Heart failure with recovered or improved ejection fraction ( HFiEF ) has been proposed as a new category of heart failure.
Whether HFiEF is clinically distinct from heart failure with persistently reduced ejection fraction remains to be validated.
Of the 5010 subjects enrolled in the Valsartan Heart Failure Trial ( Val-HeFT ), 3519 had a baseline left ventricular ejection fraction ( EF ) of less than 35% and a follow-up echocardiographic assessment of EF at 12 months. Of these, 321 ( 9.1% ) patients who had a 12-month EF of less than 40% constituted the subgroup with HFiEF.
Ejection fraction improved from 28.7±5.6% to 46.5±5.6% in the subgroup with HFiEF and remained reduced ( 25.2±6.2% and 27.5±7.1% ) in the subgroup with heart failure with reduced ejection fraction.
The group with HFiEF had a less severe hemodynamic, biomarker, and neurohormonal profile, and it was treated with a more intense heart failure medication regimen.
Subjects who had higher blood pressure and those treated with a beta-blocker or randomized to Valsartan had greater odds of being in the HFiEF group, whereas those with an ischemic pathogenesis, a more dilated left ventricle, and a detectable hs-troponin had lower odds of an improvement in ejection fraction.
Recovery of the ejection fraction to more than 40% was associated with a better survival compared with persistently reduced ejection fraction.
In conclusion, the data support HFiEF as a stratum of heart failure with reduced ejection fraction with a more favorable outcome, which occurs in a minority of patients with heart failure with reduced ejection fraction who have a lower prevalence of ischemic heart disease, a less severe hemodynamic, biomarker, and neurohormonal profile, and who are treated with a more intense heart failure medication regimen. ( Xagena )
Florea VG et al, Circ Heart Fail 2016; Epub ahead of print