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
References