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Characteristics and outcomes of HFpEF with declining ejection fraction
  • Date2021-02-23 17:16
  • Update2021-02-23 17:16
  • CountersignatureDivision of Research Planning
  • Tel043-719-8033

Clinical Research in Cardiology, 2020.109(2), 225-234, DOI: https://doi.org/10.1007/s00392-019-01505-y


Characteristics and outcomes of HFpEF with declining ejection fraction

Jin Joo Park, Alexandre Mebazaa; Il‑Young Oh; Hyun‑Ah Park; Hyun‑Jai Cho; Hae‑Young Lee; Kye Hun Kim; Byung‑Su Yoo; Seok‑Min Kang; Sang Hong Baek; Eun‑Seok Jeon; Jae‑Joong Kim; Myeong‑Chan Cho; Shung Chull Chae; Byung‑Hee Oh; Dong‑Ju Choi


Abstract

    Objective: Some patients with heart failure with preserved ejection fraction (HFpEF) experience declining of left-ventricular ejection fraction (LVEF) during follow-up. We aim to investigate the characteristics and outcomes of patients with HF with declining ejection fraction (HFdEF).
    Methods: We analyzed a prospective, nationwide multicenter cohort with consecutive patients with acute HF enrolled from March 2011 to December 2014. HFpEF was defined as LVEF ≥ 50% at index admission. After 1 year, HFpEF patients were further classified as HFdEF (LVEF ≥ 50% at admission and < 50% at 1 year), and persistent HFpEF (LVEF ≥ 50% both at admission and 1 year). Primary outcome was 4-year all-cause mortality according to HF type from HFdEF diagnosis.
    Results: Of patients with HFpEF, 426 (90.4%) were diagnosed as having persistent HFpEF and 45 (9.6%) as having HFdEF. Natriuretic peptide level was an independent predictor of HFdEF (natriuretic peptide level > median: odds ratio: 3.20, 95% confidence interval [CI]: 1.42-7.25, P = 0.005). During 4-year follow-up, patients with HFdEF had higher mortality than those with persistent HFpEF (Log-rank P < 0.001). After adjustment, HFdEF was associated with an almost twofold increased risk for mortality (hazard ratio 1.82, 95% CI 1.13-2.96, P = 0.015). The use of beta-blockers, renin-angiotensin system inhibitors, and mineralocorticoid receptor antagonists was not associated with improved prognosis of patients with HFdEF.
    Conclusions: HFdEF is a distinct HF type with grave outcomes. Further investigations that focus on HFdEF are warranted to better understand and develop treatment strategies for these high-risk patients.



  • 본 연구는 질병관리본부 연구개발과제연구비를 지원받아 수행되었습니다.
  • This research was supported by a fund by Research of Korea Centers for Disease Control and Prevention.


This public work may be used under the terms of the public interest source This public work may be used under the terms of the public interest source
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