Characteristics and outcomes of HFpEF with declining ejection fraction

Jin Joo Park, Chan Soon Park, Alexandre Mebazaa, Il Young Oh, Hyun Ah Park, Hyun Jai Cho, Hae Young Lee, Kye Hun Kim, Byungsu Yoo, Seok Min Kang, Sang Hong Baek, Eun Seok Jeon, Jae Joong Kim, Myeong Chan Cho, Shung Chull Chae, Byung Hee Oh, Dong Ju Choi

Research output: Contribution to journalArticle

Abstract

Objective: Some patients with heart failure with preserved ejection fraction (HFpEF) experience declining of left-ventricular ejection fraction (LVEF) during follow-up. We aim to investigate the characteristics and outcomes of patients with HF with declining ejection fraction (HFdEF). Methods: We analyzed a prospective, nationwide multicenter cohort with consecutive patients with acute HF enrolled from March 2011 to December 2014. HFpEF was defined as LVEF ≥ 50% at index admission. After 1 year, HFpEF patients were further classified as HFdEF (LVEF ≥ 50% at admission and < 50% at 1 year), and persistent HFpEF (LVEF ≥ 50% both at admission and 1 year). Primary outcome was 4-year all-cause mortality according to HF type from HFdEF diagnosis. Results: Of patients with HFpEF, 426 (90.4%) were diagnosed as having persistent HFpEF and 45 (9.6%) as having HFdEF. Natriuretic peptide level was an independent predictor of HFdEF (natriuretic peptide level > median: odds ratio: 3.20, 95% confidence interval [CI]: 1.42–7.25, P = 0.005). During 4-year follow-up, patients with HFdEF had higher mortality than those with persistent HFpEF (Log-rank P < 0.001). After adjustment, HFdEF was associated with an almost twofold increased risk for mortality (hazard ratio 1.82, 95% CI 1.13–2.96, P = 0.015). The use of beta-blockers, renin–angiotensin system inhibitors, and mineralocorticoid receptor antagonists was not associated with improved prognosis of patients with HFdEF. Conclusions: HFdEF is a distinct HF type with grave outcomes. Further investigations that focus on HFdEF are warranted to better understand and develop treatment strategies for these high-risk patients. Clinical trial registration: ClinicalTrial.gov identifier: NCT01389843. URL: https://clinicaltrials.gov/ct2/show/NCT01389843. Graphic abstract: [Figure not available: see fulltext.].

Original languageEnglish
JournalClinical Research in Cardiology
DOIs
Publication statusPublished - 2019 Jan 1

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Heart Failure
Stroke Volume
Confidence Intervals
Mineralocorticoid Receptor Antagonists
Mortality
Odds Ratio
Clinical Trials

