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Characteristics and outcomes of HFpEF with declining ejection fraction

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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.

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Acknowledgements

The Korean Acute Heart Failure Registry study was conducted in ten tertiary medical centers: Seoul National University Hospital, Seoul, Korea; Sungkyunkwan University College of Medicine, Seoul, Korea; University of Ulsan College of Medicine, Seoul, Korea; Chungbuk National University College of Medicine, Cheongju, Korea; Kyungpook National University College of Medicine, Daegu, Korea; the Catholic University of Korea, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Yonsei University Wonju College of Medicine, Wonju, Korea; Seoul National University Bundang Hospital, Seongnam, Korea; and Heart Research Center of Chonnam National University, Gwangju, Korea.

Funding

This work was supported by Research of Korea Centers for Disease Control and Prevention (2010-E63003-00, 2011-E63002-00, 2012-E63005-00, 2013-E63003-00, 2013-E63003-01, 2013-E63003-02, and 2016-ER6303-00) and by the SNUBH Research Fund (Grant nos. 14-2015-029, 16-2017-003).

Author information

Author notes

  1. Jin Joo Park and Chan Soon Park have contributed equally to this work.

Authors and Affiliations

  1. Division of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Gumiro 166, Bundang, Seongnam, Gyeonggi-do, Republic of Korea

    Jin Joo Park, Il-Young Oh & Dong-Ju Choi

  2. Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea

    Chan Soon Park

  3. Department of Anesthesiology and Intensive Care Medicine, Hôpitaux Universitaires Saint Louis Lariboisière, APHP, University Paris Diderot, UMR 942 Inserm, Paris, France

    Alexandre Mebazaa

  4. Department of Family Medicine, Inje University Seoul Paik Hospital, Seoul, Republic of Korea

    Hyun-Ah Park

  5. Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea

    Hyun-Jai Cho & Hae-Young Lee

  6. Heart Research Center, Chonnam National University, Gwangju, Republic of Korea

    Kye Hun Kim

  7. Yonsei University Wonju College of Medicine, Wonju, Republic of Korea

    Byung-Su Yoo

  8. Yonsei University College of Medicine, Seoul, Republic of Korea

    Seok-Min Kang

  9. Department of Internal Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Sang Hong Baek

  10. Department of Internal Medicine, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea

    Eun-Seok Jeon

  11. Division of Cardiology, Asan Medical Center, Seoul, Republic of Korea

    Jae-Joong Kim

  12. Chungbuk National University College of Medicine, Cheongju, Republic of Korea

    Myeong-Chan Cho

  13. Kyungpook National University College of Medicine, Daegu, Republic of Korea

    Shung Chull Chae

  14. Mediplex Sejong Hospital, Incheon, Republic of Korea

    Byung-Hee Oh

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  1. Jin Joo Park
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  2. Chan Soon Park
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Corresponding author

Correspondence to Dong-Ju Choi.

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Park, J.J., Park, C.S., Mebazaa, A. et al. Characteristics and outcomes of HFpEF with declining ejection fraction. Clin Res Cardiol 109, 225–234 (2020). https://doi.org/10.1007/s00392-019-01505-y

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  • DOI: https://doi.org/10.1007/s00392-019-01505-y

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