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Characteristics and outcomes of HFpEF with declining ejection fraction

Authors
 Jin Joo Park  ;  Chan Soon 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 
Citation
 CLINICAL RESEARCH IN CARDIOLOGY, Vol.109 : 225-234, 2020-02 
Journal Title
CLINICAL RESEARCH IN CARDIOLOGY
ISSN
 1861-0684 
Issue Date
2020-02
Keywords
Heart failure with declining ejection fraction ; Mortality ; Predictor ; Prognosis ; Treatment
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.

CLINICAL TRIAL REGISTRATION: ClinicalTrial.gov identifier: NCT01389843. URL: https://clinicaltrials.gov/ct2/show/NCT01389843.
Full Text
https://link.springer.com/article/10.1007%2Fs00392-019-01505-y
DOI
10.1007/s00392-019-01505-y
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Seok Min(강석민) ORCID logo https://orcid.org/0000-0001-9856-9227
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/173060
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