Predictors and Mortality for Worsening Left Ventricular Ejection Fraction in Patients With HFpEF

Liling Chen, Zhidong Huang, Xiaoli Zhao, Jingjing Liang, Xiaozhao Lu, Yibo He, Yu Kang, Yun Xie, Jin Liu, Yong Liu, Jin Yang, Weixu Yu, Wanling Deng, Yuxiong Pan, Jin Lu, Yanfang Yang, Xujing Xie, Xiaoxian Qian, Qingbo Xu, Longtian Chen, Kaihong Chen, Shiqun Chen, Liling Chen, Zhidong Huang, Xiaoli Zhao, Jingjing Liang, Xiaozhao Lu, Yibo He, Yu Kang, Yun Xie, Jin Liu, Yong Liu, Jin Yang, Weixu Yu, Wanling Deng, Yuxiong Pan, Jin Lu, Yanfang Yang, Xujing Xie, Xiaoxian Qian, Qingbo Xu, Longtian Chen, Kaihong Chen, Shiqun Chen

Abstract

Background: Definitions of declined left ventricular ejection fraction (LVEF) vary across studies and research results concerning the association of mortality with declined LVEF are inconsistent. Thus, this study aimed to assess the impact of early worsening LVEF on mortality in patients with heart failure (HF) with preserved ejection fraction (HFpEF) and to establish independent predictors of early worsening LVEF.

Methods and results: A total of 1,418 consecutive patients with HFpEF with LVEF remeasurement from the Cardiorenal Improvement registry were included in this study. Worsening LVEF was defined as an absolute decline ≥ 5% from baseline LVEF within 3 to 12 months after discharge. The Cox and logistic regression analyses were performed to assess prognostic effects and predictors for worsening LVEF, respectively. Among 1,418 patients with HFpEF, 457 (32.2%) patients exhibited worsening LVEF. During a median follow-up of 3.2 years (interquartile range: 2.3-4.0 years), 92 (6.5%) patients died. Patients with HFpEF with worsening LVEF had higher mortality relative to those with nonworsening LVEF [9.2 vs. 5.2%; adjusted hazard ratio (aHR): 2.18, 95% CI: 1.35-3.52]. In the multivariate binary logistic regression analysis, baseline left ventricular end-diastolic dimension (LVEDD), LVEF, high-density lipoprotein cholesterol (HDL-C), atrial fibrillation (AF), and diabetes mellitus (DM) emerged as predictive factors of worsening LVEF.

Conclusion: This study demonstrated that about one out of three patients with HFpEF experiences worsening LVEF during follow-up, which is associated with 2.2-fold increased mortality. Increased LVEDD and LVEF, low HDL-C levels, AF, and DM were predictors of worsening LVEF. Further studies are needed to prospectively assess the efficacy of early active management on prognosis in patients with HF with worsening LVEF.

Registration: ClinicalTrials.gov, identifier NCT04407936.

Keywords: heart failure with preserved ejection fraction; incidence; mortality; predictor; worsening LVEF.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Chen, Huang, Zhao, Liang, Lu, He, Kang, Xie, Liu, Liu, Yang, Yu, Deng, Pan, Lu, Yang, Xie, Qian, Xu, Chen, Chen and Chen.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Patient flow diagram.
Figure 2
Figure 2
Worsening left ventricular ejection fraction (LVEF) and risk of mortality. The Kaplan–Meier curves for all-cause mortality in patients with heart failure with preserved ejection fraction (HFpEF) with and without worsening LVEF.
Figure 3
Figure 3
The trajectory of worsening LVEF and eventual mortality in patients with HFpEF.

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