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Park, J. J., Park, C. S., Mebazaa, A., Oh, I. Y., Park, H. A., Cho, H. J., ... Choi, D. J. (2019). Characteristics and outcomes of HFpEF with declining ejection fraction. Clinical Research in Cardiology. https://doi.org/10.1007/s00392-019-01505-y
Park, Jin Joo ; Park, Chan Soon ; Mebazaa, Alexandre ; Oh, Il Young ; Park, Hyun Ah ; Cho, Hyun Jai ; Lee, Hae Young ; Kim, Kye Hun ; Yoo, Byungsu ; Kang, Seok Min ; Baek, Sang Hong ; Jeon, Eun Seok ; Kim, Jae Joong ; Cho, Myeong Chan ; Chae, Shung Chull ; Oh, Byung Hee ; Choi, Dong Ju. / Characteristics and outcomes of HFpEF with declining ejection fraction. In: Clinical Research in Cardiology. 2019.
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title = "Characteristics and outcomes of HFpEF with declining ejection fraction",
abstract = "Objective: Some patients with heart failure with preserved ejection fraction (HFpEF) experience declining of left-ventricular ejection fraction (LVEF) during follow-up. We aim to investigate the characteristics and outcomes of patients with HF with declining ejection fraction (HFdEF). Methods: We analyzed a prospective, nationwide multicenter cohort with consecutive patients with acute HF enrolled from March 2011 to December 2014. HFpEF was defined as LVEF ≥ 50{\%} at index admission. After 1 year, HFpEF patients were further classified as HFdEF (LVEF ≥ 50{\%} at admission and < 50{\%} at 1 year), and persistent HFpEF (LVEF ≥ 50{\%} both at admission and 1 year). Primary outcome was 4-year all-cause mortality according to HF type from HFdEF diagnosis. Results: Of patients with HFpEF, 426 (90.4{\%}) were diagnosed as having persistent HFpEF and 45 (9.6{\%}) as having HFdEF. Natriuretic peptide level was an independent predictor of HFdEF (natriuretic peptide level > median: odds ratio: 3.20, 95{\%} confidence interval [CI]: 1.42–7.25, P = 0.005). During 4-year follow-up, patients with HFdEF had higher mortality than those with persistent HFpEF (Log-rank P < 0.001). After adjustment, HFdEF was associated with an almost twofold increased risk for mortality (hazard ratio 1.82, 95{\%} CI 1.13–2.96, P = 0.015). The use of beta-blockers, renin–angiotensin system inhibitors, and mineralocorticoid receptor antagonists was not associated with improved prognosis of patients with HFdEF. Conclusions: HFdEF is a distinct HF type with grave outcomes. Further investigations that focus on HFdEF are warranted to better understand and develop treatment strategies for these high-risk patients. Clinical trial registration: ClinicalTrial.gov identifier: NCT01389843. URL: https://clinicaltrials.gov/ct2/show/NCT01389843. Graphic abstract: [Figure not available: see fulltext.].",
author = "Park, {Jin Joo} and Park, {Chan Soon} and Alexandre Mebazaa and Oh, {Il Young} and Park, {Hyun Ah} and Cho, {Hyun Jai} and Lee, {Hae Young} and Kim, {Kye Hun} and Byungsu Yoo and Kang, {Seok Min} and Baek, {Sang Hong} and Jeon, {Eun Seok} and Kim, {Jae Joong} and Cho, {Myeong Chan} and Chae, {Shung Chull} and Oh, {Byung Hee} and Choi, {Dong Ju}",
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Park, JJ, Park, CS, Mebazaa, A, Oh, IY, Park, HA, Cho, HJ, Lee, HY, Kim, KH, Yoo, B, Kang, SM, Baek, SH, Jeon, ES, Kim, JJ, Cho, MC, Chae, SC, Oh, BH & Choi, DJ 2019, 'Characteristics and outcomes of HFpEF with declining ejection fraction', Clinical Research in Cardiology. https://doi.org/10.1007/s00392-019-01505-y

Characteristics and outcomes of HFpEF with declining ejection fraction. / Park, Jin Joo; Park, Chan Soon; Mebazaa, Alexandre; Oh, Il Young; Park, Hyun Ah; Cho, Hyun Jai; Lee, Hae Young; Kim, Kye Hun; Yoo, Byungsu; Kang, Seok Min; Baek, Sang Hong; Jeon, Eun Seok; Kim, Jae Joong; Cho, Myeong Chan; Chae, Shung Chull; Oh, Byung Hee; Choi, Dong Ju.

