featurespredictorsprognosis analysis
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