Predictors of sustained reverse remodelling in patients with heart failure with reduced ejection fraction

IF 3.7 2区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS ESC Heart Failure Pub Date : 2025-02-10 DOI:10.1002/ehf2.15241

Silas Ramos Furquim, Edimar Alcides Bocchi, Maria Tereza Sampaio de Sousa Lira, Mauro Rogerio de Barros Wanderley Jr, Daniel Catto de Marchi, Pamela Camara Maciel, Andre Zimerman, Felix Jose Alvarez Ramires, Luciano Nastari, Bruno Biselli, Paulo Roberto Chizzola, Robinson Tadeu Munhoz, Fábio Fernandes, Silvia Moreira Ayub-Ferreira

{"title":"Predictors of sustained reverse remodelling in patients with heart failure with reduced ejection fraction","authors":"Silas Ramos Furquim, Edimar Alcides Bocchi, Maria Tereza Sampaio de Sousa Lira, Mauro Rogerio de Barros Wanderley Jr, Daniel Catto de Marchi, Pamela Camara Maciel, Andre Zimerman, Felix Jose Alvarez Ramires, Luciano Nastari, Bruno Biselli, Paulo Roberto Chizzola, Robinson Tadeu Munhoz, Fábio Fernandes, Silvia Moreira Ayub-Ferreira","doi":"10.1002/ehf2.15241","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Patients with heart failure with reduced ejection fraction (HFrEF) who achieve reverse remodelling (RR) can experience a new decrease in ejection fraction (EF), and the predictors of sustained RR (SRR) are not completely understood.</p>\n </section>\n \n <section>\n \n <h3> Objectives</h3>\n \n <p>The study aims to identify predictors of SRR in patients with HFrEF after an increase in EF and evaluate SRR prognosis.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>In this retrospective, observational study, we evaluated a real-life cohort of patients with HFrEF and ≥2 consecutive echocardiograms, divided according to left ventricular EF (LVEF) trajectory: no RR (NRR: 3/3 LVEF measurements < 40%), non-SRR (NSRR: second LVEF ≥ 40%, third LVEF < 40%), and SRR (SRR: second and third LVEF ≥ 40%).</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>We included 3628 of 8072 assessed HF patients in the analysis, with mean age 56.2 (±13.4) years, 64.4% male and 77.7% New York Heart Association (NYHA) I–II. Improved EF was observed for 1342 (37%) patients. Among those who achieved RR, 310 (23%) were NSRR, and 1032 (77%) were SRR. The mean (±SE) survival after the second echocardiogram was 10.6 (±0.2) years. The SRR group had the longest survival (12.2 ± 0.3 years), followed by the NSRR (10.6 ± 0.5) and NRR (9.8 ± 0.2 years) groups (<i>P</i> < 0.001). According to logistic multivariable regression, second LVEF [odds ratio (OR) = 1.06, confidence interval (CI) = 1.03–1.90, <i>P</i> < 0.001], second left ventricular end-systolic diameter (LVESD) (OR = 0.93, CI = 0.90–0.96, <i>P</i> < 0.001), second IV septum thickness (OR = 1.12, CI = 1.03–1.23, <i>P</i> = 0.012), systolic blood pressure (OR = 1.01, CI = 1.00–1.02, <i>P</i> = 0.014), NYHA I–II (OR = 1.86, CI = 1.27–2.74, <i>P</i> = 0.001) and furosemide non-use (OR = 1.87, CI = 1.27–2.74, <i>P</i> < 0.001) independently predicted SRR.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Patients with greater EF increases and LVESD reductions at EF recovery, greater septum thickness, higher blood pressure, no need for diuretics and NYHA I/II maintenance had the best chance of maintaining recovered ventricular function.</p>\n </section>\n </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 3","pages":"2190-2199"},"PeriodicalIF":3.7000,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15241","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"ESC Heart Failure","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/ehf2.15241","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Patients with heart failure with reduced ejection fraction (HFrEF) who achieve reverse remodelling (RR) can experience a new decrease in ejection fraction (EF), and the predictors of sustained RR (SRR) are not completely understood.

