Heart Failure With Recovered Ejection Fraction: Clinical Characteristics And Prognosis

Background:Chronic heart failure(CHF)is the terminal stage of various cardiovascular diseases,which is a clinical syndrome with high morbidity and mortality.At present,it is a major disease seriously affected the public health in the world.The main pathophysiology of heart failure is ventricular remodeling,hemodynamic changes,abnormal activation of neuroendocrine and other factors to promote the occurrence and development of ventricular remodeling.In recent years,studies have proposed a new type of heart failure,named heart failure with recovered ejection fraction(HFrec EF).Cardiac reverse remodeling can be observed in these patients with heart failure improved,myocardium partial or complete recovered,ejection fraction(EF)increased and clinical symptoms improved.Most of the current studies focus on heart failure with reduced ejection fraction(HFrEF)and heart failure with preserved ejection fraction(HFpEF).However,little studies have investigated heart failure with recovered ejection fraction(HFrecEF).It is unclear about the pathophysiological mechanism,diagnosis and treatment of HFrecEF.Previous researches have suggested that HFrecEF has better clinical symptoms and prognosis.Our study mainly focuses on the clinical features and prognosis of HFrecEF,aiming to discuss the differences of clinical characteristics and prognosis between different types of heart failure.Methods: A total of 756 patients admitted to the First Affiliated Hospital of Dalian Medical University from December 24,2014 to January 6,2016 were enrolled in our study,which the main diagnosis is heart failure.The patients were demanded to provide their disease history,clinical features,medication and so on.Then accept a series of medical examinations,such as blood biochemical examination,and left ventricular ejection fraction(LVEF)was measured by ultrasonic cardiogram(UCG).Patients enrolled were divided into 3 groups according to LVEF: HFrEF(currently LVEF ≤ 40%);HFrecEF(currently LVEF> 40% but previously LVEF ≤ 40%);HFpEF(current and previous LVEF> 40%).The patients were followed up for an average of 23.7 ± 9.3 months.The differences of clinical data between the three groups were compared.The endpoint is all-cause mortality.Survival curves were calculated using the Kaplan-Meier method,and Cox regression analyses were used to estimate the hazard ratio(HR)for all-cause death.Binary logistic regression was used to determine the variables with independent prognostic significance in the LVEF recovery.Results:1.Comparison of baseline data and clinical characteristics between different HF groups: There are differences between groups in age,sex,NYHA grade,heart rate,systolic blood pressure,BNP,CK-MB,hypersensitive troponin I,HB,LVEDD,prevalence of coronary heart disease,hypertension,atrial fibrillation,ischemic cardiomyopathy,diuretic utilization,ACEI / ARB utilization,β-blocker utilization,digoxin utilization,and the treatment of PCI / CABG.The male patient rate,heart rate,NYHA grade,BNP,CK-MB,HB,LVEDD,diuretic utilization and ACEI / ARB utilization in HFrEF group were higher than those in HFrecEF group and HFpEF group,systolic blood pressure was lower than the HFrecEF and HFpEF groups.The prevalence of coronary heart disease and digoxin utilization in HFrEF group were higher than those in HFpEF group,while age,prevalence of atrial fibrillation and hypertension were lower than HFpEF group.The β-blocker utilization in group HFrecEF was higher than that of group HFrEF and HFpEF,and CK-MB and hypersensitivity troponin I were lower than HFrEF and HFpEF group.PCI / CABG treatment rate in group HFrecEF was higher than HFpEF group.2.Compared HFrecEF and HFrEF groups,identifying the independent predictors of EF recovery: Two groups were compared,binary logistic regression showed the significance independent prognostic variables of LVEF recovery are as follows: systolic blood pressure,left ventricular end diastolic diameter(LVEDD),BNP,HB,spironolactone treatment.3.Comparison of prognosis and risk prediction between different HF groups: 756 patients were followed up for 23.7 ± 9.3 months.There were 260 HFrEF patients and 101 deaths;64 HFrecEF patients and 10 deaths;432 HFpEF patients and 114 deaths.Survival curves were calculated and differences between the curves were evaluated using the log-rank test,statistically significant difference(P<0.001).Compared with HFrec EF group,the Cox regression model showed that patients with HFrEF had significant higher all-cause mortality(HR 2.833,95% CI 1.479-5.425,P = 0.002),HFpEF group had a non-significant trend towards higher all-cause mortality(HR 1.735,95%CI 0.909-3.311,P=0.095).Conclusions:1.There were differences in age,sex,clinical symptoms,biochemical indicators,biomarkers,complications,and treatment options in different heart failure groups.The main cause of HFrEF was ischemic etiology,HFpEF patients with high prevalence of hypertension and atrial fibrillation prevalence,while the characteristics of HFrecEF seem to be between the two groups.2.Compared with the HFrEF group,HFpEF and HFrecEF patients had a better NYHA functional class,had lower diuretic and ACEI / ARB utilization,and had a better prognosis.The utilization of β-blocker in HFrecEF group was significantly higher than that of the other two groups.3.Nearly 20% of HFrEF patients had cardiac systolic function recovery(HFrecEF)with better functional status,better quality of life,lower all-cause mortality and better prognosis.HFrecEF is increasingly being recognized as a distinct clinical entity from HFrEF and HFpEF,which deserves further study to identify the optimal diagnostic,treatment and management strategies.