Heart Failure With Recovered Ejection Fraction: Clinical Description, Biomarkers, and Outcomes

• Published in: Circulation (New York, N.Y.) Vol. 129; no. 23; pp. 2380 - 2387
• Main Authors: Basuray, Anupam, French, Benjamin, Ky, Bonnie, Vorovich, Esther, Olt, Caroline, Sweitzer, Nancy K., Cappola, Thomas P., Fang, James C.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD by the American College of Cardiology Foundation and the American Heart Association, Inc 10.06.2014; Lippincott Williams & Wilkins
• Subjects: Adult; Aged; Biological and medical sciences; Biomarkers - blood; Blood and lymphatic vessels; Blood Pressure - physiology; Cardiology. Vascular system; Cardiovascular system; Creatinine - blood; Disease-Free Survival; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Echocardiography; Female; Heart; Heart Failure - diagnostic imaging; Heart Failure - mortality; Heart Failure - physiopathology; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Hospitalization - statistics & numerical data; Humans; Investigative techniques of hemodynamics; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Natriuretic Peptide, Brain - blood; Prognosis; Proportional Hazards Models; Prospective Studies; Risk Factors; Stroke Volume - physiology; Troponin I - blood; Vascular Endothelial Growth Factor Receptor-1 - blood; Heart failure; Description; Prognosis; Biological marker; ventricular remodeling; Cardiovascular disease; Vascular remodeling; Heart disease; Myocardium; Evolution; Circulatory system; Hemodynamics; Cardiology; Ejection fraction; heart failure; myocardium
• ISSN: 0009-7322; 1524-4539; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.113.006855

BACKGROUND—We hypothesized that patients with heart failure (HF) who recover left ventricular function (HF-Recovered) have a distinct clinical phenotype, biology, and prognosis compared with patients with HF with reduced ejection fraction (HF-REF) and those with HF with preserved ejection fraction (HF-PEF). METHODS AND RESULTS—The Penn Heart Failure Study (PHFS) is a prospective cohort of 1821 chronic HF patients recruited from tertiary HF clinics. Participants were divided into 3 categories based on echocardiogramsHF-REF if EF was <50%, HF-PEF if EF was consistently ≥50%, and HF-Recovered if EF on enrollment in PHFS was ≥50% but prior EF was <50%. A significant portion of HF-Recovered patients had an abnormal biomarker profile at baseline, including 44% with detectable troponin I, although in comparison, median levels of brain natriuretic factor, soluble fms-like tyrosine kinase receptor-1, troponin I, and creatinine were greater in HF-REF and HF-PEF patients. In unadjusted Cox models over a maximum follow-up of 8.9 years, the hazard ratio for death, transplantation, or ventricular assist device placement in HF-REF patients was 4.1 (95% confidence interval, 2.4–6.8; P<0.001) and in HF-PEF patients was 2.3 (95% confidence interval, 1.2–4.5; P=0.013) compared with HF-Recovered patients. The unadjusted hazard ratio for cardiac hospitalization in HF-REF patients was 2.0 (95% confidence interval, 1.5–2.7; P<0.001) and in HF-PEF patients was 1.3 (95% confidence interval, 0.90–2.0; P=0.15) compared with HF-Recovered patients. Results were similar in adjusted models. CONCLUSIONS—HF-Recovered is associated with a better biomarker profile and event-free survival than HF-REF and HF-PEF. However, these patients still have abnormalities in biomarkers and experience a significant number of HF hospitalizations, suggesting persistent HF risk.