Aims The recent definition of heart failure with improved ejection fraction outlined the importance of the longitudinal assessment of left ventricular ejection fraction (LVEF). However, long-term progression and outcomes of this subgroup are poorly explored. We sought to assess the LVEF trajectories and their correlations with outcome in non-ischaemic dilated cardiomyopathy (NICM) with improved ejection fraction (impEF). Methods and results Consecutive NICM patients with baseline LVEF <= 40% enrolled in the Trieste Heart Muscle Disease Registry with >= 1 LVEF assessment after baseline were included. ImpEF was defined as a baseline LVEF <= 40%, and second evaluation showing both a >= 10% point increase from baseline LVEF and LVEF >40%. Transient impEF was defined by the documentation of recurrent LVEF <= 40% during follow-up. The primary endpoint was a composite of all-cause death, heart transplantation and left ventricular assist device (D/HT/LVAD). Among 800 patients, 460 (57%) had impEF (median time to improvement 13 months). Transient impEF was observed in 189 patients (41% of the overall impEF group) and was associated with higher risk of D/HT/LVAD compared with persistent impEF at multivariable analysis (hazard ratio 2.54; 95% confidence interval 1.60-4.04). The association of declining LVEF with the risk of D/HT/LVAD was non-linear, with a steep increase up to 8% points reduction, then remaining stable. Conclusions In NICM, a 57% rate of impEF was observed. However, recurrent decline in LVEF was observed in approximate to 40% of impEF patients and it was associated with an increased risk of D/HT/LVAD.

Transient versus persistent improved ejection fraction in non-ischaemic dilated cardiomyopathy

Manca, Paolo;Stolfo, Davide
;
Merlo, Marco;Gregorio, Caterina;Cannatà, Antonio;Ramani, Federica;Nuzzi, Vincenzo;Sinagra, Gianfranco
2022-01-01

Abstract

Aims The recent definition of heart failure with improved ejection fraction outlined the importance of the longitudinal assessment of left ventricular ejection fraction (LVEF). However, long-term progression and outcomes of this subgroup are poorly explored. We sought to assess the LVEF trajectories and their correlations with outcome in non-ischaemic dilated cardiomyopathy (NICM) with improved ejection fraction (impEF). Methods and results Consecutive NICM patients with baseline LVEF <= 40% enrolled in the Trieste Heart Muscle Disease Registry with >= 1 LVEF assessment after baseline were included. ImpEF was defined as a baseline LVEF <= 40%, and second evaluation showing both a >= 10% point increase from baseline LVEF and LVEF >40%. Transient impEF was defined by the documentation of recurrent LVEF <= 40% during follow-up. The primary endpoint was a composite of all-cause death, heart transplantation and left ventricular assist device (D/HT/LVAD). Among 800 patients, 460 (57%) had impEF (median time to improvement 13 months). Transient impEF was observed in 189 patients (41% of the overall impEF group) and was associated with higher risk of D/HT/LVAD compared with persistent impEF at multivariable analysis (hazard ratio 2.54; 95% confidence interval 1.60-4.04). The association of declining LVEF with the risk of D/HT/LVAD was non-linear, with a steep increase up to 8% points reduction, then remaining stable. Conclusions In NICM, a 57% rate of impEF was observed. However, recurrent decline in LVEF was observed in approximate to 40% of impEF patients and it was associated with an increased risk of D/HT/LVAD.
2022
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https://onlinelibrary.wiley.com/doi/10.1002/ejhf.2512
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11368/3026926
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