Objectives

The study aims to identify predictors of SRR in patients with HFrEF after an increase in EF and evaluate SRR prognosis.

Methods

In this retrospective, observational study, we evaluated a real-life cohort of patients with HFrEF and ≥2 consecutive echocardiograms, divided according to left ventricular EF (LVEF) trajectory: no RR (NRR: 3/3 LVEF measurements < 40%), non-SRR (NSRR: second LVEF ≥ 40%, third LVEF < 40%), and SRR (SRR: second and third LVEF ≥ 40%).

Results

We included 3628 of 8072 assessed HF patients in the analysis, with mean age 56.2 (±13.4) years, 64.4% male and 77.7% New York Heart Association (NYHA) I–II. Improved EF was observed for 1342 (37%) patients. Among those who achieved RR, 310 (23%) were NSRR, and 1032 (77%) were SRR. The mean (±SE) survival after the second echocardiogram was 10.6 (±0.2) years. The SRR group had the longest survival (12.2 ± 0.3 years), followed by the NSRR (10.6 ± 0.5) and NRR (9.8 ± 0.2 years) groups (P < 0.001). According to logistic multivariable regression, second LVEF [odds ratio (OR) = 1.06, confidence interval (CI) = 1.03–1.90, P < 0.001], second left ventricular end-systolic diameter (LVESD) (OR = 0.93, CI = 0.90–0.96, P < 0.001), second IV septum thickness (OR = 1.12, CI = 1.03–1.23, P = 0.012), systolic blood pressure (OR = 1.01, CI = 1.00–1.02, P = 0.014), NYHA I–II (OR = 1.86, CI = 1.27–2.74, P = 0.001) and furosemide non-use (OR = 1.87, CI = 1.27–2.74, P < 0.001) independently predicted SRR.

Conclusions

Patients with greater EF increases and LVESD reductions at EF recovery, greater septum thickness, higher blood pressure, no need for diuretics and NYHA I/II maintenance had the best chance of maintaining recovered ventricular function.

Abstract Image

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

心力衰竭伴射血分数降低患者持续反向重构的预测因素

背景：心力衰竭伴射血分数降低（HFrEF）患者实现反向重构（RR）后，可出现新的射血分数（EF）降低，而持续RR （SRR）的预测因素尚不完全清楚。目的：本研究旨在确定EF升高后HFrEF患者SRR的预测因素，并评估SRR的预后。方法：在这项回顾性观察性研究中，我们评估了一组HFrEF患者和≥2个连续超声心动图患者的现实队列，根据左心室EF （LVEF）的轨道进行分组：无RR （NRR: 3/3 LVEF测量）结果：我们在分析中纳入了8072例评估的HF患者中的3628例，平均年龄56.2（±13.4）岁，64.4%为男性，77.7%为纽约心脏协会（NYHA） I-II。1342例（37%）患者的EF得到改善。在达到RR的患者中，310例（23%）为非SRR， 1032例（77%）为SRR。第二次超声心动图后的平均（±SE）生存期为10.6（±0.2）年。SRR组生存时间最长（12.2±0.3年），其次是NSRR组（10.6±0.5年）和NSRR组（9.8±0.2年）(P)结论：EF增加较大，EF恢复时LVESD降低，隔膜厚度较大，血压较高，不需要利尿剂和NYHA I/II维持的患者维持恢复心室功能的机会最大。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

ESC Heart Failure Medicine-Cardiology and Cardiovascular Medicine

CiteScore

7.00

自引率

7.90%

发文量

461

审稿时长

12 weeks

期刊介绍： ESC Heart Failure is the open access journal of the Heart Failure Association of the European Society of Cardiology dedicated to the advancement of knowledge in the field of heart failure. The journal aims to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as the clinical, social and population sciences all form part of the discipline that is heart failure. Accordingly, submission of manuscripts on basic, translational, clinical and population sciences is invited. Original contributions on nursing, care of the elderly, primary care, health economics and other specialist fields related to heart failure are also welcome, as are case reports that highlight interesting aspects of heart failure care and treatment.