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Clinical Summary

In HFpEF, LVEF seldom declines

Takeaway

  • In 11 years of follow-up, patients with heart failure with preserved ejection fraction (HFpEF) and no coronary artery disease (CAD) showed little change in left ventricular ejection fraction (LVEF).
  • Authors: “Because longitudinal LVEF assessment does not seem to play a crucial role in mortality, new treatment targets are necessary.”

Why this matters

  • Long-term LVEF changes in this heterogeneous, difficult-to-treat group have been poorly characterized.
  • Commentary discusses the blow this study deals to continuum hypothesis of HFpEF, which positioned it as precursor to heart failure with reduced ejection fraction (HFrEF).

Key results

  • 88.9% remained in HFpEF.
  • Most who transitioned to HF with midrange ejection fraction (HFmrEF, defined as LVEF 40%-49%) had baseline LVEF of 50%-55%:
    • 9.5% (12) transitioned to HFmrEF; 8 had baseline LVEF 50%-55%.
    • 1.6% (2) fell to HFrEF.
  • Subgroup with CAD had grim prognosis.
  • No correlation between mortality and recent LVEF changes.

Study design

  • Prospective single-center cohort study (n=126).
  • Consecutive HFpEF outpatients at a referral clinic underwent echocardiography at baseline, 1, 3, 5, 7, 9, and 11 years.
  • Outcome: LVEF trajectories.
  • Funding: Redes Temáticas de Investigación Cooperativa en Salud, Red Cardiovascular.

Limitations

  • Risk for selection bias.
  • Few patients available at 11-year point; dropouts, deaths may have skewed results.

References


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