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

doi:10.3389/fcvm.2022.820178

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

Front Cardiovasc Med. 2022 Feb 24:9:820178. doi: 10.3389/fcvm.2022.820178. eCollection 2022.

Authors

Liling Chen¹, Zhidong Huang^{2

3}, Xiaoli Zhao⁴, Jingjing Liang⁵, Xiaozhao Lu^{2

3}, Yibo He^{2

3}, Yu Kang^{2

3}, Yun Xie^{2

3}, Jin Liu^{2

3}, Yong Liu^{2

3}, Jin Yang^{2

3}, Weixu Yu^{2

3}, Wanling Deng¹, Yuxiong Pan¹, Jin Lu¹, Yanfang Yang¹, Xujing Xie¹, Xiaoxian Qian³, Qingbo Xu^{5

6}, Longtian Chen⁷, Kaihong Chen¹, Shiqun Chen²

Affiliations

¹ Department of Cardiology, Longyan First Hospital Affiliated of Fujian Medical University, Longyan, China.
² Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
³ Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
⁴ Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
⁵ Department of Cardiology, Shunde Hospital, Southern Medical University, Guangzhou, China.
⁶ Department of Cardiology, Maoming People's Hospital, Maoming, China.
⁷ Department of Hematology, Longyan First Hospital Affiliated of Fujian Medical University, Longyan, China.

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.

Associated data

ClinicalTrials.gov/NCT04407936