Beyond initial recovery: Heart failure with transient vs sustained improvement in left ventricular ejection fraction.

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Rasha Kaddoura, Ammar Chapra, Jassim Shah, Mohamed Izham, Rajvir Singh, Haisam Alsadi, Maha Al-Amri, Tahseen Hamamyh, Manar Fallouh, Farras Elasad, Mohamed Abdelghani, Sumaya Alsaadi Alyafei, Amr Badr, Ashfaq Patel
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引用次数: 0

Abstract

Background: There is no available data about the trajectory of heart failure (HF) with improved ejection fraction (EF) and patient clinical outcomes in Qatar.

Aim: To explore the difference in characteristics and outcomes between patients with transient and sustained improvement in left ventricular ejection fraction (LVEF) and to determine the independent predictors for sustained improvement in LVEF.

Methods: This is a retrospective cohort study that was conducted at the advanced HF clinic of a tertiary care hospital in Qatar between January 2017 and December 2018. This study included adult patients with improved LVEF and had at least three echocardiographic studies. The patients were divided into two groups: HF with transient improvement in EF (HFtimpEF) and HF with sustained improvement in EF (HFsimpEF).

Results: A total of 175 patients with HF and improved EF were included. Among them 136 (77.7%) patients showed sustained improvement in LVEF. The remaining patients with HFtimpEF were predominantly males [37 (94.9%) vs 101 (74.3%), P = 0.005] with a higher incidence of ischemic cardiomyopathy [32 (82.1%) vs 68 (50.4%), P = 0.002], dyslipidemia [24 (61.5%) vs 54 (39.7%), P = 0.03], and hypertension [34 (87.2%) vs 93 (68.4%), P = 0.03] than those with HFsimpEF. The latter experienced significantly lower rates of hospitalization [39 (28.7%) vs 20 (51.3%), P = 0.01] and diagnosis of new cardiovascular conditions during the follow-up (e.g., acute coronary syndrome, stroke, decompensated HF, and atrial fibrillation) [14 (10.3%) vs 10 (25.6%), P = 0.03] without a difference in emergency department visits or in-hospital death. Sustained improvement in LVEF was positively associated with being female [adjusted odds ratio (aOR) = 6.8, 95% confidence interval (CI): 1.4-32.3, P = 0.02], having non-ischemic etiology of HF (aOR = 3.1, 95%CI: 1.03-9.3, P = 0.04), and using a mineralocorticoid receptor antagonist (aOR = 7.0, 95%CI: 1.50-31.8, P = 0.01).

Conclusion: Patients with HFsimpEF experienced significantly lower rates of hospitalization and diagnosis of new cardiovascular conditions than patients with HFtimpEF. Sustained improvement in LVEF was positively associated with being a female, having non-ischemic etiology of HF, and using a mineralocorticoid receptor antagonist.

超过初始恢复:心力衰竭与左心室射血分数的短暂改善和持续改善。
背景:目前尚无关于卡塔尔心力衰竭(HF)伴射血分数(EF)改善的发展轨迹和患者临床结局的数据。目的:探讨左室射血分数(LVEF)短暂改善和持续改善患者的特征和预后差异,并确定LVEF持续改善的独立预测因素。方法:这是一项回顾性队列研究,于2017年1月至2018年12月在卡塔尔一家三级医院的高级心衰诊所进行。本研究纳入了LVEF改善且至少进行了三次超声心动图检查的成年患者。患者分为两组:EF短暂改善组(HFtimpEF)和EF持续改善组(HFsimpEF)。结果:共纳入175例HF合并EF改善患者。其中136例(77.7%)患者LVEF持续改善。其余HFtimpEF患者以男性为主[37 (94.9%)vs 101 (74.3%), P = 0.005],缺血性心肌病[32 (82.1%)vs 68 (50.4%), P = 0.002],血脂异常[24 (61.5%)vs 54 (39.7%), P = 0.03],高血压[34 (87.2%)vs 93 (68.4%), P = 0.03]的发生率高于HFsimpEF患者。后者的住院率[39(28.7%)比20 (51.3%),P = 0.01]和随访期间新心血管疾病的诊断率(如急性冠状动脉综合征、卒中、失代偿性心衰和房颤)[14(10.3%)比10 (25.6%),P = 0.03]显著低于急诊就诊率和院内死亡率。LVEF的持续改善与女性、非缺血性HF病因(aOR = 3.1, 95%CI: 1.03-9.3, P = 0.04)和使用矿皮质激素受体拮抗剂(aOR = 7.0, 95%CI: 1.50-31.8, P = 0.01)呈正相关[校正优势比(aOR) = 6.8, 95%置信区间(CI): 1.4-32.3, P = 0.02]。结论:HFsimpEF患者的住院率和新发心血管疾病的诊断率明显低于HFtimpEF患者。LVEF的持续改善与女性、非缺血性HF病因、使用矿皮质激素受体拮抗剂呈正相关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
World Journal of Cardiology
World Journal of Cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
3.30
自引率
5.30%
发文量
54
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