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.
We hypothesized that gender and race is associated with LVEF recovery and relapse.
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.
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.
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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