In: Clinical Research in Cardiology, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Characteristics and outcomes of HFpEF with declining ejection fraction

AU - Park, Jin Joo

AU - Park, Chan Soon

AU - Mebazaa, Alexandre

AU - Oh, Il Young

AU - Park, Hyun Ah

AU - Cho, Hyun Jai

AU - Lee, Hae Young

AU - Kim, Kye Hun

AU - Yoo, Byungsu

AU - Kang, Seok Min

AU - Baek, Sang Hong

AU - Jeon, Eun Seok

AU - Kim, Jae Joong

AU - Cho, Myeong Chan

AU - Chae, Shung Chull

AU - Oh, Byung Hee

AU - Choi, Dong Ju

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: Some patients with heart failure with preserved ejection fraction (HFpEF) experience declining of left-ventricular ejection fraction (LVEF) during follow-up. We aim to investigate the characteristics and outcomes of patients with HF with declining ejection fraction (HFdEF). Methods: We analyzed a prospective, nationwide multicenter cohort with consecutive patients with acute HF enrolled from March 2011 to December 2014. HFpEF was defined as LVEF ≥ 50% at index admission. After 1 year, HFpEF patients were further classified as HFdEF (LVEF ≥ 50% at admission and < 50% at 1 year), and persistent HFpEF (LVEF ≥ 50% both at admission and 1 year). Primary outcome was 4-year all-cause mortality according to HF type from HFdEF diagnosis. Results: Of patients with HFpEF, 426 (90.4%) were diagnosed as having persistent HFpEF and 45 (9.6%) as having HFdEF. Natriuretic peptide level was an independent predictor of HFdEF (natriuretic peptide level > median: odds ratio: 3.20, 95% confidence interval [CI]: 1.42–7.25, P = 0.005). During 4-year follow-up, patients with HFdEF had higher mortality than those with persistent HFpEF (Log-rank P < 0.001). After adjustment, HFdEF was associated with an almost twofold increased risk for mortality (hazard ratio 1.82, 95% CI 1.13–2.96, P = 0.015). The use of beta-blockers, renin–angiotensin system inhibitors, and mineralocorticoid receptor antagonists was not associated with improved prognosis of patients with HFdEF. Conclusions: HFdEF is a distinct HF type with grave outcomes. Further investigations that focus on HFdEF are warranted to better understand and develop treatment strategies for these high-risk patients. Clinical trial registration: ClinicalTrial.gov identifier: NCT01389843. URL: https://clinicaltrials.gov/ct2/show/NCT01389843. Graphic abstract: [Figure not available: see fulltext.].

AB - Objective: Some patients with heart failure with preserved ejection fraction (HFpEF) experience declining of left-ventricular ejection fraction (LVEF) during follow-up. We aim to investigate the characteristics and outcomes of patients with HF with declining ejection fraction (HFdEF). Methods: We analyzed a prospective, nationwide multicenter cohort with consecutive patients with acute HF enrolled from March 2011 to December 2014. HFpEF was defined as LVEF ≥ 50% at index admission. After 1 year, HFpEF patients were further classified as HFdEF (LVEF ≥ 50% at admission and < 50% at 1 year), and persistent HFpEF (LVEF ≥ 50% both at admission and 1 year). Primary outcome was 4-year all-cause mortality according to HF type from HFdEF diagnosis. Results: Of patients with HFpEF, 426 (90.4%) were diagnosed as having persistent HFpEF and 45 (9.6%) as having HFdEF. Natriuretic peptide level was an independent predictor of HFdEF (natriuretic peptide level > median: odds ratio: 3.20, 95% confidence interval [CI]: 1.42–7.25, P = 0.005). During 4-year follow-up, patients with HFdEF had higher mortality than those with persistent HFpEF (Log-rank P < 0.001). After adjustment, HFdEF was associated with an almost twofold increased risk for mortality (hazard ratio 1.82, 95% CI 1.13–2.96, P = 0.015). The use of beta-blockers, renin–angiotensin system inhibitors, and mineralocorticoid receptor antagonists was not associated with improved prognosis of patients with HFdEF. Conclusions: HFdEF is a distinct HF type with grave outcomes. Further investigations that focus on HFdEF are warranted to better understand and develop treatment strategies for these high-risk patients. Clinical trial registration: ClinicalTrial.gov identifier: NCT01389843. URL: https://clinicaltrials.gov/ct2/show/NCT01389843. Graphic abstract: [Figure not available: see fulltext.].

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