PT  - JOURNAL ARTICLE
AU  - Akiomi Yoshihisa
AU  - Yu Sato
AU  - Yuki Kanno
AU  - Mai Takiguchi
AU  - Tetsuro Yokokawa
AU  - Satoshi Abe
AU  - Tomofumi Misaka
AU  - Takamasa Sato
AU  - Masayoshi Oikawa
AU  - Atsushi Kobayashi
AU  - Takayoshi Yamaki
AU  - Hiroyuki Kunii
AU  - Yasuchika Takeishi
TI  - Prognostic impacts of changes in left ventricular ejection fraction in heart failure patients with preserved left ventricular ejection fraction
AID  - 10.1136/openhrt-2019-001112
DP  - 2020 Apr 01
TA  - Open Heart
PG  - e001112
VI  - 7
IP  - 1
4099  - http://openheart.bmj.com/content/7/1/e001112.short
4100  - http://openheart.bmj.com/content/7/1/e001112.full
SO  - Open Heart2020 Apr 01; 7
AB  - 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.