Article Text

Download PDFPDF

Original research
Prognostic impacts of changes in left ventricular ejection fraction in heart failure patients with preserved left ventricular ejection fraction
  1. Akiomi Yoshihisa1,2,
  2. Yu Sato1,
  3. Yuki Kanno1,
  4. Mai Takiguchi1,
  5. Tetsuro Yokokawa1,3,
  6. Satoshi Abe1,
  7. Tomofumi Misaka1,2,
  8. Takamasa Sato1,
  9. Masayoshi Oikawa1,
  10. Atsushi Kobayashi1,
  11. Takayoshi Yamaki1,
  12. Hiroyuki Kunii1 and
  13. Yasuchika Takeishi1
  1. 1Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
  2. 2Department of Advanced Cardiac Therapeutics, Fukushima Medical University, Fukushima, Japan
  3. 3Department of Pulmonary Hypertension, Fukushima Medical University, Fukushima, Japan
  1. Correspondence to Dr Akiomi Yoshihisa; yoshihis{at}


Background It has been reported that recovery of left ventricular ejection fraction (LVEF) is associated with better prognosis in heart failure (HF) patients with reduced EF (rEF). However, change of LVEF has not yet been investigated in cases of HF with preserved EF (HFpEF).

Methods and results Consecutive 1082 HFpEF patients, who had been admitted to hospital due to decompensated HF (EF >50% at the first LVEF assessment at discharge), were enrolled, and LVEF was reassessed within 6 months in the outpatient setting (second LVEF assessment). Among the HFpEF patients, LVEF of 758 patients remained above 50% (pEF group), 138 patients had LVEF of 40%–49% (midrange EF, mrEF group) and 186 patients had LVEF of less than 40% (rEF group). In the multivariable logistic regression analysis, younger age and presence of higher levels of troponin I were predictors of rEF (worsened HFpEF). In the Kaplan-Meier analysis, the cardiac event rate of the groups progressively increased from pEF, mrEF to rEF (log-rank, p<0.001), whereas all-cause mortality did not significantly differ among the groups. In the multivariable Cox proportional hazard analysis, rEF (vs pEF) was not a predictor of all-cause mortality, but an independent predictor of increased cardiac event rates (HR 1.424, 95% CI 1.020 to 1.861, p=0.039).

Conclusion An initial assessment of LVEF and LVEF changes are important for deciding treatment and predicting prognosis in HFpEF patients. In addition, several confounding factors are associated with LVEF changes in worsened HFpEF patients.

  • heart failure
  • heart failure with normal ejection fraction
  • cardiac remodelling

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

View Full Text

Statistics from


  • Contributors AY and YT: making article, drafting the article and conception of this study; YS and YK: performing statistical analysis; MT, TY, SA, TM, TS, MO, AK, TY and HK: obtaining general data; MO, AK and YT revising the article critically for important intellectual content.

  • Funding This study was supported in part by a grant-in-aid for Scientific Research (No. 16K09447) from the Japan Society for the Promotion of Science.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval The study protocol was approved by the ethical committee of Fukushima Medical University, the investigation conformed to the principles outlined in the Declaration of Helsinki, and reporting of the study conforms to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) along with references to STROBE and the broader EQUATOR guidelines.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.