Heart Failure With Improved Ejection Fraction: Clinical Characteristics, Correlates of Recovery, and Survival: Results From the Valsartan Heart Failure Trial.

Abstract

BACKGROUND:

Heart failure with recovered or improved ejection fraction (HFiEF) has been proposed as a new category of HF. Whether HFiEF is clinically distinct from HF with persistently reduced ejection fraction remains to be validated.

METHODS AND RESULTS:

Of the 5010 subjects enrolled in the Valsartan Heart Failure Trial (Val-HeFT), 3519 had a baseline left ventricular EF of <35% and a follow-up echocardiographic assessment of EF at 12 months. Of these, 321 (9.1%) patients who had a 12-month EF of >40% constituted the subgroup with HFiEF. EF improved from 28.7±5.6% to 46.5±5.6% in the subgroup with HFiEF and remained reduced (25.2±6.2% and 27.5±7.1%) in the subgroup with HF with reduced ejection fraction. The group with HFiEF had a less severe hemodynamic, biomarker, and neurohormonal profile, and it was treated with a more intense HF medication regimen. Subjects who had higher blood pressure and those treated with a β-blocker or randomized to valsartan had greater odds of being in the HFiEF group, whereas those with an ischemic pathogenesis, a more dilated left ventricle, and a detectable hs-troponin had lower odds of an improvement in EF. Recovery of the EF to >40% was associated with a better survival compared with persistently reduced EF.

CONCLUSIONS:

Our data support HFiEF as a stratum of HF with reduced ejection fraction with a more favorable outcome, which occurs in a minority of patients with HF with reduced ejection fraction who have a lower prevalence of ischemic heart disease, a less severe hemodynamic, biomarker, and neurohormonal profile, and who are treated with a more intense HF medication regimen.

CLINICAL TRIAL REGISTRATION:

URL: http://www.clinicaltrials.gov. Unique identifier: NCT00336336.

• Authors: Viorel G Florea, Thomas S Rector, Inder S Anand, Jay N Cohn
• Journal: Circulation. Heart failure (Circ Heart Fail) Vol. 9 Issue 7 (07 2016) ISSN: 1941-3297 [Electronic] United States
• PMID: 27413037 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, U.S. Gov't, Non-P.H.S., Research Support, Non-U.S. Gov't)
• Copyright: © 2016 American Heart Association, Inc.

Chemical References

• Adrenergic beta-Antagonists
• Angiotensin II Type 1 Receptor Blockers
• Angiotensin-Converting Enzyme Inhibitors
• Biomarkers
• Mineralocorticoid Receptor Antagonists
• Valsartan

Topics

• Adrenergic beta-Antagonists (therapeutic use)
• Aged
• Angiotensin II Type 1 Receptor Blockers (adverse effects, therapeutic use)
• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Biomarkers (blood)
• Double-Blind Method
• Drug Therapy, Combination
• Echocardiography
• Female
• Heart Failure (diagnostic imaging, drug therapy, mortality, physiopathology)
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Mineralocorticoid Receptor Antagonists (therapeutic use)
• Recovery of Function
• Stroke Volume (drug effects)
• Time Factors
• Treatment Outcome
• Valsartan (adverse effects, therapeutic use)
• Ventricular Function, Left (drug effects)