Clinical Characteristics and Prognostic Predictors In Hospitalized Heart Failure Patients with Improved Or Preserved Ejection Fraction

• Published in: Journal of cardiac failure Vol. 26; no. 10; p. S122
• Main Authors: Yu, Yiwen, Zou, Changhong, Yao, Younan, Huang, Yuhui, Zhang, Qi, Wang, Yunhong, Zhai, Mei, Zhang, Yuhui, Zhang, Jian, Zhou, Qiong, Huang, Yan
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.10.2020
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2020.09.350

Clinical characteristics and prognostic predictors of hospitalized heart failure with improved ejection fraction (HFiEF) patients compared to heart failure with preserved ejection fraction (HFpEF) patients are still unclear. We consecutively included hospitalized heart failure patients with left ventricular ejection fraction (LVEF) ≥40% at discharge. Patients were classified as HFiEF (documented previous LVEF<40% for at least once and maximum increase of LVEF≥ 5%) or HFpEF (previous LVEF available but none less than 40%). The primary outcome was a composite of all-cause mortality and heart transplantation. Multivariate logistic regression was used to identify diagnostic predictors for HFiEF or HFpEF, and multivariate Cox regression was conducted to determine prognostic predictors for the primary outcome. A total of 427 HF patients (age: 64±14 years, male: 63%, HFiEF: n= 117) were enrolled. Multivariate logistic regression model suggested that patients with myocardial infarction, requiring digoxin and spironolactone at discharge, without atrial fibrillation/atrial flutter and without hyperlipidemia were associated with a diagnosis of HFiEF compared to HFpEF, with an area under the receiver operating characteristic curve of 0.805 (p<0.001, 95%CI 0.758-0.852). After a median follow-up period of 54 months, 35 HFiEF patients and 104 HFpEF patients died. In HFiEF patients, multivariate Cox analysis suggested that a history of coronary artery disease (HR 8.769, 95%CI 2.354-32.664, p= 0.0012) and longer HF history (HR 1.018, 95%CI 1.006-1.029, p=0.0021) were independent predictors of the primary outcome. Whereas in HFpEF patients, lower serum albumin level (HR 0.922, 95%CI 0.887-0.959, p=0.00004) and longer HF history (HR 1.003, 95%CI 1.001-1.004, p=0.0019) were independent predictors of the primary outcome. Although both presented with preserved LVEF at study baseline, hospitalized HFiEF patients have different clinical phenotype and prognosis predictors compared to HFpEF patients. Future studies are needed for differentiating between HFiEF and HFpEF without regarding previous history for optimizing targeted management.