# Prognostic significance of subsequent decline in LVEF in heart failure with improved ejection fraction − A report from the CHART-2 study −

## TL;DR

This study shows that some heart failure patients who initially improve may later worsen, with similar risks as those who never improved.

## Contribution

Identifies a subgroup of heart failure patients with improved ejection fraction who later decline and face similar risks as those with persistent heart failure.

## Key findings

- 23% of HFrEF patients transition to HFimpEF, with 12% experiencing a decline in LVEF.
- Patients with temporary HFimpEF had a 2.95-fold higher risk of cardiovascular death or hospitalization.
- Risk factors for LVEF decline include LVEF, LVDd, BNP, eGFR, and serum sodium levels.

## Abstract

Some patients of heart failure with improved ejection fraction (HFimpEF) have subsequent decline in left ventricular ejection fraction (LVEF) after improvement, and their prognosis is uncertain.

We aimed to examine the clinical characteristics and long-term prognosis of this sub-population of HFimpEF.

We examined 399 consecutive patients with HF with reduced ejection fraction (HFrEF, LVEF ≤ 40 %) with LVEF data at both baseline and follow-up in the CHART-2 Study. We classified them as follows; persistent HFrEF group (LVEF ≤ 40 % at 1-year and 2-year follow-up, n = 238), temporary HFimpEF group (≥10 % increase from baseline with LVEF > 40 % at 1-year follow-up but LVEF ≤ 40 % at 2-year follow-up, n = 22), and persistent HFimpEF group (≥10 % increase from baseline with LVEF > 40 % at 1-year follow-up, and LVEF > 40 % at 2-year follow-up, n = 139).

The temporary HFimpEF group (adjusted hazard ratio: 2.95; 95 % CI: 1.55–5.63) and the persistent HFrEF group (2.53; 1.75–3.67) were associated with increased risks for the composite of cardiovascular death and HF hospitalization. The risk factors for decline in LVEF included LVEF (adjusted odds ratio: 0.80; 95 %CI: 0.69–0.90), LV end-diastolic dimension (LVDd) (1.14; 1.05–1.25), B-type natriuretic peptide (BNP) levels (1.04 per 10 pg/mL increase; 1.00–1.08), estimated glomerular filtration rate (eGFR) levels (0.95; 0.92–0.99) and serum sodium levels (0.70; 0.50–0.91) at 1-year follow-up.

These results indicate that patients with HFrecEF account for 23% of those with HFrEF and that 12% of them have subsequent decline in LVEF associated with similar worse prognosis as in those with persistent HFrEF.