Introduction
With increasing number of patients living with chronic systolic heart failure, the
number of patients with recovery of their left ventricular ejection fraction (LVEF)
has increased over time. Similarly the number of patients that have had LVEF recovery
and has relapse of reduced ejection fraction is a patient group that is under recognized
and not well characterized. The purpose of this study was to describe our single-center
long-term experience of patients with who have had recovery in LVEF and relapse of
reduced ejection fraction during that time, and to describe what clinical predictors
might be associated with this improvement or relapse.
Hypothesis
We hypothesized that gender and race is associated with LVEF recovery and relapse.
Methods
We reviewed serial LVEF in patients with a diagnosis of heart failure with reduced
ejection fraction (defined as ejection fraction ≤ 35%) from 2000-2016. Hazard ratios
(HR) for independent clinical predictors of recovery (defined by original LVEF ≤ 35%
and follow-up LVEF ≥ 40%), relapse (defined by patients that had recovery, that subsequently
had LVEF <40%), and remission (defined by patients that had had recovery but did not
have relapse) were determined by multivariate logistic regression.
Results
In our study cohort of 19,888 patients (67% male; 22.4% white), 7,327 (37%) experienced
recovery of LVEF over a maximum time course of 5 years. Male gender was significantly
associated with a lack LVEF recovery (HR 0.7, P<0.001) (Figure 1). Clinical history
of atrial fibrillation (HR 1.6, P<0.05), valvular heart disease (HR 1.3, P<0.05),
ACE inhibitors (HR 1.4, P<0.05), antiarrhythmic use (HR 1.6, P<0.05), ARBs (HR 1.3,
P<0.05), aspirin (HR 1.6, P<0.05), beta blockers (HR 2.4, P<0.05), calcium channel
blockers (HR 1.8, P<0.05), hydralazine (HR 1.6, P<0.05), and statin use (HR 1.5, P<0.05),
were significantly associated with a LVEF recovery. Of the LVEF recovery cohort, 4992
(68%) of patients had relapse of reduced ejection fraction. African American race
(HR 1.1, p<0.05), CABG (HR 1.2, p<0.05), and diuretic use (HR 1.2, P<0.05) were associated
with increased rates of relapse of reduced ejection fraction.
Conclusions
In our large single center experience of patients with chronic systolic heart failure,
over a third of patients experienced recovery of their LVEF. Males were significantly
less likely to recovery than females. Additionally a history of atrial fibrillation,
valvular heart disease, and guideline-directed medications for heart failure were
associated with LVEF recovery. In terms of relapse, African American race, CABG, and
diuretic use were associated with relapse.
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Copyright
© 2020 Published by Elsevier Inc.
